WASHINGTON, DC – AAHomecare is working with the Pennsylvania Association of Medical Suppliers (PAMS) and other stakeholders to address the industry’s concerns with Tomorrow Health’s operating model in the state.
Tomorrow Health is a DME company that is performing dual roles as both a provider and a third-party administrator for Geisinger Health in Pennsylvania. AAHomecare and PAMS are concerned that this arrangement has the potential to impact patient choice and continuity of care for individuals covered under Geisinger’s Medicaid contract, as well as Medicare Advantage and commercial plans in Pennsylvania. Other suppliers in the service areas covered by Geisinger and Tomorrow Health have seen a significant downturn in referrals since Tomorrow Health started to implement their referral program in the beginning of the year; a full roll-out is slated to begin March 1.
AAHomecare and PAMS are working to obtain more transparency on how Tomorrow Health’s referral platform works, including information on customer satisfaction results and how other providers are ranked and selected for referrals. AAHomecare and PAMS are also seeking stronger assurances that beneficiary choice and continuity of care are protected under this model.
More information on how their referral technology works is critical to ensure that their model is compliant with legal and regulatory requirements, especially given the potential for Tomorrow Health to deploy this model in other states in which they have a presence.
AAHomecare Weighs in on Continuity of Care for Medically Fragile Children in Texas
WASHINGTON, DC – AAHomecare has asked the Texas Health and Human Services Commission (HHSC) to implement processes to ensure that medically fragile children covered under the state’s Star Kids program can continue to be served by their current DMEPOS supplier if a change in providers is deemed to potentially subject the patient to unnecessary risk.
The current Star Kids contract with the state allows primary care physicians and other providers to make that determination and directs the MCO to “provide the Member access to those Out-of-Network services through an appropriate agreement with the Out-of-Network Provider” in those cases.
AAHomecare’s letter to the Texas HHSC asks the agency to also implement language from SB 1207 that states:
“The commission shall develop a clear and easy process, to be implemented through a contract, that allows a recipient with complex medical needs who has established a relationship with a specialty provider to continue receiving care from that provider.”
The letter also urges HHSC to take the stated intent of the bill’s lead sponsors that “specialty provider” is taken to include DME providers or any other type of provider that provides specialty goods or services to a medically fragile child. The two lead sponsors of Medicaid legislation in Texas (SB 1207, enacted 2019), Sen. Charles Perry (pictured) and Rep. Tan Parker are on record noting that maintaining relationships with medical equipment providers for fragile patients was an important objective of that legislation.
HHSC’s Medical Care Advisory Committee hosted a meeting on February 11, 2021 and included the commission’s interpretation of SB 1207. This interpretation not only did not include DME providers as “specialty providers”, but also limited the continuity of care protections to patients under 21 years of age, patients with primary insurance coverage, and limited protection based on the time of enrollment with an MCO. AAHomecare’s senior director of payer relations, David Chandler, provided comments to the committee opposing the commission’s interpretation along with other stakeholders including parents of special needs children. The committee then unanimously passed a motion urging HHSC to further consider the rule based on the testimony provided by stakeholders and state legislators who authored the bill in question.
HHSC published the proposed rule with this same interpretation on February 12, 2021 with a 30 day comment period; AAHomecare has submitted comments to the rule. Comments can be emailed to HHSRulesCoordinationOffice@hhs.texas.gov with the subject line “comments on Proposed Rule 21R032”.
AAHomecare will continue to work with the Texas Medical Equipment Providers Association (TexMEP) and all Texas stakeholders to advocate for a high standard of continuity of care.
- AAHomecare letter to HHSC– January 2021
- AAHomecare comments– February 2021
- Perry letterand Rep. Tan Parker letter on SB 1207 – December 2019
AAHomecare Offers Resources to Help Share Value of HME
WASHINGTON, DC – AAHomecare is adding additional resources as part of its ongoing effort to ensure that the HME Industry’s work in communities across America is understood and appreciated. Through the Payer Relations Council’s focus on sharing the Value of HME, AAHomecare has curated resources that highlight the major role providers and manufacturers play in ensuring high quality care, including one specific to our industry’s efforts during the COVID-19 Public Health Emergency (PHE).
A flyer titled “HME’s Impact in the Pandemic,” produced through a work group within the Payer Relations Council, outlines the challenges faced by the home medical equipment community to protect and serve patients under the extraordinary challenge of the PHE. The flyer also highlights the assistance provided on a broader scale in the healthcare community, including engaging respiratory therapists to help staff hospitals and educate employees across the country on how to use various kinds of ventilators utilized during the pandemic. A PPT deck was developed to help HME stakeholders make clear and effective presentations to legislators and payers.
AAHomecare highly encourages providers to review the resources below and incorporate them into your discussions with payers and elected officials at the state and federal level to help tell the story of HME within the greater healthcare continuum:
- HME’s Impact in the Pandemic
- HME’s Impact in the Pandemic PPT
- A day without an HME(Published by McKesson)
- Non-invasive Ventilation at Home Improves Survival and Decreases Healthcare Utilization in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease with Chronic Respiratory Failure(Precision Health Study)
AAHomecare’s Payer Relations Council continues to build on these resources and will provide further information to the industry as each is developed.