Superior HealthPlan is moving forward with rate reductions for Medicaid therapy as of today, July 15, 2016. In response, TAHC&H has released the following:
FOR IMMEDIATE RELEASE
CONTACT: Bill Noble (512) 296-4651 cell bnoble@noblestrategic.com
July 15, 2016
Contractor providing care to Texas foster
children and other Medicaid recipients
moves forward with cuts to therapy
Superior
HealthPlan claims care for kids will continue while parents and therapy
providers cry foul
Cuts are deeper in some areas of the state than
those proposed by Health and Human Services Commission that prompted lawmaker
and public outrage
Austin
– One of the largest managed care organizations (MCO) that Texas contracts with
to provide Medicaid services for disabled kids and impoverished seniors is
moving forward with cuts to the reimbursement rates therapists receive for
providing care.
Superior
HealthPlan, which serves 650,000 kids and seniors in STAR; nearly 60,000 in
STAR+PLUS; and more than 31,000 kids in foster care in Texas, first announced
the rate cuts to therapy providers in April.
The cuts to the reimbursement rates paid to therapist to provide
services for Superior’s patients was originally scheduled to go into effect
July 1, but Superior delayed implementation of the cuts to July 15. Some therapy providers have found Superior is
retroactively cutting rates for care already provided since July 1, 2016.
“Because
of these extreme cuts, therapy providers are now forced to decide if they
should put children currently receiving care on temporary or permanent hold,
stop accepting new referrals for kids, reduce the communities they serve or
cancel their contract with Superior,”
said Rachel Hammon, executive director of the Texas Association for Home Care
& Hospice (TAHC&H) whose members provide therapy services. “These rates
are deep and unsustainable and will result in longer waiting lists for kids in
need of immediate care or the complete abandonment of care for kids with urgent
health needs. The end result: taxpayers will pay more for urgent care and
institutionalization of kids that could not get the vital care they needed.”
Superior’s
move comes following cuts made last year by the Texas Health and Human Services
Commission (HHSC), which oversees Medicaid, in the amount of
money given to MCOs to provide Medicaid services: The HHSC decides on the
amount of money that is paid to managed care organizations (MCO) for each
patient they will serve on behalf of the State of Texas. The HHSC also planned
cuts to “fee-for-service” Medicaid reimbursements paid directly to therapy
providers that were scheduled to take effect July 15 until the Supreme Court of
Texas temporarily put the cut on hold July 8.
TAHC&H
is not alone in expressing their concerns: Republican and Democratic lawmakers
made specific mention of their concerns with Superior’s move and HHSC still has
not responded to their concerns:
(HHSC should) “ensure that there are specific, measurable
and public standards by which the HHSC
evaluates adequate
Medicaid beneficiary access to therapy services both in fee for service and managed care, particularly in rural areas of the state,” wrote 14 Republican lawmakers late last month
in a letter to HHSC’s Executive Commissioner Charles Smith. “(HHSC should also)
“review cost analyses performed by
contracted Medicaid managed care organizations used to
justify rate reductions to
therapy providers
for actuarial soundness…” the letter added.
TAHC&H
reviewed Superior’s new rates and found specific services most often used by
disabled children and seniors experienced reductions ranging from 10 to a
shocking 60 percent from the current rates paid to provide service.
“Several
home care therapy providers have announced the unfortunate need to layoff
therapists and reduce or discontinue offering therapy services because they
can’t continue operations at these new rate levels,” said Hammon. “We believe the rate reductions should be
stopped until a review is conducted of the impact the cuts will have on access
to care.”