September 10, 2015

Curious Baby Boy Studying Nursery RoomThis is a reminder that the Texas HHSC rate analysis department released a new proposed therapy rate reduction schedule this past Friday.

  • The new rates are scheduled to be implemented on 10/1/15.
  • The proposed rates would reduce reimbursement for Speech therapy services by 26-28% and PT & OT services by 3.5%.

Just like last time, a new rate hearing has been scheduled and is quickly approaching.

Hearing Details

  • The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on September 18, 2015, at 9:00 a.m., to receive comment on proposed Medicaid payment rates for Physical, Occupational, and Speech Therapy provided by Comprehensive Outpatient Rehabilitation Facilities/Outpatient Rehabilitation Facilities (CORF/ORF), Home Health Agencies (HHA), and Independent Therapists.
  • The public hearing will be held in the Public Hearing Room of the John H. Winters Building at 701 West 51st Street, Austin, Texas.

WE NEED THE SAME OR BETTER SHOWING at this hearing. Please come and testify.  It is important that we show HHSC and the legislature that we meant what we said the first time; this kind of proposal is not possible. They must sit down with stakeholders to come up with something different.

We (all Texas therapy providers including Epic) are continuing the same comprehensive approach we took the first time around.  I know it has been unrelenting; however, we encourage everyone to continue to stay strong and keep the message going! We are having an effect.

What We Must Do

  • Grass roots:  Please continue to call your legislators and let them know what this rate proposal, in addition to the proposed policy changes, will do to your agency’s ability to provide care. You can take action by going here:  Simply follow the instructions to call or email your legislators.
    • EMPOWERING INFORMATION: It is important to note that the Texas Speaker of the House (Joe Straus) and Lt. Governor (Dan Patrick) do not have to hold a special session to issue guidance or update a budget rider. HHSC must adhere to the overall budget numbers in the Appropriations legislation, but directives (riders) on program expenditures have a little more flexibility. Don’t let your legislative offices tell you that nothing can be done.
  • Please become involved and commit to going to the hearing:  We will have press there again and the opportunity for you and your families to speak directly to HHSC.  We know you are weary, but your voices do make a difference!
  • Repeat our message:
    • In response to the 84th Legislative Session budget bill passed in June, regulators at the Health and Human Services Commission (HHSC) are proposing to reduce rates to Medicaid therapy services. By October 1, 2015 they propose reducing $100 million in General Revenues ($233.5 million in All Funds) from Medicaid therapy spending, via rate cuts, for the FY2016-17 biennium. An additional $50 million in General Revenues savings ($116.7 million in All Funds) will be achieved through Medicaid policy changes such as coding or billing changes and medical necessity criteria over the course of the biennium.
    • Reductions of this magnitude will prohibit access to medically-necessary services.The Legislative Budget Board (LBB) should ensure that HHSC is compliant with Rider 50 by first assessing the impact of these reductions on access to care. Only after HHSC has proven a certain level of cost savings can be achieved while ALSO ensuring the state is compliant with Early Periodic Screening and Diagnostic (EPSDT), the Alberto N. settlement agreement, and access to care standards should they proceed with any rate cuts. The LBB can amend or issue further guidance on Rider 50 depending on the outcome of the analyses.
    • Examples of children who receive these services include those that have birth defects, genetic disorders. and/or physical or cognitive disabilities. Primary care physicians prescribe these medically-necessary services for the health and well-being of the child. These services are absolutely necessary and are designed to mitigate any further physical or cognitive delays that might impact that child in the future.

Thank you and please help us continue pressing forward in this fight!