Payer relations: Cures Act, state toolkit on agenda for 2019

WASHINGTON - The past year has been a busy one for AAHomecare's Laura Williard: She met with 28 states about Medicaid rates. 2019 is shaping up to be just as busy, she says.

Per the 21st Century Cures Act, passed in late 2016, the federal portion of Medicaid reimbursement for HME cannot exceed what Medicare allows. States can either base their Medicaid rates on Medicare's lowest fee schedule; or they can gather aggregated data using their Medicaid rates and utilization rates by area for 2018.

“We will be working with states around that reconciliation process and hopefully keep them from having too much at risk,” said Williard, vice president of payer relations. “I am hoping we don't have a lot of plans that just start changing their rates to Medicare rates.”

So far, 18 states have indicated they plan to go through the reconciliation process, while several others have yet to make a decision, says Williard. The rest have already moved to Medicare rates or said they would not change their rates.

Williard is also developing a state toolkit to help providers around the country lobby at the state level for legislative and regulatory changes. The toolkit will have ideas and suggestions, and actual language that can be implemented in states, said Williard.

“I've been pushing really hard this year from a state perspective to do some state legislative lobbying,” she said. “There are more wins easier at the state level than wins at the federal level.”

For example, she's putting together language that addresses Medicaid MCOs and their increasing tendency to reduce rates and limit provider networks, but there are plenty of other challenges, too.

“We will work with all the state associations in the next year to say, 'Hey, which of these issues do we want to work on,'” she said.