Simplify Medicaid HMO Administrative Requirements

TMA Testimony by Luis Benavides, MD

 HB2731 by Rep. Richard Raymond
April, 2, 2013

Good afternoon chairman Raymond and committee members.

Thank you for the opportunity to testify.  I am Luis Benavides, MD, a practicing family physician from Laredo. I am testifying on behalf of the Texas Medical Association and the Border Health Caucus strongly in favor of HB 2731, which would help simplify and streamline Medicaid HMO administrative requirements.

Last March, the Texas Health and Human Services Commission expanded the Medicaid HMO STAR and STAR+PLUS programs to all counties in South Texas as well as to rural counties not yet included under the HMO model. Most Medicaid patients are required to enroll in one of the plans. There are four STAR HMOs operating in South Texas that provide services to children, pregnant women, and poor parents, while two STAR+PLUS HMOs provide services to patients with disabilities and seniors.

I actively participate in Medicaid and my practice contracts with the Medicaid HMOs. Prior to expansion, I had only to contend with one contractor to submit my claims, prior authorization requests, or to verify benefits and services. Now my practice must interact with multiple plans, each with different prior authorization forms and standards, credentialing requirements, and time it takes to pay clean claims. While several of the plans are good partners with my practice, the varying administrative requirements for each one means that it costs my practice more resources to provide services and get paid for them.

HB2731 would help standardize and streamline Medicaid HMO administrative requirements. Standardization will make it easier for my practice to participate in Medicaid, while also lowering my practice costs. Medicaid is the lowest payer in most physician practices, so any reduction in administrative costs is essential to enhancing physician Medicaid participation.

TMA and the Border Health Caucus would suggest further improving the bill by amending it to require the Medicaid HMOs to pay clean claims within 15 days.  Contractually, the state requires plans to pay clean claims within 30 days. However, several of the plans pay much more promptly, which improves cash flow and rewards physicians who submit claims promptly and without errors.  We believe this a standard the HMO could easily meet. Expediting claims payment is also yet another mechanism to help build a broad Medicaid physician network.

I urge your support for HB2731. Thank you again for the opportunity to testify.

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Last Updated On

May 20, 2016

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