AAHomecare, ACMESA Protect N.C. Medicaid MCO Rates

The rate protections shore up legislative protections and will prevent an estimated $22 million in potential cuts to Medicaid MCO reimbursement for HME in North Carolina on an annual basis.

• By David Kopf
• Jul 08, 2021

North Carolina Gov. Roy Cooper has signed into law recently passed legislation that protects the state’s Medicaid managed care organization rate floor and extends those protections for five years.

S594 contains legislative language from the American Association for Homecare and the Atlantic Coast Medical Equipment Services Association (ACMESA) that protects legislative wins North Carolina HME stakeholders made roughly a year ago.

In July 2020, Cooper signed SB 808 into law, which ensures that MCOs cannot set rates for Medicaid beneficiaries below the state’s Medicaid fee for service rates for DME. The provision was slated to remain in place for at least the first three years of the state’s new Medicaid managed care program, which was slated for a July 1, 2021 implementation.

However, AAHomecare reports it and ACMESA learned state Medicaid officials were working on new legislation to help implement S808 without realizing that their new language would nullify the DME rate protections..

To rectify that, S594 protects those rate floor provisions and extends them for an additional two years, for a total of five years starting July 1.

The rate protections will prevent an estimated $22 million in potential cuts to Medicaid reimbursement for HME in North Carolina on an annual basis, according to an AAHomecare statement.

“Our previous work with state Medicaid officials earned us a lot of trust with them,” said Laura Williard, AAHomecare’s vice president for payer relations. “We helped North Carolina avoid $15 million in paybacks to the Federal government in the first year on implementation of the CURES Act and prevented additional paybacks and cuts in subsequent years. Getting them to support our language was critical to the effort.”

“This was a team effort from start to finish,” Williard added. “ACMESA and North Carolina suppliers have built strong relationships and established credibility for HME with key members of the legislature, and this win is the direct result of both their sustained long-term advocacy efforts and their effective outreach in support of our legislative language.”

“Rep. Wayne Sasser, Chair of the Health Committee in the NC House, was instrumental in making sure our language was included in the final bill draft,” Williard added. “North Carolina HME suppliers and the patients they serve are fortunate to have him as an advocate for high-quality based care.