TDMR Claims Providers Wary as Medicaid Bill Moves

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Texas Dentists for Medicaid Reform ("TDMR") calls for more "due process" by Texas Medicaid regulators

As the Texas Senate's Health and Human Services Committee approved Senate Bill 1803, a spokesperson for Texas Dentists for Medicaid Reform ("TDMR") called for more "due process" within the state's Medicaid regulatory apparatus.

In a statement critical of the Texas' Republican leadership, Chuck Young, TDMR's Communication Director, claimed the bill was originally "much more substantial," but that a committee substitute had seen "most of the best parts of SB 1803... taken out."

"The worst changes were the ones that impacted the so-called 'CAF holds', payment holds based on 'credible allegations of fraud'," Young said. "The old bill had some definitions of what a 'credible allegation of fraud' actually is, and had strict time limits... on payment holds. It also provided for much more well-defined processes in the determination of the actual credibility of these allegations. But most importantly, it gave providers an opportunity to respond to allegations before a CAF hold is put in place."

According to Young, provisions in the old bill missing from the new bill include:

"The provider now has no opportunity to respond to the CAF before their payments are held. This is the number one due process issue facing all Medicaid providers."

"The notion of a 'credible allegation' isn’t even defined in the new version. The problem right now is that a CAF is open to interpretation."

"CAF’s are subject to an 'integrity review', but as far as we can tell, these reviews will be unavailable for scrutiny by anyone outside of OIG. So much for accountability; the problem right now is that all these investigations are completely internal to OIG."

"Overpayment hearings can still be conducted by HHSC if the OIG chooses to go that route (we’re betting they’d generally want to be judge, jury & executioner)."

"Costs for hearings (both CAF hold hearings and overpayment hearings) are now to be split with providers! These are the same providers who are already being bankrupted by the CAF holds while trying to pay their attorneys."

Young was especially concerned over rumors that "the Governor and friends are actively making sure that the bill remains in its current state, or that nothing passes at all." He closed on a note of cautious optimism: "We’ll keep hoping... that as the bill moves forward, we see some signs of a genuine interest in concepts like rule of law and due process on the part of Texas’ conservative majority."

Background: Texas Dentists for Medicaid Reform is a 501(c)4 founded by dental practitioners "concerned about the future of dental care for the over three million Texas children eligible for Medicaid."

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