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Chris Traylor, as Executive Commissioner of the Texas Health and Human Services Commission And the Texas Health and Human Services Commission v. Diana D., as Next Friend of KD, a Child Karen G., as Next Friend of TG and ZM, Children Guadalupe P., as Next Friend of LP, a Child Sally L., as Next Friend of CH, a Child Dena D., as Next Friend of BD, a Child OCI Acquisition, LLC
Citation: Not availableDocket: 03-15-00657-CV
Court: Court of Appeals of Texas; November 8, 2015; Texas; State Appellate Court
Original Court Document: View Document
Appellants, Chris Traylor and the Texas Health and Human Services Commission, filed a Motion to Vacate the Counter-Supersedeas Order or, alternatively, to increase the Counter-Supersedeas Bond. They argue that the trial judge abused discretion by asserting that the U.S. Secretary of Health and Human Services has exclusive authority over federal Medicaid provisions and that the temporary injunction violates constitutional clauses. They suggest setting a supersedeas bond at $100 million, reflecting the alleged two-year budget impact of the injunction.
Appellees oppose this Motion on several grounds: the Appellants' objections are not based on factual or legal grounds; there are no constitutional or statutory bases for challenging the trial court's decisions; objections were not raised during the trial; Appellants waived their right to contest the bond amount; and their claims regarding budgetary impact lack evidentiary support. Therefore, Appellees argue that the Motion should be denied as it lacks substantive merit.
Additionally, Appellees provide context by stating that they represent the next friends of five children with severe conditions who receive necessary therapy services through the Texas Medicaid Program. They also criticize Appellants for attempting to introduce new arguments based on comments made by the trial judge after the filing of their Motion, asserting that such actions are improper and should be disregarded by the Court.
The trial court mandated accelerated discovery, including a deposition of Pam McDonald representing HHSC. During this deposition, Appellants provided Appellees with a new set of proposed rates developed over the previous weekend. On the morning of the initial temporary injunction hearing, Appellants filed a notice that HHSC would abandon the previously proposed rates and start anew, rendering the hearing moot. Shortly after, HHSC published a third set of proposed rates to take effect on October 1, 2015, prompting Appellees to amend their petition, seek additional discovery, and schedule a new temporary injunction hearing. During this hearing, HHSC's witness acknowledged non-compliance with a statutory requirement for conducting a cost study associated with Medicaid services.
Rider 50 of the H.B. 1 General Appropriations Bill, referenced during the hearings, does not mandate specific Medicaid funding cuts but suggests potential savings. The trial court received evidence from legislators indicating that the language of Rider 50 did not necessitate rate reductions. Appellants claimed the temporary injunction was based on a federal access-to-care statute; however, the court found that the proposed rates would lead to care denials for Medicaid recipients but ruled the injunction was based on HHSC’s failure to adhere to its own rules and obligations. The injunction specifically prohibits implementing new rates without conducting necessary cost reviews.
At the conclusion of the temporary injunction hearing, Appellees requested the trial court deny supersedeas, conditioned on a $500 bond, which Appellants contested but acknowledged the bond amount as reasonable. The court denied supersedeas and allowed part of Appellees' funds already on deposit to serve as security. Nineteen days later, Appellants sought to modify the temporary injunction, submitting an affidavit from Pam McDonald that had not been presented during prior hearings, which they used to argue the trial judge abused his discretion.
Appellants have waived the stay of trial court proceedings, with the trial set for January 18, 2016. They acknowledge that the standard of review for their appeal is abuse of discretion. Appellants argue that their Motion should be considered by the full panel, as granting it would have significant negative impacts on the lives of Appellees and other Texans. The trial court determined that implementing the proposed Medicaid rates would deny essential services to beneficiaries and threaten the viability of service providers. Allowing the State to supersede the temporary injunction would undermine any relief granted, as highlighted by the Texas Supreme Court's ruling in a similar case, which cautioned against unchecked executive power that could cause irreparable harm to the prevailing party.
Appellants’ Motion, while framed as a challenge to the denial of supersedeas, primarily attacks the substantive claims of Appellees, which is not appropriate at this stage since those claims are already under interlocutory appeal. The Court should disregard these arguments as they do not pertain to the trial court's discretion on supersedeas. The Motion lacks a clear explanation of how the denial of supersedeas violates any constitutional provisions, suggesting that the Court should focus its review on the specific issues related to the trial judge's decision on supersedeas found only in Section V of the Motion.
