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News & Press: Payment

HHSC Medicaid Rate Hearing

Monday, July 31, 2017  
Posted by: Lindsey Green
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The Texas Human and Health Services Commission (HHSC) conducted a public hearing to receive comments regarding the proposed adjustments to Medicaid rates on Wednesday, July 19th. Adjustments are proposed to be effective September 1, 2017.

 

The proposed changes include:

  • Lowering the reimbursement rate by 30% for services provided by PTAs. Fee-for-service reimbursement for services provided by therapy assistants and billed with the UB modifier will be set at 85% of the reimbursement for services provided by licensed therapists based on the salary differential between licensed therapists and therapy assistants beginning December 1, 2017 and an additional 15% for a total of 30% effective September 1, 2018.
  • Eliminating the encounter rate for home health agencies and changing to a reimbursement rate based on 15-minute increments. This change only updates the reimbursement structure for procedure codes that have a timed aspect that aligns with the AMA CPT procedure code definitions.
  • Lowering the reimbursement rates in outpatient facilities an average 12-13% and re-aligning reimbursement rates across provider types. The proposed rate changes will significantly decrease payment to ORFs, though independent therapists would slightly increase. Therapy services have been subjected to repeated and substantial cuts since 2012, an average of at least a 12% reduction.

Information about the rate hearing can be found here, 

http://legacy-hhsc.hhsc.state.tx.us/rad/rate-packets.shtml

 


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