About 100 pediatric therapists from across Texas are at the Capitol today to push for higher Medicaid payments and better oversight on the health maintenance organizations that determine which children qualify for health care in their homes.
Some managed-care companies are pushing away higher-cost children, such as those with cerebral palsy, or delaying care by 30 to 60 days to improve the bottom line, said Jerre van den Bent, president of Therapy 2000, which provides home health care in the Dallas area.
The HMOs also may have different standards or measures to determine when care is medically necessary to qualify for Medicaid, leading to a guessing game for parents and therapists, said David Reimer, executive director of KidsCare Therapy in Dallas.
One solution would be to force, by legislation if necessary, the Health and Human Services Commission to better police managed care companies and enforce uniform standards for care across Texas, Reimer and van den Brent said.
The speech, occupational and physical therapists who will visit legislator offices today have a solid message to deliver because they improve children’s lives while saving taxpayer money by avoiding expensive stays in a hospital or rehabilitation facility, said state Rep. John Zerwas, R-Richmond, who spoke to the therapists at a morning meeting.
“(You) make a huge difference to the quality of life that they have. That’s the message that you need to share with your lawmakers,” said Zerwas, one of three medical doctors serving in the House. “Most lawmakers are not going to really understand what you do, but what they do understand is the money. That is what they are up here to look out for … and when they suggest that a cut to your fees be made, they need to understand the consequences of that.”
The therapists also will push legislators to restore reimbursement rate cuts made in the tighter 2012-13 budget.
Another priority will be to avoid a 2014-15 budget proposal to tie Medicaid payments to Medicare therapy rates for office visits, where costs are lower because a higher volume of patients can be seen, said Rachel Hammon, executive director of the Texas Association for Home Care and Hospice.
Such a move would not cover costs for home-care therapists, who work with one patient at a time, often have to drive long distances between appointments, frequently have to work around school hours and typically face difficult behavioral and cognitive issues, Hammon said.
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