New Hampshire: Granite State providers seek changes to Medicaid managed care

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Monday, April 1, 2019

CONCORD, N.H. – HOMES is trying to get out ahead of the next round of Medicaid managed care contracts in New Hampshire and incorporate protections for HME providers.

In February, HOMES members met with Sen. Tom Sherman, a Democrat who chairs the New Hampshire Health and Human Services committee that oversees the Medicaid program, to discuss ongoing concerns with one contractor in particular—New Hampshire Healthy Families, a for-profit that is part of Centene Corp.

“We are trying to be proactive on this next round,” said Tamme Dustin, president and CEO of Herron & Smith in Hooksett. “How is the state going to protect us as small providers to get claims paid timely and (address) access issues?”

Chief among the concerns: a sole-source contract that NHHF has with Medline for incontinence supplies and a new fee schedule that pays roughly 70% of non-rural Medicare rates, and

Also a concern: a requirement that claims for miscellaneous codes be submitted with invoices containing MSRP information. If they don’t, providers will only be paid cost plus 10%, says Karyn Estrella, HOMES executive director.

“Invoices don’t have MSRP information—they are essentially asking for something that doesn’t exist,” she said.

Estrella has begun gathering information from providers about lost revenues and layoffs in response to a request from Sherman.

“He’s very concerned about the impact on local providers and is interested in drafting legislation, whether that can be implemented before these next contracts go into effect July 1 or it’s for the next round,” she said.