A public rate hearing is scheduled for Tuesday, February 15, 2011, at 1:30pm in the Lone Star Conference Room, Braker Center Building H, 11209 Metric Blvd., Austin, Texas 78758 on the proposed Medicaid payment rates below. Links to the specific briefing packets describing the proposed payment rates are provided, or can be found by visiting http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets.shtml.
Medicaid Fee Reviews:
- Calendar Fee Reviews: Type of Service (TOS) 1 (Medical Services), 2 (Surgery), TOS I (Professional Component), and TOS T (Technical Component) which includes: complex cytometrograms, vestibular tests, rotational testing, heart catheterization, angiography, cardiac recording and pacing, electric physiologic evaluations, and evaluation of cardiovascular function with tilt table; Nonclinical Laboratory Services; Physician-Administered Drugs; Temporary National Procedure Codes (S Codes) which includes: opthamolocial exams including refraction, physical or manipulative therapy for maintenance, and nutritional counseling/dietitian visit); Clinical Laboratory Services (NonDSHS Providers); Clinical Laboratory Services (DSHS); and Access to Care Cardiology Review
http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets/04-2011-calendar-fee-review.pdf
- Incontinence Supplies—Home Health Policy
- Esophageal pH Probe Monitoring Services
- 2011 Annual Healthcare Common Procedure Coding System Update (*effective January 1, 2011)
(1) Type of Service (TOS) 1 (Physician-Administered Drugs),
(2) TOS 1 (Medical Services),
(3) TOS 2-8 (Surgery and Assistant Surgery),
(4) TOS 4-I-T (Radiology Services),
(5) TOS 5-I-T (Nonclinical Laboratory Services),
(6) TOS 9-J-L (Durable Medical Equipment),
(7) TOS 5 (Clinical Laboratory Services),
(8) TOS W (Dental Services) and,
(9) TOS F (Ambulatory Surgical Center Services)
http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets/01-2011-annual-hcpcs.pdf
http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets/01-2011-annual-hcpcs.zip
- Physician Evaluation and Management Services
- Vaccine Administration
http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets/04-2011-vaccine-administration.pdf
- Implantable Infusion Pump
http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets/04-2011-implantable-infusion-pump.pdf
- Certified Respiratory Care Practitioner Services
- Biofeedback Services
http://www.hhsc.state.tx.us/Medicaid/programs/rad/rate-packets/04-2011-biofeedback-services.pdf
- Substance Use Disorder- MAT for Methadone (*effective March 1, 2011)
Reimbursements paid to providers for the procedure codes included in these rate actions are to be reduced by two percent. A one percent reimbursement reduction was implemented for services provided on and after Sept. 1, 2010, in compliance with a plan approved in response to the Jan. 15, 2010, letter from the Governor, Lieutenant Governor, and Speaker regarding the revision to the Spending Reduction Plan for the 2010-2011 Biennium submitted by HHSC. An additional one percent reimbursement reduction, for a total of a two percent reduction, is being proposed to begin Feb. 1, 2011, in response to the Dec. 6, 2010, letter from the Governor, Lieutenant Governor, and Speaker.
The proposed Medicaid payment rates are proposed to be effective April 1, 2011 unless otherwise noted above.