Appellants’ Motion argues that only the U.S. Secretary of Health and Human Services can enforce access to care provisions under federal Medicaid law, citing Armstrong v. Exceptional Child Ctr. Inc. However, this interpretation is overly broad and irrelevant to the current case, which is solely based on Texas law. The trial court's temporary injunction does not hinge on access to care but on the failure of the Health and Human Services Commission (HHSC) to comply with its own regulatory requirements regarding cost studies for proposed rates, violating Texas law. The court has the authority to enjoin the implementation of these rates based on this non-compliance, as established in El Paso Hosp. Dist. v. Tex. Health and Human Servs. Comm’n.
Additionally, Appellants’ reference to McCauley v. Consolidated Underwriters regarding fundamental error is misplaced. This doctrine is rarely applicable and does not pertain to the ordinary review of the temporary injunction and denial of supersedeas, which are already subject to established appellate procedures. The concept of fundamental error pertains to jurisdictional issues, which the court can address independently, but it is not relevant to Appellants’ claims in this instance. The arguments regarding federal preemption and fundamental error do not pertain to the central legal issues of this case, which are grounded in Texas law.
No federal basis exists to challenge the trial court’s actions regarding the Medicaid Act. The U.S. Secretary of Health and Human Services' exclusive enforcement rights under §30(A) do not preempt Texas law concerning adoption and regulatory compliance. Appellants' arguments, relying on Armstrong v. Exceptional Child Ctr. Inc., assert that it preempts challenges to state Medicaid implementation; however, this interpretation is overly broad and inconsistent with Supreme Court rulings and subsequent lower court decisions. In Armstrong, the Supreme Court clarified that the Supremacy Clause does not create a federal cause of action and indicated that the Medicaid Act implicitly bars private enforcement of §30(A).
The only Fifth Circuit trial court to address Armstrong, Planned Parenthood Gulf Coast, Inc. v. Kliebert, upheld that Armstrong does not prevent plaintiffs from pursuing claims under other sections of the Medicaid Act. The court interpreted Justice Breyer’s concurrence as indicating various alternative remedies exist for plaintiffs, including actions under the Administrative Procedure Act. Therefore, while Armstrong limits private enforcement of §30(A), it does not suggest broad preemption of all state or federal causes of action.
Additionally, the Supreme Court in Pharm. Research. Mfrs. Of Am. v. Walsh determined that the Medicaid Act does not preempt state laws that do not conflict with it, placing the burden on those claiming preemption to prove that the state law undermines Medicaid goals. In the current case, the Health and Human Services Commission's assertion that the trial court's temporary injunction is preempted by the Secretary's exclusive remedy under §30(A) is unfounded, as the injunction is unrelated to §30(A) or any Medicaid provision.
The temporary injunction is based on HHSC's non-compliance with the cost study requirements of 1 TAC §355.8021(a)(2)(B) and failure to adhere to the Administrative Procedure Act (APA), as established in El Paso Hosp. Dist. v. Tex. Health. Human Servs. Comm’n. To argue Medicaid preemption, HHSC must show that §355.8021(a)(2)(B) obstructs a Medicaid objective, which it has not done, thus Appellants’ claims lack merit. Additionally, Rider 50 does not require rate reductions; rather, it mandates HHSC to reform reimbursement methodology in line with industry standards while considering stakeholder input. The language concerning savings is permissive, not mandatory, as clarified by legislative correspondence presented as evidence.
The temporary injunction does not impede Appellants from setting compliant rates. It addresses HHSC's failure to follow Texas law in rate adoption and merely prohibits the implementation of rates that violate state regulations. The injunction does not prevent HHSC from meeting legislative mandates regarding rate reductions; it only disallows the execution of rates adopted unlawfully or without following the stipulated requirements. Thus, the injunction ensures HHSC complies with state law, posing no separation of powers or constitutional issues.
The Texas Supreme Court has confirmed that judicial review of reimbursement decisions by the Health and Human Services Commission (HHSC), made in violation of state law, is permissible, as demonstrated in El Paso Hosp. Dist. v. Tex. Health. Human Servs. Comm’n. In that case, HHSC failed to adhere to its own regulatory rules when altering Medicaid reimbursement calculations, leading the Court to rule the changes unlawful under Texas law. The current case mirrors this situation, with no valid claims that a temporary injunction violates the Texas Constitution. Appellants did not raise any objections or arguments in the trial court regarding violations of the Medicaid Act or constitutional provisions, and their Motion lacks necessary citations and evidence to support their claims. Without presenting their complaints in a timely manner, they have waived their right to appeal. The sole evidence cited, an affidavit by Pam McDonald, was not in existence at the time of the temporary injunction and thus cannot be used to argue an abuse of discretion. Furthermore, the Appellants consented to a $500 bond during the hearing, which precludes them from contesting its amount now. The Court should deny the Motion due to failure to preserve error and the absence of supporting references.
