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Tuesday, January 17, 2012

STATE CONSIDERING SOME CHANGES FOR DUAL-ELIGIBLES

The Texas Health and Human Services Commission (HHSC) is willing to make adjustments to its new policy of not paying coinsurance and deductible payments for Medicare Part B services for patients eligible for both Medicare and Medicaid, Billy Millwee, deputy executive commissioner for health services, told a group of physician leaders at a meeting that TMA coordinated. Mr. Millwee said HHSC will examine where the new policy has created specific access problems for patients of some specialties — such as oncology, where the charges for chemotherapy substantially skew the total cost of care. However, to reduce the size of the cut, HHSC will need specialty societies to help identify Medicaid cost savings to help offset any changes to the new policy. Mr. Millwee said the Texas Legislature charged the commission with saving nearly $300 million via this policy change, and HHSC has no authority to reverse course broadly. Dr. Malone and Carlos Cardenas, MD, represented the TMA Board of Trustees at the meeting, which also included physician leaders from anesthesiology, ophthalmology, radiology, emergency medicine, oncology, internal medicine, orthopedics, allergy/immunology, and the Border Health Caucus. Texas needs a long-term solution to the high cost of caring for the “dual eligibles.” There is no financial incentive for states to improve continuity of care for these patients since the majority of any savings would accrue to the federal government, which pays for their acute-care services. A couple of states have shown significant savings through a federal waiver that promotes stronger case management for these patients. The federal government is considering additional pilot programs that would allow states and the federal government to share in any cost savings by improving care for dual eligibles.

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