Order brings back Medicaid refunds for local agencies

Four Rio Grande Valley home healthcare agencies will start receiving reimbursements again after a judge ordered the Texas Health and Human Services Commission to accept Medicaid reimbursement requests from the agencies.

The directive came via a temporary restraining order issued against HHSC on Thursday by District Judge Catherine Mauzy in Travis County.

It was filed on behalf of Unidos Healthcare LLC, Corazon Health Care Services, Cleveland Health Care and Millennium Comfort Home Health Care, which are either based in or have offices in the Valley.

The agencies alleged they’ve been unable to receive reimbursements for telemonitoring services since the beginning of the year, when HHSC discontinued a procedure code through which those agencies filed reimbursement claims.

According to the attorney for the agencies, Edward Friedman, the move has led to hundreds of patients throughout the state being unable to receive telemonitoring services and hundreds of employees that provided those services to be furloughed.

Home telemonitoring services allow healthcare providers to monitor a patient’s health status remotely.

The agencies argued that unless the restraining order was granted against HHSC, “thousands of Texas’ most vulnerable citizens will lose vital health services causing irreparable harm to them and the health care providers who invested untold millions of dollars to provide home telemonitoring services to these citizens.”

The agencies alleged that it also violates a 2011 mandate by the Texas legislature to implement a home telemonitoring program as part of Texas Medicaid.

Friedman said HHSC’s explanation had been that the Centers for Medicare and Medicaid Services, which is the federal agency that coordinates between Medicare and Medicaid, discontinued the reimbursement code but haven’t explained why they hadn’t just used another code.

A spokesperson for Texas Health and Human Services, Carrie Williams, did not return a request for comment late Friday but told the Austin-American Statesman that HHS was exploring solutions to find other codes to work with for those services.

But how the situation unfolded in the first place remains unclear.

“From my perspective, I don’t think there has been a clear answer from HHSC,” Friedman said. “Theres’s a lot of confusion.”

However, Friedman said he doesn’t believe it was the commission’s intent to end reimbursements for those services, noting a 2018 report to the Texas legislature that the commission is required to deliver biannually.

“They talked about wanting to expand the program, particularly in underserved and under-utilized areas like the Valley,” he said. “So it’s certainly not their stated intent to discontinue the program.”

The parties are expected to be in court again on Wednesday for a temporary injunction hearing, during which the agencies hope the restraining order will be extended in order to keep receiving reimbursements until the matter is resolved.

“We’re going to go in on Wednesday and argue hard to make sure that the restraining order is not lifted while THHSC finds a fix … a solution, Friedman said.