Public Comment — Medicaid Therapy Rate Reductions

Public Policy Input — 2017

TCDD letterhead May 2017

Public Comment
Medicaid Therapy Rate Reductions
May 31, 2017

Thank you for the opportunity to provide comments on the proposed Medicaid payment rates for physical, occupational, and speech therapy provided by Comprehensive Outpatient Rehabilitation Facilities/Outpatient Rehabilitation Facilities (CORF/ORF), home health agencies, and independent therapists. The Texas Council for Developmental Disabilities (TCDD) is established by state and federal law and is governed by 27 board members, appointed by the Governor, 60% of whom are individuals with developmental disabilities or family members of individuals with disabilities. TCDD’s purpose in law is to encourage policy change so that people with disabilities have opportunities to be fully included in their communities and exercise control over their own lives.

Therapies play a critical role in helping Texas’ children with developmental delays reach their potential. Children who experience disability early in life can be disproportionately exposed to risk factors such as poverty; stigma and discrimination; poor caregiver interaction; institutionalization; violence, abuse and neglect; and limited access to programs and services, all of which can have a significant effect on their survival and development.1 Families often experience frustration, stress, disappointment, and helplessness when their children miss some of the most important learning and developmental milestones. This can impact the entire well-being of the family and can further affect the development of the child. Children and families rely on pediatric acute therapies to help them learn to crawl, walk, swallow, communicate, and prevent further delays or to meet other developmental goals. Pediatric acute therapies also build a nurturing and supportive environment for the entire family.

The Texas Health and Human Services Commission (HHSC) is proposing additional therapy rate methodology changes that, if implemented, would result in reductions of about 30% for services provided by therapy assistants. This reduction is predicted to disproportionately affect recipients who require services in languages other than English. We recommend an exemption, or a more limited reduction, for pediatric acute therapy services provided in languages other than English.

Substantial testimony from families indicate diminished access to care and waiting lists for assessments for medically necessary pediatric acute therapies. HHSC reports very few substantiated complaints associated with access to therapies. This is not surprising since HHSC does not collect or maintain the data necessary to officially substantiate an access to care issue. Despite the lack of data, the barriers faced by families of children with complex needs are real.

New reporting legislative requirements will require HHSC to track the reasons for pediatric acute therapy provider withdrawal, the number of children on waiting lists who are unable to access pediatric acute therapy, and the number of pediatric acute therapy providers no longer accepting new clients. However, the Senate Bill 1 rider limits this data collection to pediatric therapies only. We recommend:

  • collecting the data for both adult and pediatric therapies,
  • disaggregation to monitor access to therapies for persons requiring services in languages other than English, and
  • delaying additional rate reductions until new reporting requirements are implemented and the results are analyzed.

Early Childhood Intervention (ECI) providers are withdrawing from the ECI program. The federal Office of Special Education Programs reported notification from HHSC last fall that of 47 ECI providers, there are potentially 12 more providers expected to withdraw from the Texas ECI program. These additional policy changes and rate reductions will further exacerbate the ECI provider crisis. We continue to recommend therapy rate reduction exemptions for ECI providers.

Providers across the system report significant added costs associated with transitions to managed care. The transition to managed care in concert with compounded rate reductions are destabilizing the therapy provider network essential to healthy futures for children with complex needs. Without unimpeded access to acute services, some children with disabilities will not be able to take advantage of other community services that support educational inclusion, community integration, and employment and will be forced to seek support in more expensive, segregated settings. All children are enriched by being part of a community that promotes their physical, social, and intellectual well-being and leads to independence and self-determination. Texas will miss the most crucial phase of growth and development to prevent or lessen the need for more expensive services in the future if children do not have adequate access to acute therapy services.

HHSC should not proceed with the rate reductions without an objective review of the network impact of transition to managed care and the December 2016 rate reductions. An honest dialogue about preserving acute therapy capacity, the true cost of service provision, and individual access to care is needed.

We look forward to additional rate packets to implement the 25% restoration of the December 2016 rate reductions approved in Senate Bill 1 and a delay and phase-in of any changes to existing rates.

Respectfully submitted,
Jessica Ramos, Public Policy Director


  1. World Health Organization, Early childhood development and disability: discussion paper, 2012.