Extend Medicaid Changes Throughout, After Emergency, Medicine Tells State
By David Doolittle


Changes to Medicaid put in place during the COVID-19 pandemic should be extended to ensure physicians can continue to provide care for Texas’ children and youth.

That is the message the Texas Medical Association and several specialty societies sent in a letter this week to the Texas Health and Human Services Commission’s (HHSC) director of Medicaid and CHIP Services.

“The gradual reopening of the state’s economy will not mean a resumption of pre-pandemic physician practice operations. For the foreseeable future, COVID-19 will be in circulation, necessitating social distancing and continued use of related practice protocols, including telemedicine,” the letter says. “Maintaining Medicaid flexibilities will be essential to helping practices adapt to the new practice landscape, as well as remain financially afloat.”

The letter echoes one the Children’s Health Coverage Coalition sent last week encouraging HHSC to extend several programs and initiatives, including suspending copayments and enrollment fees for the Children’s Health Insurance Program (CHIP) another six months, and allowing Texas Health Steps visits via telemedicine for children older than two for another six months.

However, the letter this week includes additional requests, including prior authorization extensions and administrative flexibilities.

Specifically, the letter calls on HHSC to:

  • Extend prior authorizations for services requiring recertification for an additional 90 days;
  • To the extent possible, eliminate prior authorizations for medical services within both fee-for-service and managed care;
  • Suspend revalidation requirements through the end of the emergency period, and establish at least a six-month grace period before resuming revalidation at the end of the emergency period;
  • Ensure that practices that close temporarily do not lose their Managed Care Organization (MCO) credentials or Medicaid enrollment;
  • Suspend Medicaid and Office of Inspector General-related audits of physicians that are unrelated to suspected fraud or abuse (such as audits/recoupments related to billing and coding errors);
  • Suspend reporting related to performance or quality metrics for both physicians and MCOs, and eliminate state or plan-specific penalties for failure to meet performance targets; and
  • To the extent feasible, allow electronic signatures instead of physical ones. 

Primary care physicians, especially pediatricians and obstetrician-gynecologists, have been struggling throughout the COVID-19 pandemic. 

“Many physician practices work on a fairly tight margin of profit, especially those who see a lot of Medicare, Medicaid, or HMO patients,” TMA President Diana Fite, MD, said in response to a TMA survey of more than 1,500 Texas physicians. “We have heard from physicians who are charging on their personal charge cards, taking money from their own savings plans, and borrowing money just to pay the bills and their office staff. Meanwhile, they have no patients or very few patients to see.” 

As always, check the TMA COVID-19 Resource Center regularly for up-to-date news and the latest TMA materials for your practice.

Last Updated On

May 21, 2020

Originally Published On

May 20, 2020