For over 19 years, GIRS has tracked payer trends to develop and implement market access strategies for our clients’ Products. Specifically for Medicaid expansion and transformation, we have tracked trends in Oklahoma, Missouri, North Carolina, and Nebraska in the past.
Recently, a provider and sales representative contacted GIRS for assistance to prevent a20 percent reduction of the billing code for the client Product in the 2022 DME fee schedule for Medicaid patients under age 21 by a Medicaid Managed Care Organization (MCO) in Arkansas for the billing code of their Product.
The GIRS Payer Advocacy Compass® (PAC) team reviewed the payer’s fee schedule and also the Medicaid managed care trends in the state to understand the proposed drop in fees. The legislation Senate Bill 410, “Arkansas Health and Opportunity for Me” was found and reviewed. Senate Bill 410, the proposed “Arkansas Health and Opportunity for Me Act,” represents the second initiative for the state’s Medicaid expansion during the administration of Gov. Asa Hutchinson. As of May 9th, the legislation has passed in the Senate and is being considered by the House before being ratified into law.
The bill aims to replace the existing work requirement with a system that incentivizes work through access to government-funded private health insurance. Through a new waiver from the federal government, the Arkansas Department of Human Services will be able purchase qualified health plans from private insurers for residents of Arkansas who are eligible for the Medicaid expansion program. Eligibility is now set at 138% of the federal poverty level, which is $17,774 for an adult or $36,570 for a family of four.
If the bill passes, providers will obtain higher reimbursement from these private plans compared to the traditional Medicaid’s fee-for-service model.
Enrollees would remain qualified for the Medicaid managed care private health plans only if they met certain criteria. Those who do not qualify would be included in the traditional Medicaid fee-for-service model.
GIRS followed up with the payer to implement strategies to proactively prevent the drop in the fee change for our client’s Product in Arkansas. The payer was also asked if the potential Medicaid expansion in the state would impact the fees for the client’s code. This work with the payer continues now until a solution is obtained.
Have you developed strategies to access an expanded Medicaid Managed Care payer market in Arkansas should the bill pass? Are you tracking these Medicaid Managed Care expansion initiatives in your key payer markets? For more details on payment trends in Arkansas or other payer market reimbursement trends upcoming in 2021 and 2022, contact the GIRS PAC team for a consultation.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources
- Senate passes SB410 — formerly known as Arkansas Works (nwahomepage.com)
- Bill on Medicaid-expansion overhaul unveiled (arkansasonline.com)
About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.