Appellants consented to the bond and did not request the trial court to assess its adequacy, which limits the appellate court's ability to review the bond amount. Under Texas law, without such a motion, an appellate court lacks jurisdiction to address the issue. Appellants sought a $100,000,000 bond, claiming significant harm due to mandatory budget obligations over the next two years, but provided no supporting evidence for this claim. The assertion of harm is deemed irrational, as the anticipated savings would not be realized until after the trial set for January 18, 2016. Testimony from Richard Allgeyer of HHSC indicated that Medicaid appropriations would typically receive supplemental funding if needed, undermining the claim of financial impact from the injunction.
Additionally, Appellants must demonstrate that their requested bond would not cause substantial economic harm to Appellees, as per Texas law. Evidence presented suggested that the bond amount would indeed inflict severe economic harm, with testimony from Michael Reiswig indicating that a significant loss could jeopardize his company's operations. Finally, the temporary injunction does not hinder HHSC from implementing rate reductions, as long as it adheres to its regulatory protocols and the Administrative Procedures Act. Thus, Appellants cannot substantiate any actual adverse impact on the HHSC budget stemming from the injunction.
HHSC's failure to implement rate reductions aimed at achieving mandatory budget savings is attributed to its own inaction, rather than the temporary injunction in place. Appellants' Motion is characterized as a direct challenge to the temporary injunction, misrepresenting both the basis for the relief sought and the legal grounds for the injunction itself. The claims of federal preemption and constitutional violations presented by Appellants lack merit and are unfounded. Furthermore, Appellants have waived all objections in the Motion since they did not raise these issues in the trial court, nor do they provide evidence or record citations to support their claims. They also consented to the bond amount without requesting reconsideration, thus negating any basis for appealing the bond increase. Even if the bond request had been preserved, there is no evidence to justify the claimed bond amount, as it does not reflect any actual impact from the injunction. The Court is urged to deny Appellants' Motion. The document concludes with a certificate of service and correspondence from legislators expressing strong opposition to HHSC's proposed rate reductions for therapy services, highlighting concerns over the potential denial of critical services to vulnerable populations.
Rider 50 does not mandate reductions in reimbursement rates, as its language suggests a recommendation ("should") rather than a requirement ("shall"). This distinction raises questions about whether the Health and Human Services Commission (HHSC) has adequately considered essential factors such as stakeholder input and access to care. The proposed cuts threaten to severely limit access to necessary services for tens of thousands of Texas children with treatable conditions. The concerns voiced by almost 200 attendees at a recent public hearing further emphasize the widespread opposition to these cuts. No legislators have expressed support for the reductions, highlighting their potential harm to vulnerable populations. The letter emphasizes that it is the responsibility of elected officials to make difficult decisions rather than the agency, urging HHSC not to proceed with the proposed cuts due to their detrimental impact on low-income families and the broader community. The potential closure of clinics serving hundreds of children and the loss of jobs for their employees are also significant concerns. Access to early intervention therapies is crucial for children with disabilities, and the proposed cuts could exacerbate inequalities between low-income families and those with means.
Budget Rider 50's proposed reimbursement rate reductions are criticized for their potential to severely limit access to medically necessary services for children with disabilities. The suggested cuts could violate the rights of these children and threaten their well-being, particularly for those reliant on Medicaid. Estimates indicate that a $50 million reduction may leave 60,000 pediatric patients without essential healthcare services. Furthermore, the reductions could lead to the loss of approximately 7,500 therapists in a state already facing a shortage of healthcare professionals, adversely affecting children with serious medical conditions like cerebral palsy and developmental delays. Personal experiences of legislators underscore the importance of maintaining access to care for families with disabled members. The representatives urge rejection of these cuts, emphasizing the need for state support rather than placing additional burdens on vulnerable families. Contact information for further discussion is provided.
