Rural Texas Physician is a quarterly electronic newsletter catering to physicians in the many rural areas of Texas caring for patients and their communities. TMA’s grassroots membership is the strength of the association. For general inquiries or newsletter comments, email email@example.com.
Medicaid Managed Care Expansion and Simplification
The 2013 Texas Legislature adopted Senate Bill 7 by Sen. Jane Nelson (R-Flower Mound) directing the Texas Health and Human Services Commission (HHSC) to expand the Medicaid HMO model to new populations and services. The expansion will occur in phases over the next several years. In September 2014, HHSC will expand the STAR+PLUS HMO to rural counties not currently in a STAR+PLUS service area. It also will incorporate nursing facility services into the list of HMO-covered benefits. Adult patients with disabilities or who receive Medicaid home and community-based service must enroll in a STAR+PLUS plan. Children with disabilities may enroll voluntarily. In 2015, HHSC will implement a new HMO model, STAR KIDS, to provide services to children with disabilities.
Recognizing the hassles and disruptions caused by Medicaid HMOs, the legislature also directed HHSC to address physician, provider, and patient complaints regarding Medicaid HMO operations. SB 7 and Senate Bill 1150 by Sen. Juan “Chuy” Hinojosa (D-McAllen) require HHSC to reduce administrative hassles, ensure prompt payment of claims, and streamline paperwork and credentialing requirements. Other bills directed the Texas Department of Insurance to adopt standardized medical and prescription drug prior authorization forms for use by all health plans, including Medicaid HMOs.
HHSC surveyed physicians, providers, and consumers in December to seek input regarding policy or regulatory changes it should make to achieve HMO administrative simplification. TMA submitted these recommendations.
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Implementation of the Medicaid Primary Care Physician Payment Increase
After a year-long delay, HHSC announced in December it had received approval from the Centers for Medicare & Medicaid Services (CMS) to implement the primary care physician payment increase authorized by the Affordable Care Act. The health reform law grants a rate increase for certain primary care physicians and their services from Jan. 1, 2013, through Dec. 31, 2014. To receive the higher payments, physicians must self-attest that they practice in an eligible specialty and that either:
- They are board certified in family medicine, general internal medicine, pediatric medicine, or are a subspecialist within those designations as recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties, or
- Sixty percent of their Medicaid billings for the prior year were for eligible evaluation and management (E&M) services. Those eligible services are E&M codes 99201 through 99499 and services related to the administration of vaccines (90465, 90466, 90467, 90468, 90471, 90472, 90473, and 90474).
Eligible physicians must self-attest by completing the Texas Medicaid Attestation for ACA Primary Care Services Rate Increases form. The Texas Medicaid & Healthcare Partnership (TMHP) has compiled a list of primary care physicians who submitted an attestation form as of Oct. 16. Physicians who submitted a form but are not on the list or who have identified errors with their attestation should email TMHP at ACARateForm@tmhp.com.
The payment increase will occur in two phases. Beginning in January, Medicaid HMOs will begin making retrospective supplemental payments for eligible services rendered in the first quarter of 2013. Supplemental payments for fee-for-service claims will begin in April. Thereafter, payments will continue on a quarterly basis.
Retrospective payments will be issued to Jan. 1, 2013, for physicians who self-attest between Jan. 1, 2013, and April 1, 2014. Physicians who wait until after April 1, 2014, to self-attest will qualify only for supplemental payments back to the date their attestation form was received.
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Texas Medicaid Patient-Centered Medical Home Report
The 82nd legislature’s (2001) Senate Bill 7 requires HHSC to ensure that managed care organizations (MCOs) promote the development of patient-centered medical homes (PCMHs) for Medicaid clients and to provide payment incentives to physicians and providers that meet the requirements of a PCMH. This report covers HHSC’s work to ensure that Medicaid MCOs promote the development of PCMHs for Medicaid clients.
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Two Meaningful Use Deadlines Coming Up
Physicians participating in the Medicare electronic health record (EHR) meaningful use program have until Feb. 28, 2014 (precisely at 10:59 pm CT) to complete their attestations. Physicians participating in the Medicaid meaningful use program have until March 16.
TMA recommends that you DO NOT WAIT until the last minute to complete the attestation. Any glitch that prevents you from attesting by the deadline could compromise your 2013 payment.
CMS has created an interactive tool that helps physicians determine their eligibility to participate in various eHealth programs such as the:
- EHR incentive program,
- Value-based payment modifier program,
- Physician Quality Reporting System, and
- Maintenance of Certification Program Incentive.
The tool prompts you to answer a few basic questions to help you determine eligibility.
For more information about EHRs or other health information technology, contact TMA’s Health Information Technology Department at (800) 880-5720 or HIT@texmed.org.
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Preparing Your EHR for 2014
Physicians participating in the EHR incentive program must upgrade their EHR to the 2014 certified version prior to attesting in 2014. Check the certified Health IT Product List to see if your vendor has updated the product you use. If you do not see your EHR listed, you should ask your vendor about its timeline so that you can adequately prepare and perform testing before going live with the upgrade product.
Because of the EHR upgrade in 2014, participants of the EHR incentive program are allowed a 90-day reporting period. Unlike the any-90-day period of your first year of participation, the 2014 reporting periods are by the quarter of your choosing:
- Jan.1 to March 31,
- April 1 to June 30,
- July 1 to Sept. 30, or
- Oct. 1 to Dec. 31.
If 2014 is your first year to report on meaningful use, you will get any 90-day reporting period, not confined to calendar quarters.
Physicians needing assistance with the EHR incentive program may receive consulting help from one of four Texas regional extension centers (RECs). The RECs are qualified to help physicians navigate the complexities of the program. Check out TMA’s REC resource center to find out which REC serves your area.
For more information about EHRs or other health information technology, contact TMA’s HIT Department at (800) 880-5720 or HIT@texmed.org.
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Rural Health Open Door Forum
The Rural Health Open Door Forum, sponsored by CMS, addresses rural health clinic, community access hospital, and federally qualified health center issues, as well as some other clinical practice questions and concerns pertaining to other CMS payment systems that extend into these settings. For more information, visit the CMS website.
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Save These Dates!
- TexMed 2014: May 2-3, Ft. Worth
- 2014 TMA Fall Conference: Sept. 12-13, Austin