Payer Relations

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$ 563 M

Back in Providers Pockets from Payer Initiatives

$ 161 M

Recurring Annually from Payer Initiatives

26

States AAHomecare is Working on Rate Increase & Stability

Meet the Team

AAHomecare’s Payer Relations team is making a difference in the HME community. Advocating for fair, common-sense regulations that help put patients over paperwork, working with state and regional association leaders on Medicaid rates and other managed care payers, working with Medicaid plans and MCO plans to eliminate administrative costs for providers, and continuing to grow the resources to fight for HME interest in Washington and at the state level are a few of the ways our team is making an impact.

The team includes Laura Williard, sr. vice president of payer relations, David Chandler, vice president of payer relations, and Alexis Ward, sr. director of payer relations.

 

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Industry Impact

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Payer Relations Strategy

Payer Relations Education & Resources

Advocacy and education are the cornerstone of AAHomecare. By strengthening the foundation of HME businesses we strengthen the industry, therefore AAHomecare offers contract negotiation resources and tips, white papers, infographics, and other resources to help demonstrate value to commercial payers, Medicare Advantage plans, and Managed Medicaid plans, helping increase the value of businesses and future reimbursement. 

Payer Engagement Resources

 

Our resources also include the Value of HME brochure to help providers demonstrate their importance their importance to the health care continuum through presentations and videos that establish HME as a partner with payers, offer data supporting cost reduction and improved patient outcomes through care from HME providers, and enhanced patient satisfaction.

Value of HME Brochure
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Medicare Advantage

The Medicare Advantage Program currently has nearly 33 million participants, representing over half of all Medicare beneficiaries. AAHomecare believes now is an appropriate time for CMS to closely examine the MA Program in its “Vision for Medicare” which aims to place “the person at the center of care and drive a future where people with Medicare receive more equitable, high-quality, and whole-person care that is affordable and sustainable.” Over the last 20 years, home care technology has made tremendous strides, enabling an increasing number of patients to receive safe, efficacious, and cost-effective health care at home—the site they prefer to be. Our country’s experience with the COVID-19 public health emergency has demonstrated that Durable Medical Equipment, Prosthetics/Orthotics, & Supplies (DMEPOS) suppliers have been able to take care of many patients at home, thereby alleviating hospital overcrowding.

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Medicare Advantage

State Regulatory and Legislative Advocacy

AAHomecare’s payer relations team’s efforts have helped stop or limit proposed Medicaid reimbursement cuts in dozens of states, limited the spread of narrow network contract arrangements, and successfully lobbied TRICARE to provide retroactive relief for HME reimbursements.

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Sustainable Rates with Medicaid Programs

In the United States, 21% of the population is covered by Medicaid/CHIP and 72% of Medicaid beneficiaries are enrolled in Medicaid MCO. The total spend for Medicaid is $728.3B. AAHomecare is working to increase Medicaid FFS, secure legislative budget amendments, increase Medicaid Rate Floors, work with state programs and stakeholders on policy development and MCO/TPA oversight. 

State Sales Tax

Elimination of state sales tax on durable medical equipment has been a priority of the Association across several product categories including DME, breast pumps and supplies, complex rehab technology, sleep, and respiratory. Legislation has passed most recently in California eliminating breast pumps and supplies from state sales tax. Other states passing similar legislation include Illinois and Rhode Island for breast pumps and Washington for complex rehab technology.

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What Members Are Saying