Tag: Medicaid
Medicaid disenrollment highlights need for increased automation
August 11, 2023Liz Beaulieu, Editor
WASHINGTON – HME providers might feel like they’ve been “whipsawed” by the current Medicaid disenrollment, but there are tools and processes they can implement to continue business as usual, say industry stakeholders.
As of Aug. 1, 2023, states have disenrolled at least 3.8 million Medicaid recipients based on the most current data from 41 states and the District of Columbia, according to Kaiser Family Foundation (KFF).
“There’s a lot of whipsawing...
OIG: More oversight needed of Medicaid managed care
July 20, 2023HME News Staff
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,...
Massachusetts Medicaid pays for wheelchair repairs
July 5, 2023HME News Staff
BOSTON – The Medicaid program in Massachusetts has added new procedure codes and corresponding rates for shipping fees and wheelchair repair evaluation, according to NCART. The new codes and rates went into effect July 1. They are:
Code A9901, $3, DME delivery, set up and/or dispensing service component of another HCPCS code.
Modifier U7: Used in conjunction with K0739 for direct service components when an in-person evaluation is performed for the repair of a mobility system RE-1...
NCART to Medicaid: ‘We can’t continue down this road’
June 30, 2023Liz Beaulieu, Editor
WASHINGTON – NCART has officially put state Medicaid programs on notice that they should be following Medicare’s lead in implementing a reimbursement increase for complex rehab products and services.
NCART in June sent letters to state Medicaid programs, asking them to increase their reimbursement and to work with the organization and other stakeholders to develop policies that best serve people with disabilities.
“We’re putting a lot of focus on reimbursement...
NCART calls for Medicaid reimbursement increase
June 26, 2023HME News Staff
WASHINGTON – NCART has sent letters to state Medicaid programs asking them to increase reimbursement rates for complex rehab technology products and services. The organization points out that CMS implemented a reimbursement increase for Medicare in January to address inflation. "CRT plays an irreplaceable role in maximizing independence, quality of life and community access for individuals with significant disabilities," says Wayne Grau, executive director of NCART. "We are calling on payers...
HHS announces Medicaid flexibilities as millions face dis-enrollment
June 13, 2023HME News Staff
WASHINGTON - The Department of Health and Human Services (HHS) has announced new flexibilities to help keep Americans covered as states resume Medicaid and Children’s Health Insurance Program (CHIP) renewals.
Continuous Medicaid enrollment established under the Families First Coronavirus Response Act (FFCRA) ended on March 31, 2023, and millions of Medicaid beneficiaries stand to lose coverage in the coming months.
The new flexibilities were announced in a letter Secretary...
Florida providers to receive ARPA funds
June 12, 2023HME News Staff
TALLAHASSEE, Fla. – Florida’s Agency for Health Care Administration will grant one-time payments to providers of home and community-based services including DME, calculated as a 19% increase based on Medicaid managed care claims paid from July 1, 2020, through June 30, 2021. The relief is possible thanks to the funding provided by the American Rescue Plan Act (ARPA), which went into effect April 1, 2021. The payments do not require any application or reporting from eligible suppliers....
How to prepare for Medicaid dis-enrollment
June 8, 2023Andrea Stark
Continuous Medicaid enrollment established under the Families First Coronavirus Response Act (FFCRA) ended on March 31, 2023. I am sure I am not the first to tell you about the millions of Medicaid beneficiaries that will lose coverage in the coming months. Nonetheless, I hope I can offer a few insights to better prepare you for the ramifications of so many patients potentially changing coverage in a short period of time.
In exchange for a 6.2% Federal Medical Assistance Percentage (FMAP)...
Florida providers are in line for rate increase
May 15, 2023HME News Staff
WASHINGTON – HME providers in Florida will receive a 7.5% increase to the Medicaid fee schedule, the first in 23 years, AAHomecare reports.
Additionally, the increase must be passed along from managed care organizations (MCOs), which manage 73% of the Medicaid population in the state, to providers.
"This rate bump will protect access to critical home care services and begin to relieve the financial stress on businesses in our industry,” said Crispin Teufel, CEO of Clearwater,...
Tomorrow Health on Medicaid: ‘The drive for greater efficiency is paramount’
May 5, 2023Theresa Flaherty, Managing Editor
NEW YORK – Tomorrow Health’s move to expand its customer base to include Medicaid managed care organizations will benefit HME providers by streamlining often cumbersome processes for these patients, says CEO Vijay Kedar.
“For many Medicaid members that are in need of equipment or supplies, it is often quite complex to navigate the benefit and coverage guidelines, as well as the administrative complexity that is required,” he said. “We've felt that expanding...