Texas Providers Protest Proposed Medicaid Cuts

At a July 12 Medicaid rate hearing in Austin, Texas, DME providers testified that additional Medicaid funding cuts would hurt beneficiaries who are among the most severely disabled and vulnerable in society.

An update of the meeting the next day from the Texas Alliance of Home Care Services (TAHCS) said more than 60 providers had shared their concerns that access to care and equipment would be impacted if the state's Medicaid program cut its funding any further.

The new round of funding cuts have a proposed implementation date of Sept. 1, 2011.

TAHCS President Barry Johnson said at the rate hearing, "We cannot continue to provide free value-added services such as retraining and follow-up, because the proposed cuts would make Medicaid business unsustainable."

Texas' Medicaid program is proposing across-the-board cuts of 6 to 26 percent for various categories of DME, in addition to other previous cuts that have taken place as recently as February.

The Health and Human Services Commission (HHSC), which held the rate meeting, also is proposing to eliminate funding entirely for code E0265 - the total electric hospital bed.

Meeting recap notes from members of the Texas Rehab Providers' Council (TXRPC), noted, "For almost two hours, testimonies were given with the goal of tabling or postponing until further review the proposed rate reductions. The data analysts who were taking testimony understood the information presented; however, they cannot overturn this current proposal, as it is a mandate from the Texas legislature."

The TXRPC report added, "The only way to get these rate cuts rescinded or reduced is to make some noise. There are HHSC staff members who can help achieve this goal if they are informed of the access-to-care issues that these reimbursement reductions will cause."

TXRPC's board is creating a position letter to oppose the planned funding cuts, and the organization urged providers, DME industry manufacturers and consumers to send HHSC staff members letters that discuss "how the lower rates would prevent Medicaid beneficiaries from receiving appropriate products represented by the codes being cut."

Johnson said TAHCS has been working with HHSC for months to help find cost savings, and a TAHCS report said the organization has "been a member of a special HHSC work group to review every code and develop cost savings to help balance the budget. The purpose of the work group was (to offer) alternatives to wholesale Medicaid cuts in DME fees."

TAHCS added, "Requirements for cuts started at $20 million, but escalated to over $57 million as the legislature continued in their special session."

A rate hearing report from HHSC noted that a one-percent Medicaid reimbursement reduction for DME went into effect Sept. 1, 2010, and an additional one-percent reduction became effective Feb. 1, 2011.

A look at the list of proposed reimbursement reductions arranged by HCPCS code shows funding for many DME products would be cut 6 percent if the changes go through. Examples of items marked for a 6-percent reduction include skin protection and skin protection and positioning wheelchair cushions (codes E2622, E2623, E2624, E2625) and Group 3 power chairs, standard, with sling/solid seat/back and a weight capacity up to 300 lbs. (code K0848).

But reimbursement for a Group 2 power wheelchair, standard, with captain's seat (K0823) is slated to be cut 10.5 percent, while funding for a Group 1 heavy-duty POV could be reduced 15 percent. A wheelchair with detachable arms (desk or full length) and swing-away footrests could be subject to a 20-percent funding cut.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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