HHSC to Cut Dual Eligible Payments

The Texas Health and Human Services Commission (HHSC) plans to eliminate coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid, known as dual eligibles. The change is outlined in new rules [PDF] HSC will publish in the October Texas Register and is scheduled to adopt in January in response to the legislature's orders to cut costs.

The proposed changes limit payments for Medicare Part B services to dual eligibles to no more than the Medicaid payment amount for the same service, except for renal dialysis services. It also applies to services provided through Medicare Advantage plans or Medicare Part C. The state already does not pay coinsurance/deductibles on Part A services.

The Legislative Budget Board estimates eliminating the payments will save $296 million over the next two years. 

TMA opposed eliminating the change in the last legislative session. 


Action, Sept. 16, 2011


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