Tag: MCOs

TALLAHASSEE, Fla. – Providers in Florida believe new legislation aimed at improving the state’s Medicaid managed care program will provide much-needed stability in a state that has had a troubled relationship with the program in the past.  Introduced in January, House Bill 1165 and Senate Bill 1540 would require payers to reimburse providers at 100% of the state’s fee schedule for durable medical equipment and complex rehab technology.   “The cost of goods,...

RICHMOND, Va. - Stakeholders in Virginia are lobbying for a budget amendment that would help to safeguard DME providers by ensuring that Medicaid MCOs can't force contract terms that are unfair or unequitable, according to ACMESA. HB5005 482.20 #59h would place a threshold on how much MCOs can discount off the Virginia Medicaid fee schedule, helping to ensure that patients have access to equipment and services, and to protect providers from additional rate reductions. Stakeholders argue the amendment,...

YARMOUTH, Maine - The upward trajectory of MCOs managing state Medicaid programs has hit a kink.Despite 79% of respondents to a recent HME Newspoll reporting that MCOs manage the Medicaid program in their states, 54% report one or more have exited the market in the past year.“They can't make money at it, so they don't want to be in that business going forward,” said Paul Harbaugh of Avera Home Medical Equipment, which serves patients in North and South Dakota, Minnesota, Iowa and Nebraska.MCOs...

FRANKFORT, Ky. - KMESA is asking HME providers in Kentucky to support HB 224. Introduced last week by State Rep. Kim Moser, the bill seeks to ensure that DME providers are paid at the rate set by Kentucky Medicaid. It would also require that, should a patient transfer from one Medicaid managed care organization to another, services that are currently being provided under a PA will be honored by the new MCO; and require MCOs to cover, at a minimum, the same quantities of supplies covered under the...

WASHINGTON - AAHomecare's HME/RT Council has created two new work groups related to vents and private payers. The first will create white papers to educate policy makers about vents, and compare the differences between pediatric and adult patients and between non-invasive and invasive therapies. The second will compile Medicare MCO and Medicare Advantage payer contract information, such as timeframes for recoupments and contracting. The council meets via conference call and in-person at major industry...

Fifteen members of the Oklahoma Medical Equipment Providers Association (OMEPA), other providers from the state and VGM's Jay Kopriva joined forces at the state capitol in Oklahoma City on Feb. 5 to educate and gather support from their state representatives for H.B. 1407, a bill that would exempt HME from sales tax. Currently, Oklahoma is one of only a few states that charges sales tax on HME and supplies. “We received overwhelming support for the bill,” Kopriva said in a VGM bulletin....

SPRINGFIELD, Ill. - Proponents say a bill in the Illinois House of Representatives that would address reimbursement cuts for home medical equipment and supplies is critical as more and more payers offer below-Medicaid rates.This year, IlliniCare Health, a Medicaid MCO, announced rate cuts ranging from 10% to 50%. House Bill 5930 would prohibit MCOs from paying providers less than 10% below Medicaid “fee for service” rates.“IlliniCare was the first one, but there's been quite a bit...

SPRINGFIELD, Ill. - A bill has been introduced in the Illinois General Assembly that would help to address concerns surrounding 10% to 50% cuts to medical supply companies by certain managed care organizations, according to the Herald & Review. House Bill 5930, co-sponsored by Reps. David McSweeney, R-Barrington Hills, and Gregory Harris, D-Chicago, would prohibit medical supply companies from being paid less than 10% below Medicaid “fee for service” rates by MCOs, the newspaper reported....

SPRINGFIELD, Ill. - IlliniCare Health Plan may be only one Medicaid managed care organization with plans to drastically cut payments for DME in only one state, but when its parent company is Centene Corp., which has MCOs in 28 states, HME providers everywhere take notice.IlliniCare plans to cut reimbursement for DME up to 50% on Jan. 1, a move delayed from Oct. 1.“I would say the severity of these cuts is unprecedented in my experience,” said Kam Yuricich, who runs the Great Lakes Home...