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Monday, October 26, 2015

TMA Submits 16 Recommendations to Improve Texas Medicaid


As last week’s Texas Medicaid Congress illustrated, Medicaid’s cumbersome regulations make it that much more unlikely that physicians will participate in a program that pays so poorly. Boosting physicians’ Medicaid pay remains one of TMA’s top priorities, but that requires action by the legislature, which doesn’t meet again until 2017. Meanwhile, TMA and the Texas Pediatric Society submitted a list of 16 recommendations to Health and Human Services Commissioner Chris Traylor to make Medicaid and Medicaid HMOs work better for physicians. Among our ideas:
  • Require Medicaid HMOs to process physician credentialing applications at the same time the state is processing Medicaid enrollment. Physicians tell us it can take six months or more to enroll in Medicaid, become credentialed by the HMOs, and begin seeing HMO patients.

  • Simplify and streamline the Medicaid Vendor Drug program. The drug benefit is too complicated, frustrating, and time-consuming for physicians. No other payer has such a byzantine pharmacy benefit, thus fueling physicians’ reluctance to participate in Medicaid.

  • Make the various insurance companies and HMOs handle coordination of benefits. Stop recouping payments from physicians and forcing them to find the right insurer to bill.

  • Promote adoption of innovative Medicaid delivery models, such as physician-led accountable care organizations or patient-centered medical homes.

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