HHSC had earlier last year (6/2014) requisitioned a study from a Texas A&M study group to review and make recommendations on how therapy codes are reimbursed under the Medicaid program from other states in the nation. See http://www.hhsc.state.tx.us/news/presentations/2014/HAC-Cost-Containment.pdf,, slide 16. We are trying to obtain that study (when completed) under the Texas Open Records Act.
The bottom line with this request was to find if Texas was reimbursing Medicaid therapy-based codes at a disproportionate rate compared to other states’ Medicaid fee schedules. SynerImages had invited OPIRA to present findings of their independent study on Medicaid fee reimbursement schedules used in the other larger states, such as California, New York, and Florida at our 10th Annual Rehab Facility Conference in San Marcos last year. In that small, non-scientific survey it was found that indirect reimbursements were being made through states’ education budgets and not through their Medicaid budgets, (i.e., school-based therapy for Medicaid-aged children). Moreover, the cost of professional therapists was more expensive in these other states than in Texas. Hence, a direct comparison between these states’ Medicaid fee schedules cannot be done without first compensating for education and other alternate budget layouts and the respective economies of the states.
SynerImages, in conjunction with Quantum Decision Research, LLC, is gathering all of the states’ direct Medicaid fee schedules, along with all their respective delivery model options for Medicaid therapy services (including education-based budget reimbursements and other alternative Medicaid plans) so that one may harmonize all therapy reimbursement schedules into one comparison algorithm.
This is being done in advance of the receipt of the Texas A&M study to be delivered to HHSC and to Texas legislators during this very important legislative session. The potential from the study is for new directives to be given to adjust therapy reimbursements this year. While there are some direct conflicts of interest involved in this study (political associations between the former and current governors and other majority party leaders in the Legislation and the school), the need for an independent and comprehensive alternative study is apparent. We will be posting the results of our study in the next few months, while the current legislative session progresses and how, if anything, the Texas A&M study is utilized in discussions.