We are a collection of health care practitioners who are concerned about the funding available for necessary programs that affect children in Texas. Below is information about the hearing:

TEXAS HEALTH AND HUMAN SERVICES COMMISSION

RATE ANALYSIS DEPARTMENT

Proposed Payment Rates for Medicaid Calendar Fee Review of Therapy Services Provided by Home Health Agencies and Nursing Facilities

Payment rates are proposed to be effective January 1, 2012.

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SUMMARY OF PROPOSED MEDICAID PAYMENT RATES Effective January 1, 2012

Included in this document is information relating to the proposed payment rates for Medicaid Calendar Fee Review of Therapy Services Provided by Home Health Agencies and Nursing Facilities. The rates are proposed to be effective January 1,
2012.

Hearing

HHSC will conduct a public hearing to receive comments regarding the proposed Medicaid rates detailed in this document on November 21, 2011, at 9:00 a.m. in the Public Hearing Room of the Winters Building, located at 701 West 51st Street, Austin, Texas. This public hearing is held in compliance with the provisions of Human Resources Code §32.0282 and 1 TAC §355.105(g), which require a public hearing on proposed payment rates. Should you have any questions regarding the information in this document, please contact:
Dan Huggins, Director Acute Care Rate Analysis Texas Health and Human Services Commission (512) 491-1432; FAX: (512) 491-1998
E-mail: Dan.Huggins@hhsc.state.tx.us

Background

The Health and Human Services Commission (HHSC) is responsible for the reimbursement determination functions for the Texas Medicaid Program. Proposed rates are calculated utilizing established methodologies that conform to the Social Security Act and related federal regulations, the federally approved Texas Medicaid State Plan, all applicable state statutes and rules, and other requirements. HHSC reviews the Medicaid reimbursement rates for all acute care services every two years. These biennial reviews result in rates that are increased, decreased, or remain the same. The reviews are unrelated to any rate reduction imposed by the legislature but rather conducted to ensure that rates continue to be based on established rate methodologies.

Methodology

The specific administrative rules that govern the establishment of the fees in this proposal include these rules in Title 1 of the Texas Administrative Code (1 TAC):

• §355.313, which addresses reimbursement for rehabilitative and specialized services for nursing facilities;

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• §355.8021, which addresses the reimbursement methodology for durable medical equipment and expendable supplies in home health services;

• §355.8081, which addresses payments for laboratory and x-ray services, radiation therapy, physical therapists' services, physician services, podiatry services, chiropractic services, optometric services, ambulance services, dentists' services, psychologists' services, licensed psychological associates' services, maternity clinic services, and tuberculosis clinic services;

• §355.8085, which addresses the reimbursement methodology for physicians and other medical professionals, including medical services, surgery, assistant surgery, and physician administered drugs/biologicals; medical services, surgery, assistant surgery, radiology, laboratory, and radiation therapy; and

• §355.8441, which addresses the reimbursement methodology for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program (known in Texas as Texas Health Steps).

The reimbursement rates proposed have been adjusted to reflect applicable reductions directed by State leadership and the 2012-2013 General Appropriations Act, H.B. 1,
82nd Legislature, Regular Session. Detailed information related to specifics of these reductions can be found on the Medicaid fee schedules.

Proposed Rates

The proposed rates have been compared to Medicare rates as well as rates paid by other state Medicaid programs and other payers. The proposed rates are based on Medicare rates and are supported by other states’ Medicaid therapy rates. The methodology used to determine the proposed fee-for-service Medicaid rates are summarized below:

• Procedure codes and descriptions used in the Texas Medicaid Program are national standard code sets as required by federal laws; Healthcare Common Procedural Coding System (HCPCS) and Current Procedural Terminology (CPT).

• The proposed rates for therapy services provided by a nursing facility are based on the median salary in Texas for a physical, occupational, or speech therapist. The proposed rates for therapy services contracted by a nursing facility are based on the median salary for a physical, occupational, or speech therapist multiplied by a factor of 1.2 to account for additional administrative costs.

• The proposed rates for Home Health Agency therapy services are based on the current Medicare Physician fee minus the applicable percentage reduction effective September 1, 2011 (2 percent for services in the home). Procedure codes that are

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defined as per 15 minutes in the CPT description are also priced as such instead of at a statewide visit rate and will also be reduced by the applicable percentage reduction effective September 1, 2011 (2 percent for services in the home).

• The Medicare Low Utilization Payment Adjustment (LUPA) rate was not used as a basis for pricing because it was built exclusively for home health services delivered at four visits or less to only clients who are homebound. Medicaid Home Health therapy services are not limited to four visits nor are the clients required to be homebound so the population used as a basis for the Medicare LUPA rates is not comparable to the Medicaid population currently receiving therapy services in the home.

 

 

This is a link to the hearing notice.

If you cannot attend the hearing, you can still help! Please use this form to send an e-mail to the Texas Health and Human Services Commission

You may enter in your own message or use the one which is provided:

I fully disagree with the proposed rate change for health care services provided by home health agencies and nursing facilities. This rate change would deny healthcare services to thousands of children who desperately need them. I believe that although public funds need to be allocated properly, children who are found to be medically necessary of care should not be the ones to suffer. Please take my opinion into account when deciding.
My name is: (please put full name)
My e-mail is: (optional - You will not be added to any type of spam list, but helps to verify your identity.)

Thank you for your support.