The Centers for Medicare & Medicaid Services on Monday withdrew a proposed rule that would’ve restricted how states fund their share of Medicaid, causing serious cuts in services.
As requested by the Texas Medical Association, the Health and Human Services Commission (HHSC) has extended some Medicaid and Children’s Health Insurance Program (CHIP) flexibilities through Oct. 23.
Confused by Each Payer’s COVID-19 Policies? TMA is Here to Help
Medicaid Disaster Response Toolkit
Medicaid and CHIP Coverage and Payment Related to COVID-19 (CMS, March 5, 2020)
Medicaid Claims for Telephone (Audio Only) Medical Services (TMHP, March 20, 2020)
Federal Register: Medicare and Medicaid Programs: Policy and Regulatory Revisions (HHS, March 24, 2020)
Go to the TMA COVID-19 Resource Center
As you’re no doubt aware, telemedicine has made it possible for many physicians to continue seeing patients while reducing the risk of spread during the COVID-19 pandemic.
Temporary changes to state and federal rules, particularly regarding payment for services, have helped push up the new demand for and use of telemedicine.
Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.
In the wake of COVID-19, TMA is getting calls about which payers are covering telemedicine. TMA developed this quick reference guide to help you navigate telemedicine reimbursement. This table now reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare (which means patients can now be at home).
Additionally, the Governor directed TDI to issue an emergency rule related to the payment of telemedicine to allow state-regulated plans (about 20% of the commercial market in Texas) to allow telephone and telemedicine visits to be paid at the same rate as in-office visits. If you are not sure which patients are regulated by TDI, check this guide. Stay tuned for more detail.
Updated July 27, 2020
The Centers for Medicare & Medicaid Services (CMS) on March 30 approved Texas’ request to waive certain Medicaid regulatory requirements to help physicians and other health care professionals more effectively respond to the COVID-19 pandemic.
Leaders of the Texas Medical Association and four large primary care specialty societies on Wednesday painted for senior Medicaid officials the bleak fiscal picture of many physician practices, and requested immediate financial assistance.
Texas will again receive matching federal funds for women’s health services through a Medicaid 1115 waiver Gov. Greg Abbott announced Wednesday.
Federal lawmakers must pass a bill that would allow states to provide 12 months postpartum coverage to mothers who lose Medicaid coverage two months after giving birth, and would provide a bump in Medicaid matching dollars for those states, medicine and others said in a letter this week.
Medicine didn’t get everything it needed from lawmakers for Medicaid, including TMA’s biggest and boldest ask of the 2019 session. Still, progress TMA achieved on managed care reform and other facets of Medicaid will advance physicians’ efforts to care for the most vulnerable Texans.
The combination of the country’s highest uninsured rate and a stressed Medicaid program threaten not only the health of millions of Texans, but also the health of the economy, Texas Medical Association President Doug Curran, MD, says.
Improve Access to Care for Working Texans (Feb. 6, 2019)
Medicaid Is Vital; Let’s Improve the Medicaid Managed Care Program(Dr. Carlos J. Cardenas, Aug. 29, 2018)
Medicaid Managed Care Needs Better Oversight, Networks, Care Coordination, and Physician Payment(Douglas W. Curran, MD, June 27, 2018)
Read more TMA Medicaid testimonies.
As the future of Texas Medicaid promises to be a central topic of discussion in the 86th Texas Legislature, leaders from three pillars of the Texas health care system gathered in Austin on Oct. 12 for a first-ever summit to identify and commit to working on shared priorities for strengthening the program.
If you’ve followed the news recently, you’ve probably seen stories highlighting the struggles Texas physicians and patients are having with Medicaid Managed Care Organizations (MCOs).
House calls, yoga classes, and community networks are among the value-based innovations making Medicaid more patient-centered and more penny-wise.
A new collaboration by the Texas Medical Association and the Texas Association of Health Plans (TAHP) called the Texas Credentialing Alliance has streamlined a process that has long frustrated physicians because of its bureaucratic redundancy.
Medicaid patients in several states, including Texas, might not receive needed clinical tests because of new payment rates mandated by a federal law named, ironically, the Protecting Access to Medicare Act (PAMA).
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Got Medicaid or CHIP questions? Call or email the Knowledge Center.
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Use These Medicaid Tools to Help Get Paid More Efficiently