HHSC held a rate hearing for multiple items. See below for links to the rate packets under discussion.
- Proposed Medicaid Payment Rates for Third Quarter 2014 Healthcare Common Procedure Coding System Updates;
- Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Review;
- Proposed Medicaid Payment Rates for Gynecological and Reproductive Health Services ;
- Proposed Medicaid Payment Rates for Prognostic Breast and Gynecological Cancer Studies;
Please click on the hyperlinks above to access the rate packets and see below for public testimony given.
Catie Oosterdam, Travis Medical
- E0240TG: Bath/Shower Chair, Complex/High Level
- When the current rate of $1,935.82 was selected, it completely eliminated tilt-in-space shower chairs as an option for Medicaid beneficiaries. The industry standard tilt-in-space shower chair is the ActiveAid, model 283, with lateral supports, head support, and adjustable angle footplates. With the common accessories, it has an MSRP of $3,615. To be able to provide tilt-inspace shower chairs, the current rate requires an increase.
- E0637: Combination Sit-to-Stand System
- The industry standard for this item is the EasyStand Evolv. When adding the included accessories, the MSRP is $4,316. The current allowable, after discount is $3,271.83, limiting the medically necessary options we can provide our patients. By removing the additional discount and restoring the rate to the previously set amount of $3,556.34, we will be able to resume providing the necessary accessories.
- E0110: Forearm Crutches
- Forearm crutches are size specific, and some of the sizes cannot be provided within the allowable, creating an access to care issue for parts of the population that require these items. There is only one manufacturer of pediatric sized forearm crutches. This manufacturer has a retail price of $104 for the forearm crutches. We cannot provide these for a rate of $54.34, which is below our acquisition cost. The allowable should be considered for an increase.
- E0140: Walker with Trunk support
- Walker with trunk support is the commonly accepted code for Posture Control walkers. The large sized posture control walkers have a retail price of $436.05. With the proposed rate, we will not be able to provide the large or even adolescent sized posture control walkers. Please, maintain the current allowable.
- E0328: Hospital Bed, Pediatric, Manual
- The industry standard pediatric hospital bed is the SleepSafer Manual Articulating Bed, which has an MSRP of $8,301. The current allowable is set at $5,059.53, with a proposed increase to $5,559.53. Unless this rate is raised even higher, we are unable to provide this product at this allowable, creating an access to care issue.
- The inability to receive wheelchair repairs will cause further damage, and will ultimately result in untimely replacement of equipment. Wheelchair parts are currently facing reductions ranging from 16-71%. These reductions will result in providers unable to repair necessary equipment, creating an access to care issue for Medicaid beneficiaries.
Sean Wheeler
- Increase price of Texas reimbursement to $2,742 – 80% of Medicare rate – regarding prognostic breast and gynecological cancer studies
- Suggested reimbursement of $2,200 is too low for services
Christie Tidwell. Health Line Medical Equipment
- Patient lift, humidifier, heavy duty walkers and basic walkers should be paid for through reimbursement increases
- Oppose E0562 – reductions would cut down quality of care and products available for patients
- Maintain or increase funding for patient services
Alexis Ward, New Motion
- Decreased reimbursements and increased costs have led to a reduced number of providers – companies are now facing pressure to consolidate or sell out
- Opposed to suggested reductions and in favor of increased reimbursements – decreased reimbursements will create access to care issues and provide unsuitable products to patients
Toby Brown, Southwestern Medical
- Reimbursement codes are terrible – completely oppose rates
- Wheelchairs need two batteries even though HHSC pays for one and does not replace another when dead
- 10% decrease in funding for sling replacements is unacceptable
- E2601, E2621, E2622, E2623, E2624, E2625 should be addressed and reevaluated
Rodney Gray, Wave Healthcare
- E0445 – there are no level I pulse oximeters available to provide ‘continuous’ service mentioned in rules; use of ‘continuous’ wording should be removed
Preston Gage, Travis Medical
- Entering the pediatric industry has become extremely difficult and expensive in recent years
- Dealers now go through accreditation, more credentialing, bonding, increased insurance coverage, and now have come through the new re‐enrollment process which is very long and complex and the expenses for all these criteria continue to rise
- Only 15% of these providers have completed the re‐enrollment process
- Manual wheelchair tires‐ E2213‐E2226, power wheelchair tires E2388‐ E2395 are receiving cuts of about 16% and up to 71%. Additionally, power wheelchair motors are receiving a 23% reduction‐ typically, power wheelchairs must replace both motors at the same time to prevent damage to the remaining motor, doubling the impact of this reduction
- Reductions will result in providers unable to repair necessary equipment, creating an access to care issue for Medicaid beneficiaries – maintain or increase the current rates for these items