HHSC is required to comply with state law, and the temporary injunction permits HHSC to set rates in accordance with this law, with no infringement on Texas constitutional separation of powers or the business with the United States clauses. The Texas Supreme Court has upheld judicial review of HHSC reimbursement decisions that contravene state law, as demonstrated in El Paso Hosp. Dist. v. Tex. Health. Human Servs. Comm’n, where HHSC was found to have violated its own rules and the Administrative Procedure Act (APA) when altering Medicaid reimbursement rates. The Court did not dismiss the case based on constitutional grounds, confirming that HHSC's actions were unlawful.
Appellants failed to present any arguments regarding constitutional violations to the trial court and did not provide any record references to support their claims. They acknowledged that an abuse of discretion standard applies to their appeal, yet did not demonstrate that their complaints were timely raised in the trial court as required by TRAP 33.1(a). Failure to assert claims at the trial level precludes them from being raised on appeal. The Appellants’ motion lacked citations for preserved error and evidence supporting their arguments, which could lead to a waiver of their points.
The only evidence mentioned, an affidavit by Pam McDonald dated October 14, 2015, was irrelevant since it did not exist when the temporary injunction was issued. Thus, the Appellants cannot argue that the trial judge abused discretion based on non-existent evidence. Additionally, Appellants consented to the bond, further undermining their ability to seek appellate review. The Court should deny the motion due to these failures.
Appellants request the Court to reduce the Counter-Supersedeas Bond, having previously consented to a $500 bond, which they acknowledged as reasonable during a hearing. Since Appellants did not challenge the bond's adequacy or seek a review from the trial court, the appellate court lacks jurisdiction to modify the bond amount. Appellees do not oppose a reduction in the bond. However, Appellants propose an increase to $100,000,000 to address alleged budgetary impacts from a temporary injunction, claiming significant harm without presenting supporting evidence, such as documentary proof or affidavits. The only relevant testimony regarding the injunction's impact comes from Richard Allgeyer, who indicated that Medicaid appropriations would typically be supplemented if needed. Furthermore, for the Court to consider Appellants’ request for a higher bond, they must demonstrate that it would not cause substantial economic harm to Appellees, which the Court infers it likely would. Appellees are prepared to provide evidence on this matter if necessary.
Mr. Reiswig, president and CEO of Care Options for Kids, indicated that an annual loss of $4.5 million would lead to the closure of his company, which holds a 9% share of the pediatric therapy home health market. He asserted that requiring a $100 million bond would have a similar detrimental effect. The temporary injunction in question does not impact the Texas Health and Human Services Commission (HHSC) budget since HHSC can still implement rate reductions as long as they adhere to their regulatory rules and the Administrative Procedure Act (APA). The injunction allows HHSC to adopt rate changes if it complies with relevant regulations, but HHSC has not taken action to implement these reductions.
Appellants' motion is characterized as a direct challenge to the temporary injunction, misrepresenting its legal basis and seeking to create unfounded claims of federal preemption and constitutional violations. There is no evidence of any violation of federal law or constitutional provisions related to the injunction. Furthermore, Appellants have waived their objections by not presenting them to the trial court and have consented to the bond amount without requesting reconsideration. Any request to modify the bond is unsupported by evidence and disconnected from the impact of the injunction. As a result, the Court is urged to deny Appellants’ motion.
The document concludes with a certificate of service confirming delivery to relevant legal counsel.
Concerns are expressed regarding proposed rate reductions by the Health and Human Services Commission (HHSC) for physical, occupational, and speech therapy in home health and outpatient settings. The author, Texas State Representative Garnet F. Coleman, emphasizes that these cuts could deny critical services to approximately 50,000 low-income children with treatable chronic conditions. The letter argues that Rider 50 does not mandate these reductions and questions whether it even permits them, highlighting the distinction between "should" and "shall" in the rider's language. Coleman stresses that HHSC must consider access to care and stakeholder input, noting that a significant number of citizens attended a public hearing to oppose the cuts. No legislators have publicly supported the proposed reductions, underscoring the unpopularity of the decision. The author argues that it is the Legislature's role to make difficult decisions, and moving forward with the cuts would harm vulnerable populations and potentially exacerbate health issues. The letter concludes with a call for HHSC to halt the proposed cuts, labeling them unnecessary, harmful, and potentially self-defeating.
