Comments to Medicaid/CHIP re: Foster Program

May 10, 2007

Ivy Bela, Program Specialist
Medicaid/CHIP Division
Texas Health and Human Services Commission
P. O. Box 85200, MC-H320
Austin, Texas 78708-5200

Proposed Rules §353.4 Medicaid Managed Care Out-of-Network Requirements

Dear Ms. Bela:

On behalf of the more than 500 hospital members, the Texas Hospital Association submits for your review and consideration the following comments to the proposed rules for out-of-network reimbursement for children’s hospitals that serve clients in the Medicaid Foster Care Program prepared for the May 10th Medical Care Advisory Committee.

As currently drafted, the Texas Hospital Association must oppose the proposed out-of-network reimbursement for children’s hospitals. THA opposes the draft rules because the HHSC has provided no rationale for establishing a different reimbursement methodology for children’s hospitals. Further, the proposed rules will provide the managed care organizations with unlimited and inappropriate discretion to determine what the out-of-network reimbursement amounts will be. If adopted, the proposed rules likely will generate a significant number of payment disputes between the MCOs and hospitals.

THA respectfully requests that the HHSC withdraw the proposed rules. As the intent of Senate Bill 6 (79-R) was to develop and assure a comprehensive health care services delivery model for Texas’ children in foster care, THA recommends that the HHSC support an out-of-network reimbursement policy that is based on the prevailing fee-for-service rate to children’s hospitals providing services in Medicaid Foster Care program.

If you have any questions or require further clarification, please do not hesitate to contact Charles Bailey, General Counsel at 512.465.1038 or Patricia Kolodzey, RN, BSN, Director of Advocacy and Public Policy at 512.465.1506.

Sincerely,