WASHINGTON, D.C. – Sen. Marsha Blackburn (R-TN) is preparing to introduce legislation that would restore access to titanium and carbon fiber wheelchairs for Medicare beneficiaries and for individuals covered by plans that follow Medicare policy and coding. The Senate bill is expected to have similar language to H.R. 5371. We’ll be asking CRT advocates to help build support for co-sponsors when a Democratic co-lead for the Senate bill is confirmed. In the meantime, you can help support next week’s CRT fly-in by asking your Representative in the House to co-sponsor H.R. 5371 and work to move that legislation forward before the end of 2024. Find guidance on messaging and how to contact your representative at aahomecare.org/CRT-advocacy.
Expanding Medicaid Advocacy Resources
WASHINGTON, D.C. – AAHomecare Payer Relations Council recently met to address current issues and work on strategic planning for 2025 and beyond. While AAHomecare and the Council continue to focus on the significant concerns with Medicare Advantage and prior authorization, we are also engaged on many other important fronts with Medicaid, Medicaid Managed Care, and major payers.
The Payer Relations Medicaid Subcommittee has been working on a comprehensive environmental scan that will include the issues and opportunities that need to be addressed in each state. We will be working closely with our state and regional association partners to prioritize these concerns to bring to future meetings with the Medicaid program officials and legislators. These issues include rate stability, medical policy issues, sales tax concerns, and objectives for specific product lines.
The scan will also show when the fee schedules were last updated in a state and if rates are accurate according to the State plan amendment approved by CMS. We are also tracking the timeframes for the next Request for Proposals (RFP) for the managed care programs in the states, so we can begin proactive discussion with Medicaid leadership and legislators on adding language to protect providers in these contracts. This approach paid off recently for GAMES, who scored a win with Georgia Medicaid leadership when they agreed to add rate floor language that requires the MCO plans to pay 100% for DMEPOS. These contracts will be awarded in the upcoming months.
The Council also continues to work on other projects related to the Transparency in Coverage Rule and how to best equip our industry with tools and resources to help in payer conversations. We have been engaging in conversations with the technology companies working in this space and will be updating the industry as these resources become available.
These are just a few of the initiatives the Payer Relations Council is working on. The Council remains committed to developing a strong strategic direction to deal with critical payer issues that directly impact the HME community and to provide resources, guidance, and support to help our members engage payers more effectively.
AAHomecare Shares Comments on Comparative Billing Reports and Home Health Proposed Rule
WASHINGTON, D.C. – AAHomecare responded to CMS’ Request for Information (RFI) regarding Comparative Billing Reports (CBRs). CBRs are reports that can be issued by CMS or DME MACs that are specific to an individual provider. The report shows how the provider’s billing patterns differ from their peers. In the RFI, CMS requested answers to specific questions about provider experience with CBRs and how the program can be improved. AAHomecare’s comments were based on supplier experiences from previously issued reports and how the data analysis and supplier education can be improved. AAHomecare’s comments can be found here.
