June 25, 2007
 

 
TOA President's Update
  

By John T. Gill, MD
President, Texas Orthopaedic Association

This week, I am at the Annual Meeting of American Medical Association in Chicago.  The TOA is well represented in the Texas Delegation to the AMA with six active members.  In fact, orthopaedics is well represented at the AMA with over 60 members in the orthopaedic section.  In total, there are 555 delegates representing all of medicine in America.  The

current president is William G. Plested, MD, a surgeon from Los Angeles, CA.  The meeting runs from Saturday through Wednesday, and we cover a lot of material.

In the five days, we will dissect, debate, rewrite and vote on just under 300 reports and resolutions.  The work is divided into eight reference committees and we are each assigned to one.  Mine is Reference Committee B, Legislation, with five reports and 30 resolutions.  In addition, there will be specialty section meetings and educational sessions covering such topics as innovations in medical education, CMS physician quality reporting, and health information technology.  The printed material for the meeting now arrives at my office in a four inch deep cardboard box.

Of particular interest this year will be a forum on the National Health Care Policy Agenda.  This is the result of a resolution that was passed at the meeting last year calling upon the Board of Trustees to assemble and promulgate a National Health Care Policy Agenda to help drive the health care policy debate in the 2008 presidential election.  The agenda is the natural extension of the ongoing work of the Board in setting the strategies of the AMA to carry out AMA policy.  Basically, it is an attempt to articulate what we as physicians believe medicine should look like and how it should function going forward.  Believe me, there are lots of different opinions out there, even within the house of medicine, and the debate promises to be lively.

In coming issues, I will keep you abreast of the results of this debate.  In the meantime, I encourage each of you to listen to the various positions the candidates espouse about health care and decide for yourself what is important to you.  I hope all of you are having a wonderful summer.
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Notice of Public Hearing on Proposed Medicaid Payment Rates
     

Hearing.  The Texas Health and Human Services Commission will conduct a public hearing to receive public comment on the proposed elimination of the 2.5 percent Medicaid payment reduction for Medicaid professional providers and outpatient facilities, which was implemented September 1, 2003, in accordance with legislation enacted during the 78th Legislature, Regular Session, 2003. The public hearing will be held in the Lone Star Conference Room of the Health and Human Services Commission, Braker Center, Building H, located at 11209 Metric Blvd,

Austin, Texas.  Entry is through Security at the main entrance of the building, which faces Metric Boulevard.  The hearing will be held in compliance with Human Resources Code §32.0282 and Texas Administrative Code (TAC) Title 1, §355.201(e)-(f), which require public notice and hearings on proposed Medicaid reimbursements. Persons requiring Americans with Disability Act (ADA) accommodation or auxiliary aids or services should contact Kimbra Rawlings by calling (512) 491-1174, at least 72 hours prior to the hearing so appropriate arrangements can be made.

Proposal.  The proposal will eliminate the use of 2.5 percent Medicaid payment reduction factor and will increase the Medicaid payments to Medicaid professional providers and outpatient facilities for services covered by the Medicaid payment reduction that was implemented September 1, 2003.  The elimination of the use of the 2.5 percent Medicaid payment reduction factor is effective September 1, 2007.

Methodology and justification.  The 2.5 percent payment reduction was implemented as a result of the 2004-05 General Appropriations Act (Article II, Special Provisions, Section 28, H.B. 1, 78th Legislature, Regular Session, 2003) and Section 2.03 of H.B. 2292, 78th Texas Legislature, Regular Session, 2003.   The actual rates were not reduced effective September 1, 2003.  Instead, a 2.5 percent payment reduction factor was applied to Medicaid payments for Medicaid professional and outpatient facility services at the end of the claims payment process, as the last step before calculation of the actual payment.

