Highlighting Product and Operational Cost Challenges with Major Payers
WASHINGTON, DC – AAHomecare is working to make sure that commercial payers are aware of the rising product prices, supply chain constraints, and increased operational costs facing HME suppliers.
In individual letters to major national payers, AAHomecare details these challenges, highlights how high-quality HME reduces overall healthcare spending, and notes that “without immediate intervention, it may become cost-prohibitive for suppliers to continue providing equipment and supplies to those who need them to safely manage their medical conditions.”
The letter is designed to help set the stage for suppliers to directly engage with payers regarding your individually negotiated contracts. Ultimately, we hope this letter will support these individual provider conversations and we are planning to add additional resources to support these efforts in the near future.
AAHomecare encourages providers to reinforce these messages in discussions with payer contacts. Share a PDF version of AAHomecare’s message or download a Word version that you can personalize and edit to include details on cost challenges your company is facing.
Florida Considers MCO Rate Floor Legislation
TALLAHASSEE, FL – The Florida state legislature is currently considering HB 1165 and SB 1540, legislation to require Medicaid managed care organizations (MCOs) to reimburse at no less than 100% of the state’s current Medicaid DME schedule. AAHomecare shared details of the Florida Alliance of Home Care Services (FAHCS) legislative conference, which took place last week, in an alert to Florida companies while requesting grassroots action in the state.
During the conference, Laura Williard and members of FAHCS met with 21 state legislators to outline how DME providers have limited ability to negotiate rates with Managed Care plans due to their size, yet the standard for contracts in Florida are 60% of State Medicaid Fee Schedules. A rate floor would only raise DME to 0.8% (8/10ths of 1%) of Medicaid State MCO spending, compared to its current rate of 0.67%. Yet, this small amount would help providers remain in business and lower the overall healthcare costs in the state by keeping patients out of hospitals and SNFs.
There has been a greater awareness of the needs of the DME industry due to the advocacy work that has been completed over the past several years. This year, DME was even put into the Governor’s budget with recommendations for rate increases, however this has not been finalized at this point.
“This legislation is critical to the HME industry in Florida,” notes Williard, “Passing these bills will ensure we can continue to partner with the Medicaid managed care plans in ensuring quality care in a sustainable reimbursement model. AAHomecare and FAHCS would like to thank Representative Andrew Learned and Senator Shevrin Jones for their support in championing our legislative efforts.”
Action is needed before the session ends March 11. If you are a Florida resident, visit the Action Center and send a letter to your state Senators and Representatives.
HHS OIG Report Points to Increase in Payments to Part B and DME Payments for Hospice Patients
WASHINGTON, DC – On February 14, Department of Health and Human Services Office of Inspector General (OIG) published the report titled, “Medicare Payments of $6.6 Billion to Nonhospice Providers Over 10 Years for Items and Services Provided to Hospice Beneficiaries Suggest the Need for Increased Oversight.” For this data brief, the OIG analyzed data on hospice payments and payments for items and services not covered under the Medicare hospice benefit for hospice patients.
The OIG found that between calendar years (CY) 2010 – 2019, majority of nonhospice payments for hospice patients were for Part B items and services, and payments for Part B items and services increased by 38%. The OIG also found that payments for nonhospice care is associated with for-profit hospices. Of the $6.6B that were paid towards nonhospice care, 62% were connected to for-profit hospices. The purpose of this report is to provide insight for CMS on improper payments and help CMS evaluate potential restructuring of the hospice payment system.
See AAHomecare’s summary of the HHS OIG report for more details.