AUSTIN — The Texas Medicaid program, under pressure from lawmakers, is again proposing significant cuts in pay for therapists who treat more than a quarter-million disabled children and elderly Texans.
On Friday, the Texas Association for Home Care Hospice said the reimbursement reductions would have dire consequences, disrupting care for tens of thousands of vulnerable children, especially in rural parts of the state.
Pay cuts for certain services would be nearly 26 percent, said Rachel Hammon, the association’s executive director.
That’s more than home health therapy providers could absorb, Hammon said in a written statement. It decried a notice filed last week by the Health and Human Services Commission that said cuts would take effect July 15.
The notice said Texas pays therapists more than some other states’ Medicaid programs do. The commission runs Medicaid, the state-federal health insurance program for poor children, low-income pregnant women and elderly, and people with disabilities.
“HHSC’s proposal to make such deep cuts will result in thousands of medically fragile children and adults going without medically necessary therapy services,” said Hammon, who represents companies that hire speech, occupational and physical therapists and send them to Medicaid recipients’ homes.
For more than a year, she and spokesmen for an independent coalition of home health agencies have said the commission used flawed data in a study by Texas AM University to justify the proposed cuts. The study misconstrued data about commercial health insurers’ payment rates for therapy and ignored key differences in the billing codes of different states’ Medicaid programs, the home health industry asserted.
However, its attempts to persuade courts to halt the reimbursement cuts failed. In April, a state appeals court in Austin threw out several home-care companies’ lawsuit and cleared the way for the commission to proceed with the cuts.
On Friday, commission spokesman Enrique Marquez, asked if the move would cause loss of access for thousands of medically Texans, did not respond directly.
“The Legislature provided the framework to achieve appropriate rates while also maintaining access to care,” Marquez said in an email.
“The rate proposals are subject to [federal] approval, and HHSC will closely monitor the ability of clients to receive medically necessary services as the reimbursement rates are adjusted,” he said.
Marquez was referring to a budget provision passed last year called “Rider 50.” Over the current two-year budget cycle, it called for squeezing $350 million from Medicaid’s spending on outpatient therapy. Some of the savings were to come from policy changes designed to eliminate suspected overuse of therapy by some patients.
But two-thirds of the savings – about $233 million — are supposed to come from cutting therapists’ reimbursements.
Because the industry’s lawsuit held up the cuts, the commission expects to save only about $160 million from the rate cuts through September 2017, the end of the next federally fiscal year.
For federal fiscal year 2018, which would fall under the budget state lawmakers write next session, the rate cuts would save $135 million, the notice said.
Hammon, the trade group leader, stressed in her statement that Medicaid-paid acute care therapy services “help children with birth defects, genetic disorders, physical or cognitive disabilities and those born prematurely to function in daily life. For seniors and adults, the therapy may help in recovery from a broken hip or with progressive diseases such as Alzheimer’s or Parkinson’s.”
She noted that a doctor must prescribe the therapy, saying it’s necessary, before Medicaid will pay for it.