Local home health agencies have started receiving Medicaid reimbursements again, putting a hold on court proceedings in a lawsuit they filed against the Texas Health Human Services Commission in January.
But while the agencies are currently receive payments for providing telemonitoring services, many questions remain to be solved including whether the agencies are even being reimbursed the correct amount.
Troubles began in January when a reimbursement code for telemonitoring services was discontinued at the end of 2018, leaving home health agencies that provide those services no way to get paid.
Four of those agencies — 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 — then filed a lawsuit in Travis County against Texas HHSC on January 15.
On Jan. 17, District Judge Catherine Mauzy who is presiding over the case, granted a temporary restraining order against HHSC.
“Shortly after the TRO was entered, I believe the state began to realize the seriousness of the situation they created and they began to make expedited payments to our clients which continued through the month of February,” said Greg Saikin, one of the attorneys representing the home health agencies.
“As a result of the expedited payments and their agreement to continue making them for our clients, we agreed to basically postpone any court proceedings with the understanding that they continue to make these payments.”
Carrie Williams, a spokesperson for HHSC, said the decision to discontinue the reimbursement code was made by the Centers for Medicare and Medicaid Services, the federal agency that helps administer Medicare and Medicaid.
“We’re exploring solutions to find other codes to work with so we can keep those services moving forward,” she stated in an email on Jan. 25. “We’re actively working on a code fix and on finalizing the rates.”
However, Saikin said there was some confusion as HHSC, through Texas Medicaid Healthcare, issued a bulletin in January notifying providers to issue claims under a specific reimbursement code only to issue a new bulletin earlier this month instructing them to re-submit claims under a different code.
“So it created further confusion within the provider community,” Saikin said.
There was also issues with the Remittance and Status Reports, or R&S reports, which are given to providers with information on which claims were being reimbursed and which claims were being denied.
“The R&Ss that were being sent out to our clients contain no information about the claims that were being paid, it just had an amount,” Saikin said. “Payments were made, there’s no question about that, but until we actually get accurate R&S statements, we don’t know whether we were potentially underpaid.”
Saikin said they had not received a response from the state on why they hadn’t received accurate R&S reports.
Williams, the HHSC spokesperson, did not immediately respond to a request for comment Saturday.
A hearing on the lawsuit has not been rescheduled and it is unclear when the parties will be back in court.
“We’re hoping to work through these issues informally with the state,” Saikin said.