Texas Medicaid Reform or Destruction – The Politics of Texas Healthcare

The last four years have seen an unprecedented attack unraveled on Texas and national therapists (SLPs, OTRs, and PTs) by state’s Medicaid programs. Political pressures have been put on state legislatures to dramatically reduce Medicaid reimbursements to providers. This is no more obvious than what is happening in Texas today. The General Appropriations Act and Omnibus Budget bills (HB 1/SB 1) that were passed by the Texas Legislature during the 2015-2016 biennial session included a provision (Rider 50) that specifically targeted therapy to the tune of over 300 million dollars in state and federal reductions. This legislative initiative and the unbridled and unprecedented political influence brought upon the Texas healthcare agency TxHHSC, by the Texas Lieutenant Governor and Chairwomen of the Senate Finance Committee, triggered a proposal from the TxHHSC, to dramatically reduce reimbursements to Texas therapists in all delivery models – up to a 28% reduction to the most used and common speech treatment code, a 25% reduction to all evaluations, and a 3.5% reduction to all of the most used and common PT/OT treatment codes. Mind you, this huge push brought on and unapologetically held by the majority political party in Texas was entirely based on their narrow perception of massive Medicaid fraud and overpaid therapists in Texas – neither of which have been proven by a peer-reviewed scientific study or general professional consensus. The industry pushed back in 2015 and several therapy home health agencies and Medicaid patients filed a lawsuit against TxHHSC, an injunction against implementing those cuts.

Additionally, and simultaneous to this, Texas-contracted managed Medicaid payors instigated a massive contract discount rate cut to all therapists and implemented TxHHSC-mandated and overly stringent authorization-to-treat policy updates, heavily influenced by the legislation passed and the TxHHSC being held back by the injunction and reducing capitated rate payments to contracted managed Medicaid payors. The discount cuts in Superior’s case (the largest of such contracted Medicaid payors in Texas) were to reduce reimbursements to therapists to as low as 50% of the prevailing Medicaid (PMR) rates, but no higher than 75% of PMR for office visits and 70% of PMR for home visits. Other Texas-contracted managed Medicaid payors are planning to follow suit in early 2017 and have applied their own version of stringent authorization-to-treat policies to curtail increases in therapy services.

The result of these tactics has been to produce an operational holocaust to the therapy industry and Medicaid children in Texas. The injunction was eventually lifted by a partisan Texas 3rd Court of Appeals in July 2016 and an even more partisan Texas Supreme Court refused to even hear a review of the case in September 2016. Nonetheless, the managed Medicaid payors have not planned on adjusting their discount rate cuts. The proposed compounded effect of PMR and discount rate reductions and authorization-to-treat policy tightening will be devastating to access to therapy services in Texas. Even the politicians that voted for such a monstrosity of a piece of legislation are agreeing on this despite the overwhelming vote to pass such a mandate two years ago – the vote for was 30-1 Senate (Sylvia R. Garcia – Houston, the only descending Senate vote) and 115-33 House (actually it was 114-34 after a correction).

The only remaining firewall to this madness is the federal CMS. Nonetheless, CMS can only intervene after such cuts go into effect and manifest themselves as access to therapy services (access to care) problems for the most vulnerable children in Texas. However, there are future firewalls to such partisan acts against therapy and Medicaid children. This is the coveted right of the vote. Come November 8, 2016, you have the choice to vote for those that have shown or are willing to show courage to protect the children of Texas and keep therapy in Texas a striving industry to protect those children.

Ask the candidates for their records on the Omnibus bill (HB 1/SB 1) that caused all of this and on their own stances on therapy as a legitimate means to help support and improve the lives of Medicaid children in Texas. See the voting links above to see how your State Senator and Representative voted. Verify how candidates voted on that bill and how they reacted publicly afterward and before. Additionally, of the unanimous nine (9) Republican judges on the Supreme Court that voted to NOT review the injunction and therefore lift it, three (3) are running for re-election. See the Texas Tribune article on the candidates running in those races and vote accordingly.