Legislators are united in opposing proposed cuts to Medicaid reimbursement rates, emphasizing the importance of maintaining access to services for vulnerable children, particularly those with disabilities. Evidence indicates that early and consistent intervention leads to better educational and employment outcomes, which in turn reduces long-term dependency on care. The proposed cuts, part of budget Rider 50, threaten the viability of clinics serving low-income families, potentially leading to closures and job losses for healthcare staff. Without these services, children from low-income households will be disproportionately affected, while families with means will still have access to care. There are concerns that the proposed rate reductions may violate children's rights to necessary medical services. A significant reduction, estimated at $50 million, could result in 60,000 pediatric patients losing access to vital healthcare and could lead to the unemployment of approximately 7,500 therapists in a state already facing shortages. The situation poses a serious risk to the well-being of Texas children and contradicts the state's obligation to provide healthcare to low-income populations. The letter urges the reconsideration of these cuts and invites further discussion on the issue.
Delays in accessing healthcare services and the impact of proposed Medicaid reimbursement reductions for pediatric therapy have been highlighted as critical issues. The reductions, focused on services for preterm and medically fragile children, disproportionately burden families who rely on these essential therapies. The personal experience of a state representative, whose sister has a developmental disability, underscores the devastating consequences of reduced access to healthcare. The representative urges rejection of the proposed rate cuts, emphasizing their detrimental effects on families with children needing support.
Furthermore, concerns are raised about the potential negative impact of these cuts on service availability, patient options, and continuity of care. The representative requests information on impact studies and analyses related to these proposed changes, indicating a commitment to ensuring adequate healthcare access for vulnerable populations. The communication is directed to the Executive Commissioner of the Texas Health and Human Services Commission, reflecting a formal appeal against the proposed reductions.
I-II-ISC is urged to consider stakeholder input when determining the reimbursement methodology for therapy services. There are significant concerns regarding proposed Medicaid payment rate reductions for therapy provided by Comprehensive Outpatient Rehabilitation Facilities, Home Health Agencies, and Independent Therapists. The proposed cuts are viewed as inequitable and could lead to access issues for essential therapy services, particularly affecting vulnerable populations and rural areas. The Vice Chair of the Senate Finance Committee acknowledges the need for Medicaid cost containment but emphasizes that the large rate reductions could destabilize the provider network and threaten service availability. It is critical for the Health and Human Services Commission (HHSC) to incorporate feedback from therapy providers, who have direct insights into the implications of these decisions, ensuring that any necessary rate reductions are fair and do not compromise the quality of care for Texans.
A group of Texas state representatives, led by Carol Alvarado, submitted a letter to Chris Traylor, Executive Commissioner of the Texas Health and Human Services Commission (HHSC), opposing proposed Medicaid payment rate reductions for physical, occupational, and speech therapy services provided by Comprehensive Outpatient Rehabilitation Facilities, Home Health Agencies, and Independent Therapists. The representatives argue that these reductions, driven by budget Rider 50, will significantly limit access to essential services for vulnerable populations, particularly affecting 60,000 pediatric patients and leading to the potential unemployment of 7,500 therapists. They emphasize that the proposed changes contradict the intent expressed by Chairman John Otto of the House Committee on Appropriations, who stated that the goal was not to reduce access to care. The representatives urge HHSC to carefully consider the long-term implications of these cuts on healthcare access before proceeding with any cost-reduction strategies.
Serglo Mufioz, Jr., along with several Texas State Representatives, has expressed strong opposition to proposed rate reductions by the Texas Health and Human Services Commission (HHSC) for Medicaid payments related to physical, occupational, and speech therapy services offered by Comprehensive Outpatient Rehabilitation Facilities (CORF/ORF), Home Health Agencies (HHA), and independent therapists. These representatives emphasize the importance of these therapies for vulnerable children, asserting that reduced rates would jeopardize their access to necessary care. The letters, dated July 23, 2015, highlight concerns over the impact of these cuts on service continuity and the adequacy of care networks for children with high needs. The representatives urge Commissioner Chris Traylor to reconsider the proposed reductions, citing fiscal responsibility while advocating for the uninterrupted provision of essential therapies.
The letter expresses urgent concern regarding the implementation of Medicaid payment rate changes under the Texas General Appropriations Act, highlighting the potential negative impact on vulnerable populations in the 15th Congressional District. The author requests that relevant personnel from HHSC meet with stakeholders to clarify the development of these rates and explore potential alternatives, emphasizing the overwhelming public opposition to the proposed cuts during testimony on July 24, 2015. Witnesses indicated that reductions of up to 68% for certain services could severely limit access for individuals with complex needs, and a 37% reduction in evaluation reimbursements could hinder access to necessary assessments for services. The author also raises issues of transparency in the process, noting a lack of public comment opportunities and undisclosed methodologies behind the reductions. Furthermore, there is concern about the impact on programs like Early Childhood Intervention, as estimates on access changes have not been provided. The author urges prompt scheduling of a meeting with HHSC staff, expressing a commitment to assist in addressing these issues for the benefit of constituents.
