The American Association for Homecare might be best known for its efforts on Capital Hill, it has placed considerable emphasis on relations with payers other than Medicare for the past year — and the effort has paid off, according to the association
“With increasing pressure to save money on state budgets, it’s critical that we have a strong capability to help respond to proposed Medicaid rate cuts and rally providers and state associations to advocate for fair reimbursement policies,” AAHomecare President and CEO Tom Ryan said, of his association’s broadened efforts to work with private payers.
For the past year, the association has pursued what it labels a “multi-pronged approach” that has also involved efforts from state associations when it comes to fighting reimbursement cuts from non-Medicare payers.
That approach started with hiring Laura Williard (@WilliardLaura) in May 2016 as the association’s Senior Director of Payer Relations. Working in the industry for more than 20 years, Williard efforts included a role as senior director of regulatory affairs and contracting for Advanced Home Care, as well as stints as a board member for GAMES, vice president for NCAMES, and vice president for ATHOMES.
In her role for AAHomecare, Williard has developed reference materials on rules and regulations for these payers and assisted association members with payer relationships and concerns. Those efforts have been so successful that the association has promoted her as vice president of payer relations.
“Laura Williard has brought significant expertise and energy to her role as leader of our payer relations efforts,” Ryan said. “She has gained a great deal of credibility with HME providers and has established solid relationships with state healthcare stakeholders and other major payer organizations.”
Other elements of the multi-pronged approach include:
Information tools, such as AAHomecare’s Dobson DaVanzo Study which analyzed the full operational costs plus cost of goods against the current Medicare reimbursement environment. This has helped the industry has effectively negotiated pricing agreements for DMEPOS providers with state and national payers. Other materials include outreach materials to use when negotiating with TRICARE contractors and the Defense Health Agency regarding how CURES-mandated reimbursement adjustments have impacted TRICARE’s Medicare-derived reimbursement structure.
A legal reference to use in discussions with TRICARE, Medicare Advantage, and Managed Care payers on getting July-December 2016 claims reprocessed so that they are in compliance with the CURES Act. The Association also worked with Brown & Fortunato to obtain legal opinion on the rights and responsibilities of the states in implementing CURES language. AAHomecare also worked with state association to develop a list of questions to be sent to Medicaid Directors and to CMS for guidance and direction.
AAHomecare also spent the past year developing relationships with various private payers that work with the industry in order to influence future reimbursement decisions. Those payers include Anthem, TRICARE, the Defense Health Agency, AIM Sleep Management, and Carecentrix.
At the state level, AAHomecare worked with regional associations to protect reimbursement in several states that were aligning with Medicare reimbursement rates. These efforts included working with NEMEP to freeze New York Medicaid Incontinence Program rates until further notice, and work with the Big Sky Association of Medical Equipment Suppliers to evaluate strategy and create a white paper for presentation to BCBS Montana regarding reimbursement cuts to the 2017 fee schedule. Another example includes teaming up with the Maryland-National Capital Homecare Association to develop a response to DC Medicaid cuts that the association says should result in changes there.
