Letter to Senator John Cornyn and Senator Ted Cruz

/in /by
Dear Senator John Cornyn and Senator Ted Cruz,
Texas leads this country in successfully privatizing its Medicaid Program. The undersigned members of the Texas Association of Community Health Plans are private Texas insurers providing Medicaid health coverage to more than one million Texans. Our companies, also known by Medicaid regulators as Managed Care Organizations (MCOs), focus clinical and administrative management strategies on healthcare quality improvement and cost containment.
This Medicaid-funded insurance through Texas companies enables thousands of Texas doctors, nurses, and health care professionals to care for our most vulnerable citizens. We are honored that the success of Texas Medicaid Managed Care has led healthcare leaders from other states to visit us to learn from our track record of achieving significant savings by using private sector models and incentives. As an example, between FY2010 and FY2015, Texas Medicaid MCOs saved the state $3.8 billion and are expected to save another $3.3 billion through 2018 when compared to traditional fee-for-service Medicaid.
Download full letter HERE

Cook Children’s Health Plan will implement the following Texas Medicaid claim submission guideline

/in /by
Cook Children’s Health Plan will implement the following Texas Medicaid claim submission guideline effective March 20, 2017.
TexMedConnect Frequently Asked Questions (FAQ)
The Patient Discharge Status identifies the location of the individual at the end of the billing cycle. The most common status selected will be 30 Still Patient. This indicates the individual continues to receive services and subsequent claims will be submitted.
There are instances in which 30 Still Patient is not appropriate. For example: Any claim on which you indicate the individual has discharged or a claim which contains the last billable date of a stay (either date prior to discharge or date of death) will not have a Patient Discharge Status of 30 Still Patient.
NOTE: If you have selected Claim Frequency 1 Admit through Discharge Claim or 4 Interim – Last Claim, Patient Discharge Status 30 Still Patient must not be used
“TexMedConnect FAQ” (02/01/2015)
More details HERE

Proposed federal health plan brings uncertainty in Texas

/in /by

Proposed federal health plan brings uncertainty in Texas

Health insurers in Texas have already taken flak for rising premium prices, and that could continue under the proposed federal plan.

Kay Ghahremani, president and CEO of Texas Association of Community Health Plans, said doing away with the individual mandate would be troublesome for insurers, which she said need a predictable number of people signing up for coverage so they can keep premium costs steady and cover the costs of providing services.

“They can’t experience losses year after year; they won’t be able to stay in business,” Ghahremani said. “Just from my initial read of what’s being proposed, I don’t see anything to lessen that volatility, and in fact, I think it increases volatility for insurers.”

Read more of this article published by The Texas Tribune https://www.texastribune.org/2017/03/07/texas-federal-health-plan-brings-uncertainty

Medicaid managed-care plans come out winners

/in /by

Medicaid – Texas Association of Community Healthcare Plans

Researchers found that regional insurers that originally went into business to care for those with Medicaid — the health insurance for the poor and disabled — are filling gaps after insurers fled in many markets. Molina Health in California, WellCare in Florida, Community Health Choice in Texas, “appear to have thrived in the ACA marketplace environment,” the study says.

Rivlin says the success of these plans is likely due to their experience caring for a low-income, often very sick population. They already had well-established networks of local providers that allow them to provide care at a lower cost. As 2017 premiums went up, consumers became more willing to enroll in these more affordable, lesser-known plans.

Read full article: http://www.kunc.org/post/what-worked-obamacare-and-what-didnt-lessons-5-states

 

 

There’s a huge imbalance in how Texas provides for its old people

/in /by

A recently published article in the Houston Chronicle raises awareness around an issue that affects our aging population: the high cost of nursing homes. According to the story, there is an increasing recognition  in cities located in South Texas that “aging in place” is more cost effective and healthier than aging in nursing homes but despite this, state policy is making it difficult to expand this model across other parts of the state.

Please read the full story by clicking on this link http://www.houstonchronicle.com/business/article/As-the-population-ages-the-Rio-Grande-Valley-10890241.php?t=6c12edce6e438d9cbb&cmpid=fb-premium

Texas Medicaid Brings Back Mosquito Repellent Benefit

/in /by

AUSTIN – The Texas Health and Human Services Commission announced today that it is reinstating the Medicaid benefit for mosquito repellent due to the first reported case of Zika virus disease likely transmitted by a mosquito in Texas.

Texas quickly made the decision to bring back the benefit, which had ended Oct. 31, given the possibility of local transmission and risk of Zika in the local community. The newly reported case is a Cameron County resident who is not pregnant. Zika is spread primarily by mosquito bite and can cause severe birth defects in unborn children whose mothers are infected while pregnant.

The benefit begins tomorrow and will be in place through December, as the state collects more information about the case and scope of transmission in Texas.

“We will do all that we can to protect Texans and slow the spread of the Zika virus,” said HHSC Executive Commissioner Charles Smith. “Insect repellent is the best way to protect yourself, and we want it to be widely available.”

Eligible Texas women can go to participating pharmacies to pick up mosquito repellent, as Texas Medicaid has a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant.

The benefit includes two cans per month per eligible beneficiary. Women are encouraged to call the pharmacy ahead of time because supply can vary by location.

Women eligible for the Medicaid, CHIP and CHIP-Perinate programs are covered. Women covered under the Healthy Texas Women and Children with Special Health Care Needs programs also can receive the benefit.

The following Zika-related items also are covered under current Texas Medicaid benefits:

  • Family planning services
  • Contraceptives
  • Diagnostic testing
  • Targeted case management
  • Physical therapy
  • Long term services and support
  • Acetaminophen and oral electrolytes for Zika symptoms
  • Potential coverage for additional ultrasounds for pregnant women

For more information about the Zika virus, visit TexasZika.org.

