‘We want to make sure this is stopped’
By Liz Beaulieu, Editor
Updated 8:24 AM CDT, Wed June 30, 2021
WASHINGTON – The payer relations team at AAHomecare is working with state and regional associations to pick off attempts by managed care organizations and other insurers to decrease reimbursement for HME.
Stakeholders have a number of bills working their way through state legislatures to protect reimbursement for DME at 100% of the state Medicaid fee schedules. One of those states: New York, where A.5368 is scheduled to go before the Rules Committee before heading to the floor for a vote. A companion bill, S.5118, is also eligible for a vote.
“MCOs shouldn’t be able to use some of these crazy reductions, up to 50% off the state Medicaid fee schedule,” said David Chandler, senior director of payer relations for AAHomecare. “We’re cautiously optimistic.”
Similar legislation has also been introduced in Texas.
A newer threat targeting a specific product category has also popped up in Louisiana. Chandler in May testified before the House Insurance Committee in Baton Rouge to support a bill that would prevent managed care organizations and other payers from setting reimbursement caps for ventilators. The bill has now passed the state’s House and Senate.
“There’s this trend developing where the NIV benefit appears to be under siege by payers, particularly commercial payers, and this would be a dangerous precedent that you could cap items that CMS classifies as requiring frequent and substantial servicing,” he said. “We want to make sure this is stopped to protect access to care.”
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