• Dual Eligibles

    • Dual-Eligibles Cut Partially Reversed

      After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to reverse part of the cut in payments for patients covered by both Medicare and Medicaid.

      The tipping point was a meeting State Sen. Juan "Chuy" Hinojosa (D-McAllen) organized at the Capitol last week with Lt. Gov. David Dewhurst and House Speaker Joe Straus. The group included TMA Board of Trustees Vice Chair Carlos Cardenas, MD, of Edinburg, and La Joya family physician Javier Saenz, MD. Although Gov. Rick Perry did not attend the meeting, his support helped move the change over the finish line.

  • Top Issues

    • Texas Medicine Scores for Patients, Physicians in Legislature
      A lineup that swung for the fences — combined with a solid defense and some outstanding pitching — led Texas medicine to an outstanding season at the top of the standings in the 2015 Texas Legislature.The Texas Medical Association team hit home runs on graduate medical education funding, Medicaid fraud reform, e-cigarette regulation, tax cuts, and red tape elimination. The pitching staff threw a perfect game, keeping all inappropriate and dangerous expansions of nonphysician practitioners’ scope of practice off of the base paths.  
    • TMA's 2015 Legislative Victories Build on Past Successes
      In a 2015 legislative session marked by new state leadership, new money, and big shifts in how Texas' major health care agencies oversee care delivery, the house of medicine remained as steady as ever in its mission to ensure physicians can give their patients the best care possible. That resolve paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.
    • Texas Physicians Ask Lawmakers to Fund Critical Health Services
      Seven of Texas’ largest physician organizations — representing more than 48,000 physicians and medical students — today urged state House and Senate budget negotiators to “craft a cost-effective budget that addresses Texas significant health care needs.”  
    • Repeal Physicians’ Dual-Eligible Payment Cut
      Here’s an example of how the current policy works: An established dual-eligible patient visits a physician office for a routine visit. The 2015 Medicare deductible has been met. The physician bills Medicare for the service. The Medicare allowable payment is $72.44. Medicare will pay the physician $57.95, 80 percent of the allowable. The patient is responsible for the remaining $14.49 (20 percent). For a dual-eligible patient, the physician bills Medicaid for the remaining balance. The Medicaid allowable for the same service is $33.27. Because the Medicare payment exceeded the Medicaid allowable, Texas will not pay any additional amount. The physician must write off the $14.49.
    • Automatic Patient Enrollment in Dual Eligible Demo Starts April 1
      Unless they have opted out, thousands of Texas patients who receive both Medicare and Medicaid and who reside in a target county will be automatically, or passively, enrolled in the Texas Health and Human Services Commission's six-county Dual Eligibles Integrated Care Demonstration Project starting April 1.
  • Medical Emergency Action Center

    • Medical Emergency Fact Sheet
      Until January of this year, the federal government (Medicare) paid 80 percent of a "dual-eligible" patients visit to a doctor. The other 20 percent of the cost was paid by Texas Medicaid. The sate Medicaid program also paid the Medicare deductible for these patients. This year the Medicare deductible is $140. Under the new guidelines, which went into effect Jan. 1, 2012, Texas Medicaid no longer pays the physician the patient's 20-percent coinsurance. Nor does Medicaid pay the full $140 annual deductible if Medicare's payment for a service exceeds Medicaid's allowable.
    • Payment for Patients Dually-Eligible for Medicare and Medicaid
      To help close a $27 billion budget deficit, the 82nd Texas legislature directed the Health and Human Services Commission to implement a multitude of new initiatives aimed at trimming Medicaid expenditures by nearly $3 billion over the next two years, including reducing benefits and services for patients and applying payment reductions for physicians and providers. MembersOnlyRed
    • 5010 Deadline Extended: Dual Eligible Problem Not Fixed
      Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.
    • Medicaid to Clean Up Dual Eligible Mess
      State Medicaid officials say they will fix the mistakes and reprocess the claims of physicians incorrectly paid $0 for treating patients eligible for both Medicaid and Medicare, known as "dual eligibles." The Texas Medical Association brought the problem to their attention on behalf of physicians and their patients who were threatened with losing their health care because many physicians across the state faced financial ruin.
  • TMA Advocacy

    • Dual-Eligibles Cut Partially Reversed
      After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to reverse part of the cut in payments for patients covered by both Medicare and Medicaid.
    • BHC Ask Senate Finance Committee to Restore Dual Eligible Cuts
      Just a few days ago, the state did restore payment of the deductible payment, a tremendous relief to those practices financially struggling since enactment of the cut. Many of you on the committee fought hard to restore the deductible and I sincerely thank you for your help. However, the continued coinsurance reduction means every time I see a dual eligible patient there is a 20-percent payment cut, an unsustainable and devastating financial blow.
    • Medicaid Payment Cuts Devastating Physicians' Practices and Their Patients
      Vice Chair, TMA Board of Trustees and TMA’s Border Health Caucus, Carlos Cardenas, MD, testified yesterday before the House Human Services Committee on the devastating cut in payments for dual-eligible patients. "Texas physicians want to take care of our patients. We want to see all Medicaid, Medicare patients, and those who are covered by both payers, but … we cannot do it without your help," Dr. Cardenas said. "We need your help and action to mitigate the cut so physicians can continue to care for Texas’ elderly — and often sickest — patients. Relief for these physicians and patients cannot happen too soon."
    • HOD Urges End to Dual-Eligible Crisis
      Recommendations to help end the "dual-eligible" crisis many Texas physicians face, to set priorities for next year's legislative session, and to improve medical education were among the issues debated and voted on at the TMA House of Delegates meeting May 19 at TexMed 2012 in Dallas.
    • TMA Testifies Dual Eligible Cuts
      Eliminating payments for Medicare Part B coinsurance and deductibles to those eligible for both Medicaid and Medicare will save the state millions but it will "come at the expense of the health and well-being of some of the state's most vulnerable citizens," TMA President C. Bruce Malone, MD, told the Texas Health and Human Services Commission (HHSC) earlier this month. Read the entire testimony presented by Dr. Malone.
    • HHSC to Cut Dual Eligible Payments
      The Texas Health and Human Services Commission (HHSC) plans to eliminate coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid, known as dual eligibles.
    • Nelson Seeks to Restore Medicaid Cuts
      In mid-March, Sen. Jane Nelson (R-Lewisville), chair of the Senate Finance Subcommittee for Medicaid, asked Tom Suehs, HHSC executive commissioner, to develop a list of top funding priorities. Leading Commissioner Suehs' recommendations was a proposal to restore 7 percent of the proposed 10-percent cut in physician payments for both Medicaid and the Children's Health Insurance Program.