Strengthen Medicaid MCO Oversight and Improve Access to Care

TMA Testimony by Doug Curran, MD

House Human Services Committee
Testimony in Support of House Bill 2453 by Rep. Sarah Davis

Written Testimony Submitted on behalf of

  • Texas Medical Association 
  • Texas Academy of Family Physicians
  • Texas Pediatric Society
  • American College of Obstetricians and Gynecologists — District XI (Texas) 
  • Texas Association of Obstetricians and Gynecologists

April 2, 2019

Chairman Frank, Vice Chair Hinojosa, committee members, I am Doug Curran, MD, a practicing family physician from Athens, Texas, testifying in favor of House Bill 2453. I speak today on behalf of the Texas Medical Association, Texas Academy of Family Physicians, and the specialty societies representing pediatricians and obstetricians-gynecologists. Throughout my career, I have cared for thousands of Medicaid patients. And every day I see how the program benefits the patients who live in my community. Without Medicaid, millions of poor and low-income Texans would not get the health care services they need to remain productive members of our community. So I greatly appreciate the opportunity to support legislation that will make Medicaid better by strengthening HHSC oversight and accountability, modernizing outdated business operations, and improving systems of care so patients get the right care at the right time.

Over the past six months, leaders from TMA, the Texas Hospital Association, Texas Association of Health Plans, and Texas Association of Community Health Plans have met monthly to identify opportunities to reform Medicaid. While we do not always sing Kumbaya, we have developed a better understanding of the root causes of many of problems facing the program. And many problems are much more complex than we first realized, such as simplifying Medicaid prior authorizations. I mention this because we appreciate that in crafting HB 2453, Chair Davis has undertaken an inclusive process to ensure all stakeholders have a voice in designing solutions to fit the problems her bill seeks to address.

We applaud Chair Davis for her work and look forward to continued collaboration with her, the committee, and Medicaid stakeholders as the bill evolves. I also would like to thank Chairman Frank for his efforts to eliminate costly red tape and overhead within Medicaid managed care.

As you consider HB 2453, let me highlight a few critical reforms that the bill will achieve. 

  • Enhancing accountability and oversight of managed care organizations 

Obviously, HHSC must quickly and meaningfully penalize poorly performing plans and implement timely, appropriate corrective measures. At the same time, Texas must not focus exclusively on removing or punishing bad MCOs. Plans that perform well, as well as the physicians who participate in their networks, should be recognized and rewarded. For Texas Medicaid managed care to constructively evolve, the state must determine how to quickly replicate and expand the highest-performing plans’ best practices so that Medicaid managed care works better for all. 

  • HB 2453 will help by:
    • Establishing a provider ombudsman to resolve individual provider complaints while also identifying systemic issues that may require a contractual or policy change;
    • Enhancing the Medicaid managed care report cards to help patients make more informed decisions; and
    • Publicizing Corrective Action Plans taken by HHSC.
  • Strengthening care coordination

Care coordination remains inordinately confusing and time-consuming, well short of its intended goals. The intent of care coordination is to ensure patients, particularly those with the most significant needs, get the right care at the right time, as well as to help physicians successfully transition patients from one level of care to another, such as from an inpatient stay to the community, where follow-up care may be needed. But these connections are not happening routinely. Reforming Medicaid care coordination is a high priority for our members. 

  • HB 2453 will help by:
    • Promoting consistent terminology to help patients, physicians, and providers better understand the types of coordinating services plans provide and providing clear guidance on the level of care coordination a patient and physician can expect by type of plan;
    • Promoting innovative best practices for care coordination, including use of embedded care coordinators and virtual services to help rural and small practices; and
    • Establishing care coordination performance metrics to ensure compliance with HMO contractual obligations
  • Establishing a fairer appeals process

After patients exhaust the internal Medicaid MCO appeals process, they have the option to pursue a fair hearing to review an adverse determination. But as we have learned over the past year, fair hearing officers may not have the clinical expertise and training to evaluate whether the basis for the original denial is sound.

  • HB 2453 will help by: 
    • Establishing a voluntary, independent, external medical review process to ensure an objective and fair assessment of the denial of service.
  • Streamlining administrative procedures  

For Texas Medicaid managed care to work effectively and efficiently, Texas must eliminate redundant, silly, and onerous red tape that benefits no one. 

  • HB 2453 will help by:
    • Increasing transparency and scrutiny of prior authorization requirements;
    • Ensuring prior authorization requests are not denied solely for technical or minimal errors; and
    • Establishing a list of chronic conditions or illnesses for which the Medicaid MCOs must establish extended prior authorization timeframes. 

86th Texas Legislature Letters and Testimonies

TMA Legislative main page

Last Updated On

April 02, 2019

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