Tag: David Chandler
CGM bill aims to preserve two-channel option
February 14, 2025Theresa Flaherty, Managing Editor
LITTLE ROCK, Ark. – A new bill in Arkansas is the first on a state level to try and stem the “migration” of coverage for continuous glucose monitors to a pharmacy-only benefit.
Introduced Jan. 27, HB1255 would amend existing Medicaid coverage of CGMs to allow beneficiaries to obtain CGMs through the DME benefit and would allow DME providers to bill for the devices using a HCPCS code rather than the national drug code number used by pharmacies.
“We don't...
Stakeholders push two-channel option for CGMs
November 27, 2024Theresa Flaherty, Managing Editor
WASHINGTON – Users of continuous glucose monitors have reported difficulties obtaining equipment and supplies when their insurers eliminate coverage under DME, adding more evidence that there needs to be a two-channel option, stakeholders say.
As CMS has expanded coverage of CGMs and supplies, some payers have begun making it a pharmacy-only benefit, limiting brand choices and narrowing networks.
“One patient wrote that they attempted to obtain sensors from three different...
AAHomecare promotes Chandler
June 27, 2024HME News Staff
WASHINGTON – AAHomecare has promoted David Chandler to vice president of payer relations. Chandler has been with the association for five years and has been instrumental in the formation and strategy of AAHomecare’s Payer Relations Council and has taken a leading advocacy role with the association's Diabetes Council in protecting and expanding access to diabetes equipment and supplies in the home. “David has forged strong relationships with policymakers, HME leaders and patient...
CMS piles on prior auth requirements
February 7, 2024Liz Beaulieu, Editor
YARMOUTH, Maine – A rule finalized in January is CMS’s latest bid to fine-tune the prior authorization process for Medicare Advantage plans and other payers to increase efficiency and transparency.
The agency in January finalized a rule requiring MA plans and other payers like Medicaid and Medicaid managed care to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. For some payers, CMS says, this cuts the current...
Stakeholders on Medicare Advantage: ‘We need an avenue to go to’
September 2, 2022Liz Beaulieu, Editor
WASHINGTON – Industry stakeholders didn’t waste the opportunity to provide CMS with feedback on Medicare Advantage, telling the agency there’s an urgent need to improve oversight of the program.
Industry organizations, state and regional associations, and individual providers all submitted comments to a request for information before an Aug. 31 deadline, says Laura Williard, vice president of payer relations for AAHomecare.
“While there are some protections...
Payer relations: Make your voice heard
April 6, 2020David Chandler
Q. What is the role of HME trade associations in payer relations efforts?A. Working with your state/regional association and AAHomecare can help you become more educated and engaged on payer relations issues. These associations represent the collective provider community, and provide input and advocate for HME policy priorities to a wide range of payers. Building relationships with government and commercial payers is a necessary function for associations so that when issues come up and solutions...
Payer Relations: Choose the correct path
March 11, 2020David Chandler
Q. What are the pros and cons of solving state Medicaid issues with regulation vs. legislation?A. There are two principal paths to solving state Medicaid issues: either through regulation or legislation. Both are effective ways of resolving issues, but each comes with their own costs and benefits. It is typically a good idea to start with the regulatory approach so that you don't burn any bridges with state regulators and overlook any potential allies. However, I always recommend weighing the pros...
Payer Relations: Maintain working relationships
February 12, 2020David Chandler
Q. What are some of the most common problems faced when it comes to payer relations?A. Payer relations professionals face a wide range of problems on any given day, but the most common issues can be categorized under three main topics: working with Medicaid managed care organizations (MCOs), identifying who to contact at a payer, and determining the most efficient way to solve a problem with a payer. Knowing how to navigate these problems gives anyone in payer relations an advantage.The first issue...
Payer Relations: Establish a point person
January 8, 2020David Chandler
Q. What is payer relations and why is it so important?A. You may have contemplated this question and wondered why many companies are putting so many resources into this area. Simply put, payer relations (also referred to as payor relations by some) describes operations that work with a range of third-party payers to make sure patients have access to high quality equipment and care. Payer relations goals can be accomplished in three general ways: by working directly with insurance companies,...
David Chandler on MCOs: 'We need to transform school of thought'
April 1, 2019Liz Beaulieu, Editor
WASHINGTON - AAHomecare will grow its payer relations team in April to include David Chandler as its director of payer relations.Chandler is director of reimbursement and government affairs for Liberty Medical Specialties based in Whiteville, N.C.; treasurer of the Atlantic Coast Medical Equipment Services Association; chairman of the Medicare Jurisdiction C Advisory Council; and a member of AAHomecare's Regulatory Council and State Leaders Council. He also serves on the North Carolina Board of Pharmacy/DME...