The reenrollment requirement also
“This has been a long time coming.”
applies to physician assistants and advanced practice registered nurses, psychologists, social workers, podia- trists, and chiropractors. At press time, roughly 98,000 Medicaid profession- als had yet to reenroll, according to the Texas Health and Human Services Commission (HHSC). Launched in April, the online
portal upgrades also coincide with a statewide effort to centralize the cre- dentialing process among Medicaid HMOs — an idea spurred on by Med- icaid reform legislation TMA backed in 2013 and carried out in another package of medicine-friendly Medic- aid bills won in 2015. (See “Medicaid in the Legislature,” page 56.) For Austin pediatric cardiologist
Hanoch Patt, MD, the changes mean he will no longer have to step away from caring for patients to sign paper documents and mail them to HHSC to complete the enrollment process he starts online. “It didn’t make sense,” the member of TMA’s Select Commit- tee on Medicaid, CHIP (Children’s Health Insurance Program), and the Uninsured, said. Dr. Patt says it can take two months
for HHSC to confirm his practice is reenrolled. Meanwhile, health plans wait on confirmation before they can recredential the physicians to remain active in their networks, allowing physicians to continue seeing patients and getting paid for their services — a process Dr. Patt says can take another month or two. If his practice hires a new physician, “you’re talking almost half a year before you’re ready to go.” “This has been a long time coming,
at least since the beginning of man- aged Medicaid [in 2012]. I don’t think HHSC was aware initially of the slow- down in these processes, and it took some time, but they now understand
the challenges from our standpoint,” Dr. Patt said. “It’s difficult enough to take care of these very vulnerable pa- tients who need good health care, so any kind of streamlining that decreas- es our cost of providing needed care for these patients is significant.” That’s especially true, he adds, after
the 2015 Texas Legislature ultimately nixed a plan to continue paying select primary care physicians at rates that match Medicare per ACA. Despite the House’s advancement of the measure, the plan dissipated in the final weeks of the session in favor of shifting the funds into sweeping tax cuts. ACA increased Medicaid primary care pay- ments to Medicare rates for 2013 and 2014 using federal funds, but the pay bump expired Dec. 31, 2014. “It’s important to recognize that
streamlining all of these Medicaid ad- ministrative processes is great. But it’s a small piece of a very big puzzle,” Dr. Patt said. “It’s so economically chal- lenging to take care of these patients, and we had the opportunity to be pro- active this session on a primary issue affecting Medicaid. We almost made it. But it’s extremely disappointing to see that work undone.”
ENROLLMENT MADE EASY HHSC has slowly but surely chipped away at the administrative red tape. “The legislature spoke loud and
clear, and we want providers to par- ticipate in the managed care system,” said Gary Jessee, deputy director for HHSC’s Medicaid and CHIP divi- sion. “Anything we can do, we want to do: enrollment, claims, credentialing, prior authorization. We are working through a number of those areas to try to improve the provider experience.” When it comes to enrollment,
HHSC Director of Claims Administra- tion and Operations Management K.J.
+ 54 TEXAS MEDICINE August 2015
TMHP provider reenrollment page:
www.tmhp.com/Pages/Topics/ACA.aspx
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