Highmark Health Options reverses earlier decision, will fully reimburse, backpay nurses

Highmark Health Options, the company responsible for a large portion of Medicaid recipients in Delaware, has reversed its earlier decision to decrease reimbursement for nurse practitioners in the First State while still fully reimbursing physicians for the same services, Rep. Melissa Minor-Brown said Thursday.

Advanced practice registered nurses will be retroactively reimbursed for all services provided in 2023, which were previously reimbursed by Highmark Health at only 85% of the regular rate. The state’s Division of Medicaid and Medical Assistance was alerted of the decision Thursday, and Minor-Brown said official letters will be going out to all advanced practice registered nurses Friday.

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House Majority Whip Melissa Minor-Brown

House Majority Whip Melissa Minor-Brown

Minor-Brown, a Democrat from New Castle who is also a registered nurse, was part of a statewide push to get Highmark Health to give advanced practice registered nurses their full reimbursement. Nurses initially noticed a decrease in rates earlier this year and struggled to get the insurance company to explain why.

Highmark Health, in an emailed statement, had defended the change, noting that the new reimbursement rate for advanced practice registered nurses was “commensurate with required training, experience, and areas of responsibility relative to that required by physician licensing.”

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The company did not immediately respond to requests for comment on the reversal of its earlier decision.

“There is power in numbers and the collective voice of nurses,” Delaware Nurses Association Executive Director Christopher Otto wrote in an email, punctuating the statement with three exclamation points.

The executive director of the Delaware Board of Nursing also sent out a congratulatory email.

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Brad Why is a psychiatric nurse practitioner at Bancroft Behavioral Health

Brad Why is a psychiatric nurse practitioner at Bancroft Behavioral Health

Brad Why, a psychiatric nurse practitioner who operates his private practice Bancroft Behavioral Health in Milltown, was one of the leaders of the charge to get Highmark to explain the previous change in reimbursement rates and get the decision reversed.

When he heard the news Thursday morning that he’d succeeded, he was overjoyed.

Still, he acknowledged that the reversal could be temporary, and Highmark Health Options could later revert to the reimbursement rates that left nurse practitioners scrambling to provide necessary care to patients statewide.

“But if they do,” he said, “we’ll be ready for it.”

This article originally appeared on the Delaware News Journal: Highmark Health will return to fully reimbursing Delaware nurses