Tag: Managed Care

WASHINGTON – Some people enrolled in Medicaid managed care may not be receiving all of their medically necessary health care services, according to a new study from the Office of Inspector General.  There are three key factors causing concern, the OIG says: the high number and rates of denied prior authorization requests; the limited oversight of prior authorization denials in most states; and the limited access to external medical reviews.  What the OIG found  Overall,...

As we were putting the finishing touches on this June issue, news broke that Humana has contracted with AdaptHealth and Rotech Healthcare, two national HME providers, to provide HME products and services to its Medicare Advantage HMO members.  This is a big deal for a whole lotta reasons.  We’ve all read the headlines. Insurers are increasingly targeting Medicare Advantage plans as a source of growth. Last year, Humana outlined plans to expand its Medicare HMO offerings, specifically,...

LOUISVILLE, Ky. - Humana has announced agreements with AdaptHealth and Rotech Healthcare to provide home medical equipment services to its Humana Medicare Advantage HMO members.  The two national companies will begin providing services to these members under a value-based structure beginning July 1, with each serving a specific region of the country.  “Partnering with national DME partners under a value-based arrangement aligns with our goal to enhance access to the home care...

ALEXANDRIA, Va. – The National Community Pharmacists Association supports bipartisan legislation reintroduced March 17 to improve transparency and prevent the use of “spread pricing” in Medicare managed care programs. Spread pricing is when pharmacy benefit managers overbill the state or Medicaid managed care programs, under-reimburse pharmacies for medications dispensed and retain the difference, the association says. A broad ban on these practices would save the federal government...

MIRAMAR, Fla. – Integrated Home Care Services, an independent administrator of home health, DME and home infusion benefits, plans to offer expanded services in 13 states to meet the growing demand for home care. Founded in 2015, IHCS currently serves the home care needs of more than 2.2 million patients through partnerships with managed care organizations and risk-bearing provider organizations across the country. "IHCS was created to better meet the needs of the managed care industry,”...

SACRAMENTO, Calif. – The California Association of Medical Product Suppliers (CAMPS) and the University of California, San Francisco, have launched a survey to collect provider experiences on the state’s transition to a Medi-Cal Managed Care Plan for California Children’s Services (CCS). Anonymous results from the survey, which should only take three to five minutes to complete, will be shared with the California Department of Health Care Services (DHCS). In 2018, DHCS instituted...

BOSTON – The MassHealth Medicaid program is implementing a 10% rate increase for DME claims with dates of service effective July 1, 2021.    It's also implementing a 50% increase for labor code K0739, which covers repair or nonroutine service for DME other than oxygen equipment requiring a skilled technician.  “This is a big win when we needed it most,” said Jason Morin, president & CEO of HOMES. “Between the pandemic impacts and the recent respiratory...

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...

AAHomecare has worked with TexMEP and other stakeholders to get three bills introduced in the state legislature on rate stability and patient access to quality HME. HB 3679 would require Medicaid managed care organizations to reimburse providers at no less than 95% of the state’s published Medicaid DME fee schedule. HB 3678 would update the insurance code to support Medicaid continuity of care and patient choice language, and ensure adequate reimbursement. HB 3677 would amend...

COLUMBIA, S.C. – HME providers are fighting large managed care organizations that are increasingly pushing into more states and offering reduced reimbursement rates, say industry stakeholders.  The straw that’s breaking the camel’s back: The COVID-19 pandemic pushing the cost of doing business even higher, says Craig Douglas, vice president of payer and member relations for VGM.  “Acquisition...