Rural Texas Physician

Spring 2014

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

STAR+PLUS Expands to Rural Areas

On Sept. 1, the STAR+PLUS Medicaid managed care program will expand to 164 rural counties not currently participating in the model. With this expansion, elderly patients eligible for Medicaid long-term services and supports (LTCSS) and adult patients with disabilities will be required to enroll in a STAR+PLUS plan. Children with disabilities can voluntary enroll.

For patients eligible for all Medicaid services, STAR+PLUS HMOs cover all traditional Medicaid visits, such as doctor visits, emergency care, and hospital services, as well long-term care services. For patients dually eligible for both Medicare and Medicaid, Medicare will continue to provide acute care services, while the STAR+PLUS HMO will provide LTCSS. 

Patients with intellectual and developmental disabilities, including those living in a Intermediate Care Facility or those who are eligible for certain long-term care services, also will be enrolled in STAR+PLUS l for their acute care services, such as doctor visits and hospital care. They may live in a community-based Intermediate Care Facility for Individuals with Intellectual Disabilities or Related Conditions (ICF-IID) or receive services through one of the following ICF-IID waiver programs:  

  • Home and Community-based Services (HCS),
  • Community Living Assistance and Support Services (CLASS),
  • Texas Home Living (TxHmL), or
  • Deaf Blind with Multiple Disabilities (DBMD).   

Nursing facility services were originally scheduled to transition to STAR+PLUS Sept. 1. The Texas Health and Human Services Commission (HHSC) has postponed moving nursing facility residents into STAR+PLUS Medicaid managed care until March 1, 2015. 

For more information, visit HHSC’s Medicaid Managed Care Initiatives page.  

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Physician Recommendation Key to HPV Vaccination

A letter from the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, Centers for Disease Control and Prevention, and other organizations urges physicians to recommend their patients get vaccinated against human papillomavirus (HPV).  

The letter highlights HPV-associated disease statistics, HPV vaccine safety and efficacy, and vaccine recommendation guidelines.  

The letter concludes, “As a health care provider, we urge you to improve the strength and consistency of your recommendation for HPV vaccination to your patients. Your recommendation is the No. 1 reason someone will get the HPV vaccine and be protected from HPV-associated cancers and disease.” 

For more on HPV vaccination, read “Breaking Down Barriers” in the April Texas Medicine.  

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Demonstration Project to Streamline Dual-Eligible Patient Care

In early 2015, Texas will test a new way to integrate care for Medicare-Medicaid dual-eligible patients by allowing some of the state’s Medicaid managed care plans to manage  patients’ Medicare services and coordinate care across both programs. Texas is among roughly 20 states to take advantage of the new initiative created by the Affordable Care Act (ACA).

In 2012, the Texas Health and Human Services Commission (HHSC) submitted a proposal to the Centers for Medicare & Medicaid Services (CMS) for a fully integrated, capitated approach that involves a three-party agreement among a managed care organization with an existing STAR+PLUS contract, the state, and CMS for the full array of Medicaid and Medicare services. 

The initiative will test a new payment and service delivery model to alleviate fragmentation and improve coordination of services for dual eligibles, enhance quality of care, and reduce costs for the state and federal government. The demonstration project is set to start in early 2015 and will continue through Dec. 31, 2017.

Unless patients proactively opt out of the demonstration project or choose their preferred Medicare Advantage plan, the state will automatically enroll them in one that matches their current STAR+PLUS Medicaid plan. 

Under the project, managed care organizations will receive a capitation payment from CMS for the Medicare portion of services and from HHSC for the Medicaid portion. The project will run in six counties — Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant — before going statewide. Approximately 133,000 patients will be affected by the pilot. For more information, visit the HHSC web site.

TMA supports the pilot’s goals to improve care and lower costs. Physicians want to ensure patient protection in the process. For more on the state’s 2012 expansion of Medicaid managed care, read “Roadblocks to Medicaid Managed Care” in the October 2013 Texas Medicine

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 More NHSC Funds in President Obama's Budget

President Obama’s 2015 budget, released March 4, requests $810 million for the National Health Service Corps (NHSC), a $505 million increase over the $305 million provided by the mandatory Affordable Care Act (ACA) NHSC Fund. The National Health Service Corps would receive more than $3.9 billion over the next six years to place 15,000 health professionals — an increase of 6,100 over current levels — in medically underserved areas throughout the nation.

