Texas Providers Fend off Medicare Cuts

Organizing and lobbying from state and national stakeholders reversed significant planned cuts from Superior HealthPlan.

Medical equipment suppliers in Texas recently banded together to hold off reimbursement reductions proposed by a managed care company.

Texas' 85th Legislature requires that the state's Health and Human Services Commission (HHSC) reduce Medicaid spending by $830 million and suggests DME rate reviews as one possible avenue of cost savings.

Superior HealthPlan, which administers much of the state's Medicaid program, proposed in early February to lower reimbursement rates to as much as 60 percent of Texas Medicaid from 85 percent for some product categories. The letter offered providers 30 days to accept the rate reductions or lose their status as a participating provider with Superior.

Many providers, however, said they never received the notification and some providers, and alleged that the reimbursement rates were below market value, contrary to Superior's claim in its letter.

As a result, providers in the state began working with the Texas Medical Equipment Providers Association (TexMep), as well as other entities to push back. For instance, VGM Group Government Relations organized a provider conference call with providers who were prepared to voice their concern with Superior, Texas HHSC and their elected officials. 

Also, providers engaged legal counsel led by Brown & Fortunato to file a formal complaint with Texas HHSC that showed how the cuts were not reflective of the market, as Superior had contended in its initial notification.

“Providers stepped up and answered the call for action by engaging with public officials to display their opposition to these egregious cuts,” said Collin Brecher of VGM Government Relations. “Texas providers, huddling around the TexMEP state association as a unified front, proved to be an extremely effective strategy. While states are looking to trim their budgets, these proposed cuts are going to continue to appear, and providers in all states must remain proactive by building relationships at the state level to prevent these types of harmful cuts from being implemented.”

Following the complaint, Superior posted a notice on its website informing readers that it will not be changing its reimbursement structure for the time being after all.

"Superior HealthPlan is committed to providing cost effective, high quality services and products to our members," according to the notice. "Based on further evaluation of our recent proposed reimbursement restructuring for specific medical supplies for durable medical equipment (DME) providers, we are suspending the restructuring at this time. We will be working with the Texas Health and Human Services Commision (HHSC) to address DME costs as directed by the 85th Legislature in potentially a different type of provider based initiative at a later date."

“We are exceptionally pleased that Superior reconsidered their recent plan to cut reimbursement and force providers to accept rates below market value,” said Texas Medical Equipment Providers association in a released statement. “This was achieved thanks to many providers who reached out to their Superior representatives, attorneys, and HHS to voice their concerns. As an association, we plan to continue discussions with HHS relating to the value of DME and the issues we encounter as providers.”

About the Author

Joshua Bolkan is a freelance writer. He can be reached at jbolkan@gmail.com.


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