Concerns have been raised by Medicaid providers in Senate District 3 regarding proposed rate cuts for acute care therapy providers, including physical, occupational, and speech therapists. The Texas Legislature directed the Health and Human Services Commission (HHSC) to implement Medicaid funding reductions and cost containment strategies, which may lead to decreased access to care, particularly in rural areas. The proposed cuts are based on an HHSC analysis of data from Texas A&M University, which may not provide an equitable comparison of state Medicaid rates. Additionally, existing Texas Administrative Code rules for rate-setting do not account for commercial rates, which can be influenced by various factors such as utilization limits and cost-sharing.
Stakeholders have suggested alternative strategies to achieve necessary savings, and it is crucial for HHSC to consider these proposals to avoid negative impacts on care access, especially in rural regions. Moreover, Local Mental Health Authorities, like the Burke Center, provide essential services, and further discussions have highlighted the unique challenges faced by East Texas communities in accessing therapy services. There are concerns that the proposed rate cuts will disproportionately affect the Burke Center's Early Childhood Intervention program, which has shown successful outcomes. The need for adequate access to services for Medicaid recipients is emphasized to ensure compliance with federal requirements.
Funding reductions and therapy rate cuts threaten the viability of the Early Childhood Intervention (ECI) program in Texas, potentially increasing overall healthcare and educational costs in the community. The author, a State Representative, acknowledges the efforts of the House Appropriations Committee in managing a limited budget but urges against a one-size-fits-all approach to cost-saving measures across the state, highlighting the unique challenges faced by local mental health authorities (LMHAs). The letter emphasizes the need to consider the cumulative impacts of these cuts, particularly on the Burke Center’s ECI program.
Furthermore, with over four million Medicaid recipients in Texas, many of whom are children, the proposed rate reductions by the Texas Health and Human Services Commission could significantly hinder access to necessary therapy services. The letter references Rider 50 from the Texas Legislature, mandating $150 million in reductions for Medicaid acute care therapy services for the FY 2016-2017 biennium, effective October 1, 2015. The author calls on the Centers for Medicare and Medicaid Services (CMS) to thoroughly review these proposed reductions to prevent access restrictions to medically necessary services. The letter is signed by multiple members of Congress, underscoring the urgency and bipartisan concern regarding the issue.
On September 10, 2015, correspondence addressed to Executive Commissioner Chris Traylor of the Health and Human Services Commission references the 84th Legislature's passage of the 2016-2017 General Appropriations Act (HB 1), which includes Rider 50. This rider mandates reforms to the reimbursement methodology for acute care therapy services, including physical, occupational, and speech therapies, to align with industry standards and ensure efficient use of taxpayer funds. The goal is to adjust Medicaid pediatric acute care therapy rates to levels comparable to market rates without compromising access to care or violating federal law. The letter emphasizes that previous studies highlighted Texas Medicaid rates for these services as significantly higher than commercial rates in Texas and other states. Senator Jane Nelson expresses her support for adhering to legislative intent while implementing responsible rate reductions. She believes the rider provides the necessary flexibility to phase in these adjustments to avoid service disruptions for children. The correspondence also indicates a need for the agency to inform lawmakers about potential impacts on access to care resulting from these cuts.
Speaker Joe Straus emphasized the responsibility of the Health and Human Services Commission (HHSC) to inform the Legislature about any potential harm to access to care and network adequacy resulting from proposed Medicaid rate reductions for acute care services, which are vital for many Texas families. The state must provide Medicaid services that recipients qualify for while ensuring efficient management of the Medicaid program and prudent use of taxpayer funds.
The Legislature has directed HHSC to reform the reimbursement methodology for acute care therapy to align with industry standards, which includes proposed rate reductions. Originally, HHSC aimed to cut therapy rates by $50 million annually for two years but is now revisiting this due to a dismissed court challenge. The Commission is expected to propose new rates in compliance with federal law, while being urged to consider stakeholder input regarding access to care.
Senator Craig Estes expressed concerns from Medicaid providers in his district about these rate cuts, which could limit access to therapy services, particularly in rural areas. He highlighted the need for HHSC to balance cost containment with adequate service provision and to consider alternative strategies that would mitigate adverse impacts on access to care for Texans relying on these services.