It includes a plan to add $5.23 billion over 10 years to train 13,000 medical residents through a new competitive graduate medical education program that incentivizes high-quality physician training. The administration has requested a total of $77.1 billion to fund the U.S. Department of Health and Human Services (HHS) in 2015.

The budget also aims to improve and expand access to mental health services by allocating $50 million to train 5,000 new mental health professionals to serve students and young adults. 

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 Apply For Meaningful Use Exemption by July 1

 Physicians who are not participating in the Medicare electronic health record (EHR) incentive program, also known as meaningful use, will be penalized by Medicare beginning Jan. 1, 2015. To prevent the penalty, physicians must either attest to meaningful use by Oct. 1, 2014, or apply for a hardship exemption by July 1, 2014.

Physicians who meet the following criteria are automatically exempt from the program and do not need to file an exemption application

Specialties: If you’re classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as one of these five specialties, you don’t need to file an exemption and will be exempt for payment year 2015:   

  • Diagnostic radiology, 
  • Nuclear medicine, 
  • Interventional radiology, 
  • Anesthesiology, and 
  • Pathology.   

New to practice: If you are in your first year of practice, you do not need to claim an exemption. Based on Medicare data in PECOS, the Centers for Medicare & Medicaid Services (CMS) says it will know you are new to practice and will automatically exempt you. 

Hospital-Based: If you perform more than 90 percent of services using place of service codes 21 or 23 (hospital), then you will automatically be exempt from the Medicare penalty. 

Other exemptions are available, but you must take the time to fill out the 14-page application and submit it to CMS by July 1, 2014. If multiple physicians at one practice are applying, be sure to include the multiple NPI addendum

You can apply for a hardship exemption if your circumstances fall under one of the following categories:   

  • Infrastructure: You must demonstrate that your practice is in an area without sufficient Internet access to comply with meaningful use and that you face insurmountable barriers to obtain such connectivity. 
  • Unforeseen circumstances: This exemption can be claimed in the case of a natural disaster, closing of a practice, bankruptcy, or if the EHR vendor goes out of business. 
  • Lack of face-to-face patient interactions: If your specialty isn’t listed above as exempt and you lack face-to-face interactions with your patients, you can claim an exemption. 
  • 2014 EHR vendor issues: If your EHR vendor was unable to obtain a 2014 certification by July 1, 2014, you should file an application for exemption.   

Exemptions must be renewed annually, and you may not claim an exemption for more than five years.

For more information on penalties and exemptions, refer to TMA’s one-pager. Contact TMA’s Health Information Technology Department with questions by email or by calling (800) 880-5370.  

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 New Stage 2 Meaningful Use Tool

 The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have a new tool to help you meet the meaningful use Stage 2 transitions of care measure. The EHR Randomizer allows physicians to exchange data with a designated test electronic health record (EHR) system to meet part of the measure.

The transitions of care requirement includes three measures. The EHR Randomizer assists in meeting the third measure, which requires you to:    

  • Conduct at least one successful electronic exchange of a summary-of-care document with a recipient who has EHR technology developed by a different company, or 
  • Conduct at least one successful test with the CMS-designated test EHR during the EHR reporting period.    

CMS and ONC have chosen McKesson and Meditech as test EHRs. The agencies have asked other EHR technology developers to participate in the test program.

Follow these steps to use the EHR Randomizer:    

  1. Register online with EHR Randomizer. Your EHR technology will pair automatically with a different test EHR from a list of authorized systems. 
  2. Send a Consolidated Clinical Document Architecture (CCDA) summary-of-care record to the test EHR. Make sure the test CCDA document you submit doesn’t contain actual patient data.     

Within one day of the test transmission, the test EHR will email you a notification of success or failure. Keep the notification as proof of meeting the transitions of care measure.

For more detailed information, view the EHR Randomizer Test Instructions.

