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AAHomecare: North Carolina Medicaid Increasing Reimbursement Rates
The increases target 13 HCPCS codes described as “emergency needs.”

November 2, 2023 by Laurie Watanabe

North Carolina flag on a flagpole, fully unfurled in the wind, against a blue sky with clouds.

The American Association for Homecare (AAHomecare) is reporting Medicaid rate increases for home medical equipment (HME) in North Carolina.

In a Nov. 1 announcement, AAHomecare credited “strong relationships with North Carolina Medicaid officials and members of the state legislature, ACMESA leaders, and the AAHomecare Payer Relations Team” for the $3.2 million increase in funding.

“The ACMESA Medicaid and legislative committees has been working in earnest for the past two years to get a rate increase since North Carolina discontinued a pandemic 5-percent relief-related rate hike,” the AAHomecare bulletin said.

Laura Willard, AAHomecare’s VP of Payer Relations, said, “North Carolina HME advocates have done a great job in building relationships and educating policymakers on the value of homecare and need for sustainable reimbursements. Those efforts are critical to succeeding in a highly competitive state budget environment. The ACMESA state legislative team, chaired by Tyler Kiser (TLC Medical), deserve great credit for paving the way.”

ACMESA Executive Director Beth Bowen added, “ACMESA is thankful for the rate increase provided on essential codes on the DME fee schedule. Our strong relationship with NC Medicaid is one we value and has enabled our providers to continue to provide quality DME services to North Carolina Medicaid beneficiaries. ACMESA and AAHomecare will continue to fight in the next legislature to obtain a much-needed across-the-board increase. Now is the time to continue to reach out to our legislators to remind them of the value DME brings to NC Medicaid.”

The increases focus on 13 HCPCS codes that industry advocates have identified as having an “emergency need,” with immediate action required “to ensure access to care.”

The impacted codes include A7520 (tracheostomy/laryngectomy tube); A7521 (tracheostomy/laryngectomy tube); A4623 (tracheostomy, inner cannula); B4158 (enteral formula for pediatrics); B4160 (enteral formula for pediatrics, calorically dense); T4544 (adult disposable incontinence product); T4542 (incontinence product, disposable underpad); A4351 (intermittent urinary catheter); E1007 (wheelchair accessory, power seating system, combination tilt and recline with mechanical shear reduction); K0739 (repair or non-routine service for DME); K0005 (ultralightweight manual wheelchair); E1161 (adult manual tilt-in-space wheelchair); and K0861 (Group 3 multiple-power power wheelchair).

Image: istockphoto/BSPollard

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