Tag Archive for: texas

Medicaid is working for Texas families

With a poverty rate of 48.8%, Fabens is the poorest town in Texas and it’s the only town where more than half of households live on less than $25,000 a year. Fabens is home to closely 10,000 men, women and children, of which 80% receive their health coverage through Medicaid.
In 2010, one of the last Kellogg Community Partnership (school based) Clinics in the El Paso area closed its doors. Without that nearby clinic, impoverished Fabens families had limited access to health care. Without a single bus line servicing Fabens, residents found traveling to access health care was grueling.

In 2012, I established the only private, stand-alone, family medical clinic in Fabens. It functions as a result of our partnership with El Paso Health who contracts with the state to manage Medicaid in our region. President and CEO Frank J. Dominguez makes personal visits to doctor’s offices. Dominguez and I believe it is critical to provide customized clinical services, according to the community needs, and to support the way Texas runs Medicaid using the managed care model.

This approach allows plans, such as El Paso Health, the flexibility to develop unique programs. Annually, they organize healthy Thanksgiving dinners and provide back-to-school backpacks loaded with school supplies.

We invest Medicaid funds in the latest technology for screenings and other preventive equipment enabling clinic efficiencies. For example, we have the ability to perform an in-office EKG and confidently assure a mother that her son’s heart is performing well, easing her mind while preventing an unnecessary hospital visit.

Our approach also means working beyond typical office hours. Fabens patients know that they can knock on my door, even after 5 p.m., and I will see them. It means sharing my cell phone number with patients and driving to meet a family in a shopping mall parking lot on a Saturday for a child that needs stitches.

Our specialist partners also open their doors so our patients avoid costly ER and hospital visits.

Today, these investments and modifications have paid off. Our clinic is one of the highest-ranked for meeting critical state standards for preventive health care and pediatric checkups called Texas Health Steps. For my patients, the number of ER visits that could have been prevented, a common measure used by the state and El Paso Health to determine outcomes, is by far the lowest rate in El Paso, and one of the lowest in Texas. Our clinic costs are also some of the lowest in the entire state Medicaid program, making our partnership a win for both patients and taxpayers.

As Texas legislators examine the effectiveness of the family medical clinic in Fabens, we, together with El Paso Health, want them to understand what we know firsthand. Medicaid is working for Texas families. We call on state leadership to continue to support the Medicaid so that clinics like the one in Fabens thrive.

Dr. Ulysses Urquidi operates the only private family medical clinic in Fabens.

Your Turn

Ulysses Urquidi Guest columnist

Texas Medicaid

Benefit Update for Early Childhood Intervention for Texas Medicaid Effective September 1, 2017

Information posted July 18, 2017

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers

should contact the client’s specific MCO for details.

Effective for dates of service on or after September 1, 2017, Early Childhood Intervention (ECI) Services Comprehensive Care Program (CCP) benefits will be updated for Texas Medicaid.

New Benefit Information

The Medicaid medical policy describes the scope of the ECI Medicaid benefit, which may differ from the Physical, Occupational, or Speech Therapy (PT/OT/ST) Medicaid benefit, as follows.

  • Speech therapy (ST) treatment codes will now be billed per encounter.

o  Only one individual encounter-based speech therapy treatment procedure code is payable once per day per provider.

o  The rendering speech therapy provider should select the code that best reflects the totality of the session delivered.

  • Physical therapy (PT)/occupational therapy (OT) procedure codes representing supervised modalities will be payable as untimed procedure codes and billed per encounter.
  • PT, OT, and ST group treatment will be payable as untimed procedure codes and billed per encounter.
  • A modifier to designate whether a therapy treatment was provided by a licensed therapist or a licensed assistant will be required on all claims for therapy treatment procedure codes.
  • It will now be permissible to deliver targeted case management (TCM) in inpatient and outpatient hospital settings.
  • Missed visits may be rescheduled within the Individualized Family Service Plan

(IFSP) authorization period with appropriate documentation.

For more information about Early Childhood Intervention for Texas Medicaid please download load PDF from Community First Health Plans

 

Medicaid managed-care plans come out winners

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

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 squanders $40 billion a year in taxpayer health care contributions

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/