The 2.5 percent Medicaid payment reduction was applicable to professional services delivered by physicians and other professional providers (e.g., ambulance providers; clinical laboratory services providers; advanced practice nurses (APNs), including nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs); psychologists; licensed professional counselors (LPCs); licensed clinical social workers (LCSWs); licensed marriage and family therapists (LMFTs); podiatrists; chiropractors; home health agencies; Texas Health Steps (THSteps) providers; laboratories; radiology providers; radiation therapy providers; family planning providers; hearing aid services providers; optometrists, opticians, and other vision care providers; in-home services for total parenteral hyperalimentation; physical therapy providers; occupational therapy providers; audiologists; speech-language-pathology providers; respiratory care providers; Case Management for Children and Pregnant Women providers; physician assistants (PAs);  and the like) and outpatient facilities (e.g., hospitals, ambulatory surgical centers (ASCs)/ hospital ASCs (HASCs); maternity service centers; renal dialysis facilities; birthing centers; tuberculosis clinics; and the like).

The 2.5 percent Medicaid payment reduction was not applicable to Medicaid payments for services provided by federally qualified health centers (FQHCs); rural health clinics (RHCs); services provided by public providers that fund the state share of their payments through certification of public expenditures; Targeted Case Management for Early Childhood Intervention services; payments for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); payments for physician-administered drugs, biologicals, blood products, and radiopharmaceuticals; children's hospitals; Medicare crossover claims; and Indian Health Services.

The 2008-09 General Appropriations Act (Article II, Special Provisions, Section 57(a)(3)(i), H.B. 1, 80th Legislature, Regular Session, 2007) appropriated $103.8 million general revenue funds for the State Fiscal Year 2008-09 biennium for this restoration.

Briefing Package.  A briefing package describing the proposed elimination of the 2.5 percent Medicaid payment reduction will be available on or after June 25, 2007.  Interested parties may obtain a copy of the briefing package prior to the hearing by contacting Kimbra Rawlings by telephone at (512) 491-1174; by fax at (512) 491-1998; or by e-mail at Kimbra.Rawlings@hhsc.state.tx.us.  The briefing package also will be available at the public hearing.

Written Comments.  Written comments regarding the proposed payment rates may be submitted in lieu of, or in addition to, oral testimony until 5 p.m. the day of the hearing.  Written comments may be sent by U.S. mail to the attention of Kimbra Rawlings, Health and Human Services Commission, Rate Analysis, Mail Code H-400, P.O. Box 85200, Austin, Texas 78708-5200; by fax to Kimbra Rawlings at (512) 491-1998; or by e-mail to Kimbra.Rawlings@hhsc.state.tx.us.  In addition, written comments may be sent by overnight mail or hand delivered to Kimbra Rawlings, HHSC, Rate Analysis, Mail Code H-400, Braker Center, Building H, 11209 Metric Boulevard, Austin, Texas 78758-4021.   
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This Week In Texas: Mignon McGarry Memos

By Mignon McGarry
TOA Legislative Advocate / Memos: Thu May 10 & Tue May 8, 2007
TOA Online Version: All Memos

 

June 18th, Tuesday
 Late Friday afternoon, Governor Perry announced that he had vetoed 49 bills, bringing his total number of vetoed bills and resolutions for 2007 to

52.  This number was far from his record setting 83 in 2001 but significantly more than the 20 bills vetoed in 2005.

Other than HB 1892, the transportation bill vetoed by Perry in May, the veto of HB 2006 relating to the use of eminent domain authority received the most attention.  HB 2006 by Rep. Beverly Woolley/Sen. Kyle Janek contained a controversial provision which would have required a governmental entity to compensate property owners for road projects that reduce access to their property.

Governor Perry used his line item veto authority to cut $570 million from HB 1, the state’s budget for 2008-2009.  The budget, as approved by Perry, increases the state’s general revenue spending by $7.7 billion or 11.8 percent over the current budget.

The full text of the veto proclamations can be found on Governor Perry’s website at http://www.governor.state.tx.us.
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Disability Management for Injured Texas Workers
    

Click here to view the flyer TMA has created to educate our members about the new Disability Management requirements in the workers' compensation system.
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