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North Carolina implements Medicaid rate floor

North Carolina implements Medicaid rate floor

RALEIGH, N.C. – North Carolina Gov. Roy Cooper on June 29 signed S594, a bill that creates a rate floor for durable medical equipment, ACMESA and AAHomecare report. 

Per the legislation, reimbursement for DME will be set at 100% of the lesser of the supplier’s usual and customary rate or the maximum allowable Medicaid fee-for-service rates for DME and supplies, orthotics and prosthetics. 

The legislation, which went into effect July 1, protects rate floor provisions for Medicaid managed care organizations enacted one year ago and extends them for an additional two years beyond the original three-year term for a total of five years of protection.  

“Our previous work with state Medicaid officials earned us a lot of trust with them,” said Laura Williard, AAHomecare’s vice president of payer relations. “We helped North Carolina avoid $15 million in paybacks to the federal government in the first year on implementation of the CURES Act and prevented additional paybacks and cuts in subsequent years. Getting them to support our language was critical to the effort.” 

ACMESA and AAHomecare estimate the rate protections prevent $22 million in potential cuts to Medicaid reimbursement for DMEPOS in North Carolina on an annual basis.


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