HHSC UPDATE: 

On September 6, TOTA met with Matthew Ferrara, who serves as HHSC’s Director of Quality Oversight for the Medicaid and CHIP Services Department to discuss the Rider 57 therapy monitoring efforts.  Rider 57 was passed as part of the 2018-2019 state budget during the 2017 Regular Session, and directs HHSC to monitor the effects of therapy rate reductions and policy changes through an analysis of the number of complaints, appeals, fair hearings, utilizations, and waiting list volume.  Mr. Ferrara reported that nine months into the data collection process, HHSC has received minimal data from providers.  We need your help to continue to educate HHSC on the effects providers are experiencing prior to the next legislative session that begins in January 2019.  Please e-mail Mr. Ferrara directly with any information you can provide on the above requests (specifically, number of complaints, appeals, fair hearings, utilizations, and waiting list volume) as well as any clinic closures or clinics not accepting new Medicaid patients (regardless of Managed Care Organization).  He would like specific information, not just numbers.  Therefore, if you are reporting your waiting list volume, please include the child’s name, MCO, discipline and Medicaid number.  TOTA is not a covered entity under HIPAA law, therefore we cannot send PHI to HHSC on your behalf.  Clinic closures and clinics no longer accepting Medicaid should be specified as well (name, location, and caseload at closure).  Mr. Ferrara’s email address is [email protected].  We must organize and act so that HHSC can provide the Legislature with the most accurate information about what is happening at your clinics and practices; with incomplete or inaccurate data, HHSC will be unable to report anything other than the cuts and policy changes have had no effect.  Please ACT TODAY!

 

Medicaid Wait List Reporting Update


HHSC requested the MCOs to provide their notification process and point of contact for therapy providers to report when Medicaid individuals are placed on a provider waiting list.   

The attached document contains the MCO wait list information.

 

Medicaid Complaint Process

The Texas Legislature has required that Health and Human Services (HHSC) shall submit, on a quarterly basis, information related to pediatric therapy services, and whether there is a negative effect to access of care. 

Fee-For-Service

Medicaid fee-for-service providers must exhaust the administrative and medical appeals provider resolution process with the HHS claims administrator contractor before filing an appeal or complaint with HHSC. Written appeals and complaints may be sent to HHSC at:

Texas Health and Human Services Commission
HHSC Claims Administrator Contract Management
P.O. Box 204077
Mail Code 91-X
Austin, Texas 78720-4077

 

Click Here to Submit a Complaint to HHSC

 

Contact us with any questions.