For more information about the EHR Medicare and Medicaid meaningful use incentive programs, see the TMA website or contact TMA’s Health Information Technology Department at (800) 880-5720 or by email

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New TDA Program Helps You Recruit NPPs

The new Texas Department of Agriculture (TDA) Rural Communities Health Care Investment Program assists rural areas in recruiting nonphysician practitioners (NPPs). The program’s funds come from a permanent endowment established from the tobacco settlement for the state of Texas.

The program provides partial student loan reimbursement or stipend payments to NPPs who: 

  • Practice in a qualifying community upon receiving their license within the past 12 months, or
  • Change employment from a practice site in a large county (more than 500,000) to a qualifying community to practice in their licensed field. 

To apply and learn more, download the program application from the TDA website. The application deadline is May 1, and TDA will notify award recipients in July. 

Eligible clinicians include, but are not limited to, dentists and licensed nonphysician mental health care professionals. Clinicians must hold a Texas license (other than MD or DO) to work in a health care field and: 

  • Be newly licensed in the field (received first license on or after Jan. 1, 2013); or
  • Move from a practice site in a large county (more than 500,000) to a qualifying community to practice in their licensed field. 

Additional eligibility requirements for clinicians include: 

  • Be a resident of Texas; 
  • Begin providing services in a qualifying community no later than six months after the award announcement; 
  • Provide services to clients who receive at least one form of indigent care in a qualifying community; 
  • Agree to practice in the qualifying community for at least 12 consecutive months; and
  • Provide services in a county that has either medically underserved area (MUA) designation or health professional shortage area (HPSA) designation appropriate for the provider type applying to the program (for example, primary care health professionals apply for a primary care HPSA). 

If you have questions, contact the State Office of Rural Health at (512) 936-6730 or by email

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Register for the Texas Health Home Summit Today

Join your colleagues for the second annual Texas Health Home Summit May 8-9 at the Westin Austin at The Domain to learn about medical home models and best practices and to interact with experts at various stages of medical home implementation. Register, and access fee information online.

Presented by the Texas Medical Home Initiative and the Texas Health Institute, the event will focus on integration of behavioral health into the heath home and health homes for children and adolescents. TMA is a sponsor of the event and a planning committee member. 

The summit encompasses: 

  • An understanding of the medical home and how it promotes accessible, continuous, and culturally effective health care.
  • Awareness of best practices to improve the medical home for all types of patients.
  • Knowledge about how state and federal legislation impacts medical home implementation.
  • Tools that can be used in their clinical practice or community to promote the medical home.
  • A focus on consumer engagement and strengthened partnerships between families, health professionals, and the health care system. 

Albert C. Hergenroeder, MD, chief of Baylor College of Medicine’s Adolescent Medicine and Sports Medicine section, and Jennifer Markley, RN, TMF Health Quality Institute’s senior director for Quality Improvement, will headline a session on care transitions. 

Amy Gibson, chief operating officer of the Patient-Centered Primary Care Collaborative in Washington, D.C., will address recent studies focused on the effectiveness of the health home. 

Continuing medical education credit information for the summit will be announced soon. Email Stephanie Ondrias at the Texas Health Institute with questions.

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Take The Phyicians Foundation's 2014 National Physician Survey

Let your voice be heard! Complete the 2014 National Physician Survey, sponsored by The Physicians Foundation, a nonprofit organization that works to improve physician satisfaction. The foundation’s third national survey gives you and your colleagues a chance to comment on the current state of the medical profession in what may be the most comprehensive survey of American physicians ever undertaken.

Your responses to the survey will help The Physicians Foundation provide a state of the union of the medical profession to policymakers, political leaders, and the public so that the physician’s perspective can command the attention it deserves.

And here’s a bonus: When you take the survey and include your email address, you’ll be entered into a drawing for a $10,000 travel voucher, a $2,000 Apple voucher, or an iPad Air. Plus, participants who provide an email address will receive a copy of the full survey report.

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Save These Dates!  

TexMed 2014
May 2-3, Ft. Worth

TMA will hold its first Rural Health Forum to discuss the challenges and opportunities physicians face when practicing in rural areas.  The meeting will be held in conjunction with TexMed in Fort Worth on Thursday May 1, from 6:30-9:30 pm at the Omni Fort Worth, second floor, Texas AB.  The meeting is open to all TMA members. RSVP to Stacy Warren at

2014 TMA Fall Conference
 Sept. 12-13, Austin 

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