Tag: Medicaid
CMS proposes changes to state-directed provider payment rates
May 21, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule that would cap state-directed provider payment rates at 100% of Medicare payment rates for expansion states and 110% of Medicare payment rates for non-expansion states (or 100% of the Medicaid state plan rate if a comparable Medicare rate is not available).
The rule would also:
Apply similar limits to certain targeted Medicaid fee-for-service payments, and
Establish consistent national standards...
Ohio Gov. DeWine signs executive order aimed at Medicaid fraud
May 20, 2026HME News Staff
COLUMBUS, Ohio – Ohio Gov. Mike DeWine has signed Executive Order 2026-01D to allow the Ohio Department of Medicaid (ODM) to implement emergency rules to require more frequent revalidation of providers identified as higher-risk for committing fraud.
Additionally, DeWine sent a letter to the Centers for Medicare & Medicaid Services (CMS) on May 1 committing Ohio to partnering with the Trump Administration and using a more stringent revalidation process to better prevent fraud.
Under...
North Carolina extends Medicaid rate floor
May 13, 2026HME News Staff
RALEIGH, N.C. – Both chambers of the North Carolina General Assembly have approved a one‑year extension of the state’s Medicaid rate floor, moving its expiration from June 30, 2026, to June 30, 2027, according to a bulletin from AAHomecare. House Bill 696 was signed into law by Gov. Josh Stein on April 30. This extension builds on a success for North Carolina providers first achieved in 2021, when the state enacted Senate Bill 594 to establish a Medicaid rate floor for DMEPOS. That...
Oz announces new nationwide Medicaid anti-fraud effort coming, but offers no details
April 28, 2026HME News Staff
WASHINGTON – Dr. Mehmet Oz announced last week that all 50 states will be required to explain their plans to revalidate some of their Medicaid providers.
Oz, Centers for Medicare & Medicaid (CMS) Administrator, made the announcement April 21 during a health care summit hosted by Politico. In the announcement, Oz said that the CMS will ask states to share their strategies within 30 days, according to several online news reports.
"It's an example of what we'd like them to do...
In brief: OIG’s PAP investigation, Oz’s Medicaid revalidation initiative, CCS’s agentic AI platform
April 27, 2026HME News Staff
WASHINGTON - Medicare payments made to suppliers for PAP devices generally complied with Medicare billing requirements, according to a new report from the Office of Inspector General (OIG).
For fiscal year 2017, the Comprehensive Error Rate Testing (CERT) Program determined continuous PAP (CPAP) devices had the second highest improper payment amount in the DMEPOS category, with estimated improper payments totaling $495 million for CPAP devices used for the treatment of obstructive sleep apnea...
Aeroflow Health supports efforts to extend Medicaid coverage in Wisconsin
April 14, 2026HME News Staff
ASHEVILLE, N.C. – Aeroflow Health supports the passage of the 2025 Wisconsin Act 102 to expand postpartum Medicaid coverage from 60 days to one year. The company says the act, which goes into effect July 1, 2026, means mothers in the state now have more time to focus on recovery and explore the care resources available for themselves and their babies. “Extended Medicaid coverage during the first year of postpartum gives mothers peace of mind that care will be there when they need it,”...
Texas Medicaid responds to feedback, reduces severity of cuts
April 3, 2026Theresa Flaherty, Managing Editor
AUSTIN, Texas – After strong pushback, the Texas Health and Human Services Commission (HHSC) will limit most rate adjustments for Medicaid to 5% or less – a huge improvement over the agency’s original proposal of cuts up to 85%, say HME providers.
At a hearing in November, about 50 stakeholders testified against the proposed cuts, which originally included18.66% to 39.47% for oxygen (depending on modality), 78.25% for pulse oximeters and 51.06% for adult formula.
“It...
Department of Treasury wants to pay for information on fraud
March 31, 2026HME News Staff
WASHINGTON – The U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN) on March 30 issued a proposed rule paving the way to pay whistleblowers for actionable tips on fraud schemes targeting government health care benefit programs such as Medicare and Medicaid.
“As promised, Treasury will reward whistleblowers who provide timely, actionable information on fraud, sanctions violations, and other significant illicit finance activity,” said Secretary...
In brief: Medicare comparison legislation, Omnipod expansion, Owlet partnership
February 18, 2026HME News Staff
WASHINGTON — Senator Tim Scott, R-S.C., has introduced the Apples to Apples Comparison Act of 2026, which seeks to require the Centers for Medicare and Medicaid Services (CMS) to provide seniors with clear, comparable data when choosing between Medicare Advantage (MA) and traditional fee-for-service coverage. By giving seniors accurate cost and coverage information, the legislation empowers them to choose the plan that best meets their health care needs. “Seniors...
Provider Tyler Riddle lobbies for payment parity for Georgia Medicaid
February 16, 2026HME News Staff
ATLANTA – Tyler Riddle, CEO of MRS Homecare, appeared before the Georgia House Health Appropriations Subcommittee on Feb. 10 to request that Medicaid rate floor language be included in the fiscal year 2027 state budget, ACMESA reports. Speaking on behalf of Georgia’s HME providers, Riddle reinforced the critical importance of Medicaid payment parity for durable medical equipment (DME) under Georgia managed care organizations – a key priority...