HHSC proposes eliminating Medicaid payments of Medicare Part B coinsurance, deductible for dual-eligible patients

Submit comments on the rules before Nov. 21

posted 11.16.11

As part of an effort to reduce the cost of Medicaid to the state, the 82nd Legislature directed the Health and Human Services Commission to implement many new initiatives aimed at trimming Medicaid expenditures by roughly $2 billion in general revenue in the 2012-13 biennium.

One eliminates Medicare Part B coinsurance and deductible payments for dually-eligible patients if the payment exceeds the Medicaid allowable. If Medicaid pays more than Medicare, the state would pay the coinsurance or up to the Medicaid allowable, whichever is less.

The HHS council considered the proposed rules at its September meeting and they were approved. Now, HHSC has published the rules for formal public comment. Scheduled to take effect Jan. 1, 2012, HHSC estimates this policy will save more than $400 million over the biennium.

At an HHSC meeting on Nov. 4, TMA President Bruce Malone, M.D., testified against this action, saying that while it will save millions, the savings “come at the expense of the health and well-being of some of the state’s most vulnerable citizens.”

He continued, saying that the proposed rules “penalize the physicians who care for the sickest and frailest Medicare patients. They hit particularly hard practices in rural, inner city, and border Texas since those practices serve a disproportionate number of dually eligible Medicare patients. In addition to compromising the financial viability of these practices, we fear that the rules could result in fewer physicians willing to set up a practice in the communities that most need them.”

To view the proposed rules, go to the Oct. 21 Texas Register and scroll to page 3 in the PDF (page 7057 in the document). HHSC will accept comments until Nov. 21. Submit comments by mail to Stephanie Stephens, Operations Coordinator, Medicaid/CHIP Division, Mail Code H100, Texas Health and Human Services Commission, PO Box 85200, Austin, TX 78708-5200; by fax to (512) 491-1977; or by e-mail to stephanie.stephens@hhsc.state.tx.us.