Current Priorities in the Area of Reimbursement

Some of HAH’s ongoing priorities in the area of reimbursement include:

1. Secure introduction of state legislation to appropriate funds to draw down available DSH 2011-2015

2. Improve Medicare payments for members

  • Streamline administrative processes for private payers to reduce patient receivables and administrative costs, and claims denials (simplify their pre-authorizations, business rules to lower administrative costs)
  • Work with national affiliate partners to maintain market basket updates
  • Support efforts of the Value Coalition to address geographic variation
  • Work with national affiliate partners to minimize the regulatory cost burden on providers as the ACA is implemented

3. Improve Medicaid payments for members

  • Secure introduction of legislation to address waitlist reimbursements and presumptive eligibility
  • Develop coalition and lobby state legislature for passage of bills
  • Work with DHS to expand the post-acute level payment system
  • Work with DHS and other key stakeholders to revise the level of care tool and link to the RUGS IV implementation
  • Develop cost data in the post-acute care arena following implementation of a sub-acute level payment system

4. Introduce legislation to ensure the financial viability of state DME providers

5. Explore DSH-like funding for post-acute members

  • Determine required reporting necessary
  • Inquire state/federal willingness to pursue

6. Recoup Medicaid managed care payments that have been unpaid for more than one year

  • Determine outstanding payments
  • Develop continued forum to dialogue with existing plans to resolve issues
  • Develop regular status reports
  • Involve necessary state stakeholders in discussion
  • Engage ACS and garner political support for recoupment effort

7. Mitigate impact of COFA migrants

  • Determine impact costs – work with state to gain accurate figure/ identify patients
  • Support Medicaid programs that offer optimal coverage
  • Support efforts to work with Congressional delegation and federal agencies

8. Develop reasonable RAC audit guidelines with our national affiliates to mitigate the administrative burden to facilities

  • Support efforts to work with Congressional delegation and federal agencies

9. Protect and improve the Medicaid Program

  • Explore methods for Medicaid reimbursement for telehealth
  • Work with members to increase Medicaid EHR Meaningful Use utilization
  • Work with state legislative and regulatory agencies to expand the Medicaid program
  • Fight cuts to the Medicaid program
  • Support members as Medicaid audits are implemented