MISSION, TEXAS - A torrent of changes have besieged the Rio Grande Valley's health care delivery system, causing treatment clinics to curtail their services, pharmacies to close, and creating an access to care issue that has left thousands of Medicaid patients without healthcare.
At a news conference TODAY at the Mission Chamber of Commerce, Representative Sergio Muñoz, Jr. explained the new policies that the Health and Human Services Commission (HHSC) has adopted regarding their Medical Transportation Program. The state's re-interpretation of the law and pertinent rules have caused a major curtailment to access to care for children who are served by children's therapy centers.
The first blow came with a legislative change that cut reimbursement for physicians who serve patients eligible for both Medicaid and MediCare.
Then, on March 1, the new health care delivery system for Medicaid patients was rolled-out in South Texas, known as "managed care," whereby a set of managed care organizations have been named to administer the Medicaid program. An estimated 400,000 residents are being impacted.
Within weeks of the controversial transition to managed care, the Managed Care Organizations through their Pharmacy Benefit Managers allowed the reduction of a set of reimbursement rates for pharmacists, forcing many of our local pharmacies to close their doors.
The latest of these changes are two mid-March Health and Human Services Commission (HHSC) policy changes to their Medical Transportation Program (MTP)… The first of which disallows transportation to therapy clinics for children under 15 years of age unless accompanied by a parent or guardian, and secondly, once at the therapy center, allowing therapy only if a parent, guardian, or eligible consented adult is present. This change has created a devastating effect on patients and providers alike.
"The new interpretation of existing laws and rules by HHSC has created a hardship for many of our residents in Deep South Texas," explained Rep. Muñoz. "With the stroke of a pen the agency has sent therapy providers into a crisis mode to find a way to restore the access to this type of care for the children who need it most. The policy was changed from one day to the next without any prior notice and without any regard to our unique set of dynamics here in the Rio Grande Valley…
The absence of an effective public transportation system and the number of eligible Medicaid recipients compounds the effects of the policy for Valley."
Rep. Muñoz has had several meetings with the Commission to look for solutions to the challenges that the changes have created. Regarding changes to the MTP, Muñoz encourages all providers to abide by the current policy changes, but pledges to continue his work to find a compromise that will offer relief.
At a recent meeting with HHSC Executive Commissioner Tom Suehs, Senator Juan Hinojosa, Rep. Muñoz, and Suehs mutually agreed that a regional approach has to be taken when considering such important state policy.
"A one-size-fits-all approach is not appropriate in this case," continued Muñoz. "The health care of our children is much too critical of an issue to hastily develop state policy that effects a certain sector of the state much more than another. I wholeheartedly agree that the rules for MTP should be "tweaked" to allow for regionalization… allow for a specific region's set of dynamics including the local public transportation system (or lack thereof), the culture, and the historical practice be taken into consideration before the rules are adopted."
Rep. Muñoz has called for HHSC to suspend the new MTP policies, but to date the agency has no plans to do so. He and other Valley legislators are also calling for the agency to cease any new policies or rules that would cause a disruption in services, saying that our medical community requires a chance to stabilize.
Meetings will continue until a set of solutions can be agreed upon.
CONTACT: RICHARD P. SANCHEZ
121 E. Tom Landry