Georgia: Providers ‘celebrate’ new contracts

ATLANTA – Providers in Georgia, at press time, were waiting for the state Medicaid program to announce which case management organizations (CMOs) will receive contracts that include a new rate floor for DME. 

In late 2023, Medicaid officials agreed to set the rate floor for DME at 100% of Medicaid fee-for-service rates and included the provision in its RFPs. 

“(From providers in Georgia), I’ve heard of contracts that ranged from 60% to 80% of the current rate, so it will make a big difference for those providers,” said Laura Williard, senior vice president of payer relations for AAHomecare, who worked with the GAMES board and Peachtree Government Relations to get the rate floor implemented. 

The CMO contracts, which are five-year contracts with options for three one-year renewals, were initially expected to be implemented July 1, but at press time in early June the winners hadn’t been announced. Williard anticipates a fall timeframe, at this point, she says. 

When they are implemented, the contracts will also be a win for beneficiaries who have been facing access issues when providers can’t – or won’t – accept reimbursement that’s too low, says Tyler Riddle, president of MRS Homecare in Tifton, Ga. 

“The Medicaid beneficiary really suffers at those discounts, so this is certainly something to celebrate,” he said. 

The next step for stakeholders is having the rate floor made permanent. Right now, it expires with the new contracts, says Williard. That’s risky because a future administration might be more friendly to CMOs or believe that rate negotiations belong between the contracting parties. 

“(As it stands now), we’d have to make sure the language is added into the next contract,” she said. “I would prefer it to be in statue and permanent. Right now, we’ve got people that are very supportive of us keeping that, so we are trying to get it put into legislation in the 2025 session.”