Advocate

Dear APRN Business Owners:

Please forgive the short notice, but this Friday in Austin is a very important meeting for all of us who perform Texas Health Steps exams.  Any NP or PA billing under their own numbers, not that of a physician, may soon receive only 92% of the MD reimbursement for all well checks.  As many of you know, well checks incorporating all of the THS requirements are very time-consuming.  In my practice, an 8% cut in revenue = the salary of one medical assistant. 

Please take a minute to write one of the voting members below and express your opinion on this proposed cut to APRNs who perform THS exams.  Kathy Hutto gives us some very good advice on what to include in our letters.  And please consider coming to the meeting and voicing your opinion if you can.  Again, I understand this is very short notice. 

If you do write a letter, why not cc Kathy so that CNAP will be aware of your involvement.  I sincerely thank you for any help you may give.  Please forward this information to other APRNs who are Medicaid providers.

Marty Strong

From Kathy Hutto with CNAP:

Here is a link to the agenda:  http://www.hhsc.state.tx.us/news/meetings/past/2013/110813-mcac.shtml  for the Medical Care Advisory Committee meeting on Friday at 9 am at:

Department of Aging and Disability Services
John H. Winters Building
Public Hearing Room
701 W. 51st St.
Austin. 

Agenda Item 17 is the one of interest: 

Reimbursement Methodology for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services

HHSC proposes to amend 1 TAC §355.8441 to clarify the Medicaid reimbursement methodology for Physician Assistants and Advanced Practice Registered Nurses who provide Early and Periodic Screening Diagnosis and Treatment (EPSDT) or Texas Health Steps (THSteps) services. The proposed rule also includes an administrative update to clarify reimbursement for vaccines.
-Tim Villasana, HHSC (this will be the staff person who will make the presentation).

Although Public Comment is Agenda Item 24, please note the comment:  *Public comment will be taken following each item, after a staff presentation, and/or before a vote on an action item.

So people who show up at the meeting will be able to testify.  The HHSC staff will lay out the agenda item, there may be some discussion among the committee members, public comment will be taken and then they will vote.  Testimony should be succinct and filled with as much in the way of statistics as possible, i.e. how many THStep services to how many children do you provide in a year that will be impacted by this change?  What will be the impact of the reduction on your practice?  Will you have to reduce staff?  Reduce hours? Limit the number of THStep services provided?  What you say is important, but how it is said is important too.  The emphasis needs to be on the patients and access to health care.

The Medical Care Advisory Committee is a federally mandated committee that reviews and makes recommendations to the state Medicaid director on proposed rules that involve Medicaid policy or affect Medicaid-funded programs.  It used to be made up of almost all physicians, but it is more diverse now.  The members are listed below.  If you cannot attend the meeting, you can click on each of their names and send them an email expressing your concerns.  I would not send the email to any of the non-voting members except Dr. Glomb as none of the others have any impact on this issue.

Voting members

Dianna Mosley Burns, M.D. - San Antonio
Pediatrician

Paula S. Gómez - Brownsville
Community Care Provider

Gilbert A. Handal, M.D., Vice Chair – El Paso
Pediatrician

David Henkes, M.D. – San Antonio
Physician Payment Advisory Committee Representative
Pathologist

George B. Hernandez, Jr., J.D. – San Antonio
Hospital District

George N. Smith, D.O. – West
Osteopath

Michael D. Vaclav, D.D.S., MCAC Chair – Amarillo
Dentist

Peggy Deming – San Antonio
Hospital Payment Advisory Committee Representative

Edgar Walsh Jr., R.Ph. – Harlingen
Pharmacy

Colleen Horton, MPA – Austin
Disability Advocate

Donna Smith - Austin
Pediatric Physical Therapist

Mary Helen Tieken, RN, BSN - Floresville
Registered Nurse

Non-voting Members

Corliss Powell - Austin
Agency Representative – Department of Aging and Disability Services

James Rogers, M.D. - Austin
Agency Representative – Department of Family and Protective Services

Olga O. Rodriguez – Austin
Agency Representative – Department of State Health Services

William B. Glomb, M.D. – Austin
Agency Representative – Health and Human Services Commission

Tamela Griffin – Austin
Agency Representative – Department of Assistive and Rehabilitative Services

Once the rule is actually proposed and printed in the Texas Register, written comments on the proposal may be submitted to Dan Huggins, Director of Acute Care, Rate Analysis Department, Texas Health and Human Services Commission, P.O. Box 149030, MC-H400, Austin, Texas 78714-9030; by fax to (512) 730-7484; or by e-mail to Dan.Huggins@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas Register.  It is anticipated that the rule will not be published until January 2014.

This change just applies to APRNs and PAs billing under their own numbers.