Texas providers: Managed care is hurting Medicaid patients, businesses
The complaints were a familiar refrain for the
"Texas Medicaid managed care system faces great but surmountable challenges that must be addressed with all due haste, beginning with enhanced scrutiny not only of the health plans but also how the state's own actions -- including deep funding cuts and insufficient agency staff -- jeopardize Medicaid's ability to care for the neediest among us,"
READ: Hundreds of
Committee members held Wednesday's hearing in the
The problems that
Providers asked lawmakers Wednesday to force the more than dozen managed care organizations across the state to adopt similar processes and standards. Providers said the companies differ in what they consider a medically necessary service and will ask for different types of documents before approving a service, for example.
The burdensome paperwork has led to delays and denials of services for children who need them as well as payments to providers, providers said.
"A lot of the times requested information is in the reports, that's just not being read carefully," she said. "I don't create a different letter any more. I just circle the (information), but ... we still have to wait, and the kid is regressing each day they're not receiving therapy."
"It's not advocating for the need of this child," she said.
Other providers complained of insufficient pay for their therapists, who are leaving in droves; delays in communication between managed care organizations whenever a patient changes managed care plans; and a managed care organization abruptly dropping a provider without a clear explanation.
Members of a few managed care companies told lawmakers they would be willing to work together to standardize processes to eliminate paperwork for providers and offered to address providers' specific complaints at the hearing.
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The health commission has assessed more fines each year against managed care organizations. In 2009, the agency assessed
The agency freed up
"We're really here in a listening mode," said
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