Tag: Managed Care
Prior authorization metrics provide new insight, KFF says
August 18, 2026HME News Staff
WASHINGTON – Medicare Advantage insurers denied 13% of standard prior authorization requests, Medicaid managed care insurers denied 14% and ACA Marketplace insurers denied 18%, according to a new analysis from KFF.
Insurers were required to post the first year of prior authorization metrics for the 2025 calendar year by March 31, 2026. KFF collected and analyzed these metrics from the largest insurers in most market segments for which reporting is required.
Other key takeaways from the...
TBO adds managed care expert to team, expanding services for HME providers
February 23, 2026HME News Staff
LAS VEGAS – Tactical Back Office (TBO) has added Lauren Barranti to its team, adding managed care and growth strategy expertise to its health care platform. With more than 20 years of health care experience, Barranti brings deep experience across home care, managed care and medical supply organizations, with a particular focus on the California at-risk medical group market. Her background includes serving as CEO of California...
CMS issues guidance to states on Medicaid managed care changes
September 10, 2025HME News Staff
WASHINGTON – CMS is issuing preliminary guidance to states on the implementation of new federal payment limits for state directed payments (SDPs) in Medicaid managed care.
CMS has yet to release a final rule, but by providing this guidance now, the agency says states have additional time to plan their efforts to meet the requirements laid out in the One Big Beautiful Bill Act. The letter provides states with information on the reduced payment, details on eligibility for a temporary...
In brief: Sleep think tank, Medicaid managed care fraud, diabetes reorg
September 5, 2025HME News Staff
SAN DIEGO – Resmed has launched the Sleep Institute, a global clinical insights initiative dedicated to advancing the science and understanding of sleep health.
The company says the Sleep Institute partners with clinicians, researchers, policymakers and health system leaders to deliver objective, non-commercial, evidence-based insights that help inform care innovation, support policy decisions and elevate sleep as a global health priority.
“Sleep Institute reflects...
AdaptHealth mobilizes infrastructure for new contract
August 6, 2025Theresa Flaherty
PLYMOUTH MEETING, Pa. – AdaptHealth has begun laying the groundwork for a new five-year, $1 billion capitated agreement that it expects will accelerate growth in 2026.
As part of the agreement, announced Aug. 5, AdaptHealth will provide home medical equipment and supplies for 10 million members in multiple states who are part of a major national health care system.
“This new partnership is a clear endorsement of our ability to deliver patient service excellence...
AAHomecare to grow payer relations team
January 16, 2025HME News Staff
ALEXANDRIA, Va. - AAHomecare is currently searching for a new senior manager of payer relations. The person will be responsible for working in conjunction with payer relations leadership in developing an ongoing industry strategy involving commercial managed care, Medicaid managed care organizations, Medicare Advantage, and state Medicaid programs. AAHomecare is looking for someone to develop ongoing relationships with payers, industry stakeholders at state/regional associations, manufacturers, providers,...
Medtrade preview: New track addresses ‘biggest problem providers have right now’
January 15, 2025Liz Beaulieu, Editor
DALLAS – Medicare Advantage and Medicaid managed care will receive heightened attention at Medtrade this year in a new track of six sessions hosted by AAHomecare and led by members of its Payer Relations Council.
The association has tapped into the providers on the council, including Chair Cadie McGonagill of Lincare, to provide their on-the-ground experience.
“You’ll still hear from me, David (Chandler, vice president of payer relations) and other experts, but...
Medtrade preview: Kerry Tyler wants every attendee to leave inspired
December 13, 2024Liz Beaulieu, Editor
DALLAS – For those who are ready to put the work in, Kerry Tyler says inspiration will be ready for the taking at Medtrade 2025, whether it’s through the new Managed Care Track in the conference program, the returning Tech Talks on the show floor or the Welcome to Dallas Reception and other networking events.
“‘Inspiration exists but it has to find you working’ is a Pablo Picasso quote that I like,” said Tyler, associate show director. “It implies...
AAH, Medtrade collaborate on new track
October 3, 2024HME News Staff
WASHINGTON – AAHomecare has collaborated with Medtrade on a new Managed Care track that includes sessions for both beginner and advanced payer relations strategies. The association’s Payer Relations Council developed six classes for the track. “The AAHomecare Payer Relations Council has some of the brightest and most respected payer relations experts in the industry,” says Laura Williard, senior vice president of payer relations for AAHomecare. “By learning...
Florida Medicaid announces additional contracts
July 25, 2024HME News Staff
TALLAHASSEE, Fla. – Florida’s Agency for Healthcare Administration has announced additional statewide Medicaid managed care contracts for five companies following appeals of the original awards in April, AAHomecare reports.
The full scope of awards now includes:
Aetna Better Health of Florida* – Regions D, E, I
Florida Community Care* – Statewide
Humana Medical Plan – Statewide
Molina...