WASHINGTON, DC – Over the past two-plus years, AAHomecare has partnered with state and regional HME association leaders and other stakeholders to forestall reimbursement cuts and limit narrow network arrangements with Medicaid and MCO payers across the nation. In 2018, our state-focused education and advocacy efforts helped stop or limit potential CURES-mandated Medicaid rate cuts in 29 states.
State-level advocacy will remain a major focus for the Association in 2019, as we continue our work to stabilize Medicaid and MCO reimbursement rates and maintain strong beneficiary access and choice for HME. We plan to build on our successes by devoting additional resources to our payer relations program, while also opening up a front to strengthen access to CRT.
Seeking Separate Benefit Status for CRT at State Level
The Association has identified a new area to protect the interests of CRT/mobility providers by advocating for “separate benefit” legislation for CRT at the state level.
A separate benefit category for CRT will help suppliers address the needs of individuals with disabilities and chronic medical conditions who require these advanced products and will also help protect these products from across-the-board cuts from state Medicaid agencies and MCOs. Developing a separate benefit for this product category could also expand access to CRT for Medicaid beneficiaries by broadening coverage and eligibility requirements.
“Highly specialized products like CRT need regulatory requirements that recognize the unique nature of both the equipment and the patients who use them,” explains AAHomecare chairman Steve Ackerman, CEO of Spectrum Medical. “State-level separate benefit legislation will ultimately allow more Medicaid beneficiaries and their caregivers to take advantage of these life-changing products.”
HME Veteran with Medicaid and Mobility Expertise to Support Campaign
This initiative will be supported by Bridge Public Affairs, a firm with extensive state-level advocacy experience. John Goetz, former director ot government affairs with Permobil, will lead Bridge’s work. Goetz’s extensive knowledge of mobility issues, established contacts with state legislators and regulators, and past experience working for Tennessee’s Medicaid agency will be invaluable to this effort.
“State Medicaid coverage and reimbursement issues are increasing nationwide, especially for complex rehab,” notes Goetz. “It is important that the HME industry take steps to guarantee those that we serve get the equipment they need and deserve. These efforts will benefit the entire industry and will build momentum for change nationally.”
“Our expanded commitment to payer relations has paid major dividends in protecting HME from Medicaid reimbursement cuts in dozens of states,” adds Tom Ryan, AAHomecare president and CEO. “As more patients are served by Medicaid, MCOs, and Medicare Advantage, AAHomecare’s payer relations efforts will become increasingly important in protecting HME interests.
Renewed Federal Separate Benefit Efforts Also Planned
AAHomecare plans to join NCART, national consumer organizations, state associations, and other mobility stakeholders in advocating on Capitol Hill for a CRT separate benefit for Medicare, as well. While Congress has kept many CRT products exempt from the bidding program, current Medicare coverage and classification policies do not align with the unique attributes of this equipment and the high level of service and customization required that go along with it.
By working towards a separate benefit for CRT under both Medicaid and Medicare at the same time, AAHomecare and its partners will be able to better raise the profile of this issue and develop support in both state legislatures and in Congress.
