title: North Carolina Association challenges the state Medicaid agency and wins!
abstract: After Judge Beecher Gray ordered parties to attempt to settle before re-appearing on September 29, AHHC Executive Vice-President Tim Rogers and staff met with DMA officials as well as members of the General Assembly and Governor's office. Using a comprehensive approach, AHHC launched an immediate political and press campaign to help convince DMA in addition to its legal actions. Articles and testimony from affected PDN patients and their parents began appearing in North Carolina newspapers, and ultimately the state was persuaded to settle this issue out of court. At press time, DMA has finally instructed the state Attorney General to proceed with legal settlement papers that will in essence support all the issues AHHC was fighting for. North Carolina will maintain the current (higher) PDN reimbursement rate; will NOT recoup any funds from providers: and will file a state plan amendment and repay CMS the federal share. Due to AHHC's action, North Carolina providers have been spared nearly $4 million in recoupments and potential agency closure and shut-down of the PDN program ... which serves only 380 North Carolina residents. After nearly two years of having to react and advocate for its members, the North Carolina association can now rejoice in the fact that "you can fight city hall..." and win! Rogers reports "the North Carolina association has entered into a new era of stature and respect and advocacy on behalf of its record 570 agency members. This was truly a team effort and stands as a great legacy for AHHC." AHHC now enjoys a much improved, collaborative relationship with the North Carolina Department of Health and Human Services and DMA. AHHC has entered into a whole new era of cooperation and dialogue with the new Medicaid administration in North Carolina. DMA has been tremendously supportive and has expressed renewed interest in learning more about the state's growing home care and hospice industry. AHHC has a staff of five and a contract staff of three. Rogers rejoined the AHHC staff in 2001 after seven years in private home health and hospice employment. He states, "It was my dream to ultimately rejoin AHHC as its EVP and staff, like long-time AHHC regulatory expert Sherry Thomas. That dream materialized in 2001, and I must say--it's so good to be back HOME. "The last two years have been memorable for our great association, its staff, and its board of directors. But two special people who helped maintained our very existence during these lawsuits were attorney Renée Montgomery and Judge Jack L. Cozort. I always knew that Renee and Jack were among the state's health care legal experts, but never did I dream that they would envelop such passion, devotion, and vigor during this process." At the 2003 AHHC Annual Meeting, AHHC formally recognized Montgomery, Cozort, and Thomas as its "Home Care and Hospice Heroes."
authors: Parker, Poe, Adams & Bernstein, LLP, Raleigh, North Carolina, USA. reneemontgomery@parkerpoe.com
authors: Renée J
authors: RJ
authors: Montgomery
authors: Timothy R
authors: TR
authors: Rogers
mesh_terms: D006699:Home Care Services / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D009657:North Carolina; D011637:Public Health Nursing / Q000191:economics* / Q000331:legislation & jurisprudence; D013221:State Health Plans / Q000331:legislation & jurisprudence*; D014481:United States