Texas DME Suppliers Rally to Stop Reimbursement Cuts

AUSTIN, Texas (March 6, 2018)—Dozens of medical equipment suppliers in Texas rallied together to successfully prevent proposed reimbursement cuts by Superior HealthPlan. The cuts, which suppliers were notified of in a letter received in early February, would have been substantially lower than Texas state Medicaid, reducing rates for certain product categories from 85 percent of Texas Medicaid to 60 percent, with a few suppliers receiving a reduction to 65 to 70 percent.

The letter gave providers 30 days to accept or reject their plan. Those who decided to reject the new rates would have their Participating Provider Agreement terminated by Superior HealthPlan. For all other suppliers, the rates would go into effect beginning May 1, 2018. Multiple suppliers reported to VGM that they never received the written notification due to inaccurate mailing addresses by Superior and later determined that the rates would be impacting their contracted reimbursement rates.

VGM Group organized a provider conference call with providers who were prepared to voice their concern with Superior, Texas Health and Human Services Commission and their elected officials.

“Providers stepped up and answered the call for action by engaging with public officials to display their opposition to these egregious cuts,” said Collin Brecher of VGM Government Relations. “Texas providers, huddling around the TexMEP state association as a unified front, proved to be an extremely effective strategy. While states are looking to trim their budgets, these proposed cuts are going to continue to appear, and providers in all states must remain proactive by building relationships at the state level to prevent these types of harmful cuts from being implemented.”

Providers also engaged legal counsel led by Brown & Fortunato to file a formal complaint with Texas HHSC to demonstrate how these cuts are not reflective of the “market” as Superior had noted in the initial notification of these cuts.

“We are exceptionally pleased that Superior reconsidered their recent plan to cut reimbursement and force providers to accept rates below market value,” said Texas Medical Equipment Providers association in a released statement. “This was achieved thanks to many providers who reached out to their Superior representatives, attorneys, and HHS to voice their concerns. As an association, we plan to continue discussions with HHS relating to the value of DME and the issues we encounter as providers.”

In a February 26 online notification, Superior HealthPlan released the following statement: “Superior HealthPlan is committed to providing cost effective, high quality services and products to our members. Based on further evaluation of our recent proposed reimbursement restructuring for specific medical supplies for durable medical equipment (DME) providers, we are suspending the restructuring at this time. We will be working with the Texas Health and Human Services Commission (HHSC) to address DME costs as directed by the 85th Legislature in potentially a different type of provider based initiative at a later date.”

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