WASHINGTON, DC – AAHomecare’s payer relations program continued to pay major dividends for HME suppliers nationwide through our work protecting reimbursement rates and maintaining market access for Medicaid programs, MCOs, private insurers, and other major payer groups.
With the advent of the COVID-19 pandemic, the Association shared guidance for relaxing authorization and delivery requirements as well as other flexibilities with policymakers and spearheaded a sign-on letter to major commercial payers from 150 suppliers, manufacturers, and other HME stakeholders in support of our recommendations. As a result, 34 state Medicaid programs and all major commercial payers adopted these practices or granted similar flexibilities to help suppliers serve patients safely and effectively under challenging circumstances.
The payer relations team also worked with TRICARE contractors and the Dept. of Defense to ensure adoption of higher rates granted in the CARES Act for the duration of the COVID-19 Public Health Emergency (PHE) and retroactive for claims back to March 6.
Medicaid Rate Stability Remains a Priority
AAHomecare has worked with state legislatures in several states to establish Medicaid rate floors and added Virginia to the list of states protected in November 2020. The Payer Relations team is now laying the groundwork to advocate for rate stability, oversight of managed care organizations, and strong patient access protections in other states. Four states, Texas, Oklahoma, New York, and Florida, are among the states where AAHomecare will be engaged in the first quarter of 2021.
In Texas, AAHomecare has been coordinating with TexMEP and other HME stakeholders ahead of the state’s upcoming legislative session to protect rate stability and establish MCO oversight. With Texas employing every-other-year legislative session format, efforts to develop strategy and build stakeholder consensus in advance are critical to success when the legislature convenes again for a 140-day session starting in January.
Oklahoma Gov. Kevin Stitt is pushing to establish an MCO to cover 80-90% of the state’s Medicaid patients, potentially starting as early as July of 2021. OMEPA has been working with state legislators to stop the move, and AAHomecare is lending support to help refine their strategy and analyze the proposed MCO contract. New York is another state where our Payer Relations team will be active in first quarter of 2021, working with NEMEP to develop legislative strategy and draft language to establish rate stability and protect patient access/choice.
AAHomecare is also continuing our efforts to ensure rate protections and open access under Florida MCOs. The Centene/WellCare plan for HME and home health covering nearly half of the state is transitioning to a third-party administrator (TPA) model in 2021; we are currently working with FAHCS to ensure strong oversight for that plan including prohibiting self-referrals.
Effective oversight and strong rate protections for MCOs and TPAs will be priority for AAHomecare’s Payer Relations team as these entities’ share of the Medicaid market continues to increase.
State revenue collections across the country have decreased significantly in the wake of COVID-19, and Medicaid programs are certain to be among the candidates for cost-cutting for states to address budget shortfalls. Our experience working with state Medicaid officials in more than two dozen states to prevent potential rate cuts esulting from the 2016 CURES bill will be crucial in responding to any new proposed reductions in 2021.
AAHomecare’s Payer Relations Council draws on the expertise and collaborative mindset of more than 30 HME leaders to share best practices and develop resources to use in our engagements with policymakers and private payers. For 2021, the Council is working on a model to analyze Medicare patient outcome data to demonstrate the cost-effectiveness for selected HME products. Using data that clearly shows the value of HME products and services can underpin our efforts to push back against new rate-cutting proposals – and also make a difference in our advocacy work and engagement with private payers across a wide spectrum.
AAHomecare Joins Comments on Maine Medicaid Rate Analysis
AAHomecare joined HOMES in commenting on Medicaid rate analysis commissioned by the Maine Department of Health and Human Services to help guide future rate-setting efforts. The joint comments take issue with the choice of states used for comparison purposes, noting significant differences in the service areas and Medicaid program operating structures vs. those in Maine. The comments also push back against using Medicare bidding rates as another benchmark in their analysis.
The comments highlight extensive missing, incomplete, and/or mischaracterized data used by the contractor who developed the comparison. Using oxygen concentrators as an example, the comments show that the missing data could be impacting the rate comparison by 20-25%.
HOMES and AAHomecare conclude the comments by offering to help Maine DHHS correct issues with contractor’s analysis and develop a report that better reflects the operating environment and cost factors HME suppliers are facing in serving the state’s Medicaid beneficiaries. See the complete comments here.