Originally published by our member Driscoll Health Plan

Texas squanders $40 billion a year in taxpayer health care contributions

/in /by

Ken Janda, CEO of Community Health Choice, recently published a piece in which he touched on issues concerning health insurance costs and tax dollars spent on Medicaid and other programs for the poor in Texas. He stressed on the idea of expanding  on  fiscally responsible coverage similar to the Texas-managed Medicaid program.

Ken identified seven areas that impact the cost of health insurance of tax payers in Texas:

  1. Texans pay federal taxes designated for part of each states’ health care needs, but these dollars don’t come back home to Texas.
  2. Texans pay property taxes that help cover costs for uninsured and underinsured treated at hospital emergency rooms.
  3. Texans pay sales taxes instead of income taxes to fund all state services, including health care.
  4. Texans pay crippling societal costs for a state with more sick citizens and poor health care.
  5. Texans pay higher health care insurance premiums on their own policies due to higher prices charged by providers to offset uncompensated care.
  6. Texans who self-fund their own health care pay at least 30 percent more as compared with negotiated insurance rates.
  7. Texans pay up to 10.5 percent higher premiums for Marketplace health insurance because Texas refused to expand Medicaid and has not set up its own state-run exchange for health insurance.

Read more: https://www.tribtalk.org/2016/10/13/texas-squanders-40-billion-a-year-in-taxpayer-health-care-contributions/

Keeping your appointment with your doctor

/in /by

parkland_newsletter_summer

Making an appointment means the doctor’s office is aware you are coming and has made time to see you.

No matter how hard we try, sometimes life gets in the way of our plans. It may be a last-minute phone call, an unexpected visitor at the door, or you are stuck driving in traffic. The result is you may be late or miss your appointment.

What should you do?
It’s important to call the doctor’s office and tell them you will be late or need to cancel the appointment. If you’re going to be late, the office may not be able to get you in with the doctor as soon as you arrive. Or the office may suggest you reschedule your appointment for another day or time. If you have to cancel your appointment, they can usually set up a new appointment with you during the same call.

As it is with any other schedule—work, school or social plans—when you are late, you can miss something important. And you leave others waiting. No one likes to be left waiting.

It’s the same with your doctor. Most doctors’ daily schedules are full with patients needing to be seen. If one person is late, it can make the rest of the day run behind. This can mean longer wait times for patients (like you) that arrive afterward and on time for their appointment.

Again, no one likes to be kept waiting, especially when they have an appointment. Remember the appointment you made is just as important to your doctor as it is to you. Both the doctor and you set aside time for your medical needs.

If you have ever had to wait past your appointment time, chances are, someone else was late for their appointment earlier that day.

FirstCare at the White House

/in /by

On Monday, September 12, 2016, FirstCare President and CEO firstcare-president-and-ceo-darnell-denttraveled to Washington D.C., to participate in a meeting at the White House, on behalf of FirstCare and the Texas Association of Community-based Health Plans (TACHP), at the President’s request and hosted by Health and Human Services (HHS) Secretary Sylvia Burwell, along with 11 other insurance industry CEOs from across the country. The purpose of the meeting was for the administration to address constructive solutions and strategies with insurers who’ve committed to remain in the Health Insurance Marketplace.

President Obama joined the meeting in-person and participated in the discussion, imparting to the attendees that the federal government is interested in partnering with the health insurers to address fixes within the Marketplace and promoting best practices from insurers who have been Marketplace participants, thus ensuring the program continues for Americans after his term in office ends in 2017.

This was Darnell’s first trip to the White House. “I was privileged to meet the President, who thanked me personally for attending,” he said.

Throughout the meeting, Darnell—the sole representative from a provider-sponsored plan and Texas-based plan—gave a voice to the provider-sponsored plans in the Marketplace. He spoke about our efforts in customer engagement and outreach, care coordination, the risk pool and the impact of Marketplace Special Enrollment Periods (SEPs).

The opportunity to address these and other concerns directly to Secretary Burwell, Acting Secretary Andy Slavitt (CMS), Marketplace CEO Kevin Counihan, and President Obama allowed the attendees to share their solutions and ideas to help keep the Marketplace a viable option for Americans. Darnell was encouraged by the topics discussed in the session stating, “The open dialogue fostered a free-flow of ideas and supported the strong sense of cooperation this administration has towards the health insurers committed to participating in the Marketplace in 2017.”

For further details on the meeting, check out the articles posted in USA Today, The Washington Post, CNBC, The New York Times and Modern Healthcare.

How to report abuse and neglect

/in /by

El-Paso-First-NewsletterThe Health and Human Services Commission (HHSC) requires network Providers to forward any report findings they receive to the appropriate managed care organization. El Paso First Network Providers who have received abuse, neglect and exploitation (ANE) report findings on El Paso First Members from the Department of Family and Protective Services (DFPS) or Department of Aging and Disability Services (DADS) must submit a copy of the report to El Paso First within ONE business day from the date the report is received. In addition, any ANE report findings received on or after Sept. 1, 2015, must also be reported to El Paso First immediately.

Providers can submit ANE report findings to El Paso First via email at APSReport@epfirst.com, which is secure and confidential.

For additional information on reporting abuse, neglect and exploitation:

  • Texas Family Code 261.404 and Human Resources code Chapter 48 require any person to report any allegation or suspicion of ANE against a child, an adult with a disability or an elderly adult to the appropriate entities.
  • To report suspicion of ANE of a child, contact the DFPS at 1-800-252-5400
  • To report an adult or child who resides in or receives services from nursing or assisted facilities, home and community support agencies, adult day care, and foster care facilities, contact the DADS at 1-800-647-7418

If you have any questions or concerns regarding this information, please call the Provider Relations department at 1-877-532-3778, ext. 1507