“We fear the proposed reductions will severely limit access to medically necessary services for the most vulnerable in our state,” says the letter, which was signed by Democratic representatives from Austin and colleagues across the state. “While short-term cost containment may be possible using this methodology, the longer term cost to our state and to those most in need is potentially catastrophic.”
Home health agencies, among the groups providing the services, expect to see an average reduction of 18 to 20 percent in revenues for acute therapy services, while providers who offer only speech therapy would see far greater cuts, said Bill Noble, a spokesman for the Texas Association of Home Care & Hospice.
The cuts being proposed by the Health and Human Services Commission are based on data from a study the Legislature commissioned two years ago from Texas A&M Health Science Center researchers, he said. The commission concluded that the rates being paid were too high, Noble said, adding that he disputes that.
The researchers compared payment rates and caseloads in Texas among regions and also to therapy programs in other states. They also looked at payments to providers in commercial programs, but they didn’t draw conclusions about the data, said Jenny Jones, vice president for governmental and public affairs at the health science center.
The Health and Human Services Commission is proposing various cuts, which it says still will provider higher-than-commercial plan payments to therapists. For example, home health agencies are paid $135.14 for an hourlong visit, which is nearly double the average that Texas commercial plans paid in 2013, or $68.24, said commission spokesman Enrique Marquez. His agency wants to reduce that to $98.95.
Did the researchers think the therapists were overpaid in Texas?
“I don’t know that you can make that conclusion,” Jones said. “There were hundreds of tables of data provided. That’s HHSC’s interpretation.”
Jones said she doesn’t understand the processes the Health and Human Services Commission used to reach that conclusion and believes there are questions that still need to be answered.
“If someone would answer why the spike and why some of the regional variations (in clients and rates) we’d be closer to a solution,” she said.
In the upcoming two-year budget cycle, lawmakers reduced state funding for the therapy services by $150 million. When a federal match is added in, the total loss is $350 million over the 2016-17 biennium, Noble said.
“It’s a huge reduction in reimbursements,” he said.
Noble said the Health and Human Services Commission is relying on data that shows an anomaly it hasn’t explained: a 53 percent increase in patients served in a single year, between 2011 and 2012. The number of patients rose from 285,192 to 435,386, while costs shot up from $378.7 million to $665.6 million, he said. Over the next three years, those numbers remained relatively flat.
“The state has never investigated what is driving that, so they can’t explain it,” said Noble.
Marquez disputed Noble’s data. Marquez provided numbers Tuesday that didn’t show a huge spike between 2011 and 2012, but they did show big increases over five years.
Between 2009 and 2014, Medicaid therapy payments rose from $436.1 million to $722.4 million, while the number of patients climbed from 170,128 to 242,364, that data show.
State Rep. John Zerwas, a physician and Republican from Simonton, said in a separate letter to Traylor on July 15, that while he supports cost containment and voted for the budget, he is worried about the fate of Texas’ most vulnerable residents.
The reduced Medicaid rates “could lead to the inability of our state to maintain an adequate network of these providers,” Zerwas wrote. “Additionally, thousands of Texans, providers, and small and large businesses, all of whom will be impacted by these decisions, were unable to offer public testimony on the budget provision. It is important that your agency, through its rate setting process, takes into account their perspectives.”
©2015 Austin American-Statesman, Texas, Distributed by Tribune Content Agency, LLC.