Volume XXXI, Number 4
April 2016

House Committee Gets Earful on Medicaid Managed Care Problems

Late payments and increased costs are among the issues raised by THCA representatives during a hearing on Medicaid managed care last month.

The House Human Services Committee has been charged by Speaker Joe Straus to “review Medicaid managed care organizations policies and procedures” and to “identify the savings achieved by moving Medicaid into managed care.”

Residents who rely on Medicaid to pay for their care in Texas nursing facilities were moved into managed care just over one year ago.

But serious problems still remain, according to THCA Reimbursement Committee member Danny King.

“I have been in long term care since 1986 and have had the experience of working through several reimbursement process changes,” King, who serves as Director of Reimbursement for StoneGate Senior Living, said. “”The problems and issues with this latest change have been worse on providers than any change in history.”

King told the committee that the Texas Medicaid billing system is no longer simple, forcing facilities to add staff. He also said facilities are dealing with a high volume of claim denials and claims paid incorrectly, which then must be appealed.

These and other factors have led to serious payment delays.

“We’re still dealing with March, 2015 claims and trying to get the MCO’s co pay them correctly,” he said.

Patsy Tschudy, who is Director of Managed Care for Cantex Continuing Care Network, detailed some of the problems she has faced. She said the role of Service Coordinator is still not understood and properly utilized. She called for on-going education for the MCO’s and for the facilities so they can better tap into the services.

In his testimony, THCA President and CEO Kevin Warren offered four recommendations that would quickly address the situation:

  • Activate the resources necessary to immediately resolve the interface and exchange problems between the Texas Medicaid and Healthcare Partnership (TMHP) and the MCO’s over the MESAV data.
  • Begin a comprehensive review of the Dual-Eligible six-county pilot prior to consideration of expansion.
  • Convene a workgroup of providers, state agency staff, and the MCO’s to help standardize billing practices, data elements and reporting procedures.
  • Fully implement the managed care payment incentive programs as required under Senate Bill 7 and ensure that facilities which meet licensure and certification requirements are eligible to participate.

Following Warren’s testimony, committee chair Richard Pena Raymond pledged he would work to make sure each of the recommendations is adopted.

President’s Report

 Legislative Update

  • House Committee Gets Earful on Medicaid Managed Care Problems

Commitment to Care


If you have any questions about the THCA Commitment to Care Initiative or would like to share your facilities successes please contact Gloria Bean-Williams by email or call (512) 458-1257.

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