North Carolina rate protects DME

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Tuesday, July 7, 2020

RALEIGH, N.C. – North Carolina Gov. Roy Cooper on July 2 signed Bill 808, including a provision creating a rate floor for durable medical equipment.

The bill, a year in the making by groups like ACMESA and AAHomecare, prohibits managed care organizations from setting rates below the state’s Medicaid fee-for-service rates for DME.

“ACMESA's strong relationship with AAHomecare enabled us to learn from the problems experienced in other states as they rolled out their MCO programs,” said Craig Rae, ACMESA president. “We were then able to act proactively to secure legislation that will protect beneficiary access to home medical equipment. Hats off to our members that took the time to contact their elected officials, and to meet with them in Raleigh to discuss the importance and impact of this legislation.”

The provision will remain in place for at least the first three years of the state’s new Medicaid managed care program, which is set to start July 1, 2021.

The provision in the bill states specifically: “For the first three years of the initial standard benefit plan prepaid health plan capitated contracts required until Article 4 of Chapter 108D of the general statues, the rate floor for durable medical equipment under managed care shall be set at 100% of the Medicaid fee-for-service rates for durable medical equipment.”

ACMESA began working on this issue in 2019 to ensure providers were fairly reimbursed once the managed care program was launched. The group worked with a lobbyist to amplify its message in the state capitol.