Tag: Managed Care Organizations (MCOs)
Medicaid update from Texas: ‘No feasible way’ to survive proposed cuts
December 5, 2025Theresa Flaherty, Managing Editor
AUSTIN, Texas – Proposed Medicaid cuts of up to 85% by the Texas Health and Human Services Commission (HHSC) would destroy the state’s durable medical equipment (DME) infrastructure – and patient access along with it, say providers.
Proposed rates published in October include cuts of 18.66% to 39.47% for oxygen, depending on modality, 78.25% for pulse oximeters and 51.06% for...
Tomorrow Health courts Medicaid MCOs
April 4, 2023HME News Staff
NEW YORK – Tomorrow Health has announced new technology that it says can help Medicaid managed care organizations move beyond analog fax and phone workflows for home-based care, get up-to-the minute insight into order status and better manage members with complex cases. The company says its technology can provide an extra layer of efficiency by providing care coordinators with important DME-related information, such as referring provider details, product category estimated delivery date, confirmed...
Home Care Alliance seeks to expand network
March 21, 2022HME News Staff
HALIFAX, Va. – The Home Care Alliance of Virginia seeks to expand its DME provider network to serve patients of the United Mine Workers of America Health and Retirement Funds. HCAV is one of seven contractors serving UMWA beneficiaries nationwide and is currently seeking providers in multiple areas, including Utah, Wyoming, Illinois, Pennsylvania, West Virginia, Kentucky, Tennessee, Alabama and Missouri. HCAV provider members can serve UMWA patients in their service areas under the HVAC contract....
Florida: MCO legislation fails to cross finish line
March 17, 2022HME News Staff
TALLAHASEE, Fla. – Language that would have required managed care organizations in Florida to reimburse at no less than 100% of the state’s current Medicaid DME schedule was not included in the final version of an appropriations package, according to AAHomecare. “While we didn’t accomplish our top goal this time around, I am convinced that the extensive work engaging legislators, the Agency for Health Care Administration, the Governor’s office, the Florida Association...
Florida providers push hard to safeguard Medicaid
February 4, 2022Theresa Flaherty, Managing Editor
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,...
In brief: Rotech files IPO, Numotion buys SpinLife, NC goes with rate floor
July 9, 2021HME News Staff
ORLANDO, Fla. – Rotech Healthcare Holdings has filed for an initial public offering of up to $100 million and plans to list on the Nasdaq under the symbol ROTK.
The company had $534 million in sales for the 12 months ended March 31, 2021.
Rotech Healthcare offers a comprehensive range of home medical equipment and products and services across five core business lines: oxygen, ventilators, sleep therapy, wound care and DME. The company's payer mix includes commercial insurers,...
State news: Oklahoma, Louisiana, New York
June 14, 2021HME News Staff
The Oklahoma Health Care Authority does not have the authority to implement a managed care plan for the state’s Medicaid system, according to a State Supreme Court ruling. The ruling was cheered by the Oklahoma Medical Equipment Providers Association and other health care providers who have been fighting the proposed move in the state legislature and in the courts. “OMEPA and other health care leaders in Oklahoma have done an exceptional job in spotlighting the potential impacts of the...
MCOs and Medicaid: Call for support in NY
March 2, 2021HME News Staff
ALBANY, N.Y. – AAHomecare is calling on providers in New York to help build support for two new bills in the state legislature that would require Medicaid managed care organizations to reimburse for DME and complex rehab at no less than 100% of the published Medicaid fee schedule for the same services and supplies. A.5368 was introduced in the State Assembly on Feb. 16 and S.5118 was introduced in the State Senate on Feb. 24. “This legislation is critically needed to ensure...
Virginia: Stakeholders seek to restrict Medicaid MCOs
August 27, 2020HME News Staff
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,...
Not all MCOs are hot on Medicaid
May 17, 2019Liz Beaulieu, Editor
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...