New Senate Bill Rider to Propose Medicaid Reductions in Therapy

Yesterday, March 24, 2015, the Texas Senate Finance Committee workgroups adopted suggestions for a Rider (Rider 51) to Article II of SB 2, the omnibus Senate budget bill for biannual 2016-2017, to target a $373M reduction in general funds to Medicaid in the form of a “cost containment”. Of that amount, it was to target acute therapy services for a $200M reduction (based on the 83rd Legislature mandate for the followup biannual). This is the first direct mention of therapy rate reductions and/or stronger authorization processes for therapy services.

The proposed language is included here, SFC_Article_II_3_24_2015_11_46_44_AM_FINAL on page 65. The $200M reduction over two years based on the past biannual 2013-2014 totals for Medicaid acute therapy claims ($1.387B) would dictate an approximately 14.42% decrease. A more accurate estimate would be based on the 2014-2015 biannual total claims paid. This action would indicate that this Senate finance committee, which includes the recently elected State Sen. Lois Kolkhorst, has put the overwhelming burden of this “cost containment” rider on therapy to the tune of 53.62% of the targeted reductions in the overall Medicaid cost containment portfolio.

So, the question that remains is “how will the HHSC hand out these reduction targets within the therapy delivery models and reimbursement processes?” Will the HHSC report on the A&M study be taken literally, without any checking of facts or collaboration with advocates, and used towards forming this reduction scheme? If that report is taken as gospel (and that would be a colossal mistake for the entire state), and the numbers from it are used accordingly, all (ST, PT, and OT) evaluation and PT/OT treatment codes would be targeted initially with some consideration to authorization procedures becoming ever more stringent (how would that be possible without endangering access to therapy care?).