AUSTIN, Texas — On Feb. 11, Texas Medicaid providers were surprised to learn of changes to incontinence products quantities that will take effect April 1. According to Barry Johnson, president of the Texas Alliance for Home Care Services, the change was posted on the state's Medicaid website "literally overnight with no notice."
"The manufacturers we contacted were very concerned and uninformed," Johnson said. "They must now re-tool their packaging to meet the new supply requirements," he said, noting at least one major vendor has said meeting the April 1 date isn't possible.
Johnson said affected items include diapers, pull-ups and liners, which will be reduced from 300 per month per beneficiary to 240; and underpads, which will be reduced from 150 per month per beneficiary to 120.
If beneficiaries need more, providers must get a letter of medical necessity from the physician demonstrating need, although "we have no guidance what would qualify on the LMN for approval of additional supplies," Johnson said.
"This is absolutely ridiculous because it affects special needs beneficiaries with diseases such as cerebral palsy, spina bifida and muscular dystrophy," he continued, pointing out that patients with "these and other neuromuscular diseases never experience improvement in their urinary control. In fact, the loss of bladder control becomes worse by age.
"These reductions will severely affect special needs beneficiaries ... most are children," Johnson said. "Guess nobody said the state had a heart for less fortunate individuals who cannot go to the Capitol and complain."
Another issue for Medicaid providers, Johnson said, has added Texas to the list of states eying "competitive procurement" for DME.
Based on a proposal from Thomas Suehs, executive commissioner of the Texas Health and Human Services Commission, the new system would take effect in September 2012 and would either limit Medicaid providers to those selected through a competitive procurement process or through competition for exclusive manufacturer agreements.
"Either approach will result in lower reimbursement rates," Suehs said in a report presented Feb. 17 to the state's Senate Finance Committee on Medicaid.
Johnson said he would be testifying before the committee about the effects of such a change "if they will listen."
Last year, Texas Gov. Rick Perry threatened to opt out of Medicaid. The state is now asking the federal government for permission to operate the program as it sees fit.
Texas Medicaid covers 3.6 million beneficiaries, and the state spends 25 to 30 percent of its budget on the massive program. That figure could rise to 40 percent if growth trends continue, state officials believe.