Court Sides with Home Health Agencies in Reimbursement Fight

A judge has ordered the Texas Health and Human Services Commission (HHSC) to accept telemonitoring reimbursement requests from home health providers, who claim the agency has failed to do so since the beginning of the year.

That’s according to the Austin American-Statesman. Previously, Home Health Care News reported on the four home health companies behind the lawsuit, who say they will go out of business — consequently depriving Texans of care — without court intervention.

Unidos Healthcare LLC; Corazon Health Care Services LLC; Cleveland Health Care LLC, which operates as Vital Connections; and Millennium Comfort Home Health Care LLC filed the suit in Travis County District Court Tuesday

In total, about 300 other home health providers in the state have also been affected, the agencies claim.

The lawsuit comes after the Centers for Medicare & Medicaid Services (CMS) and HHSC changed the telemonitoring service reimbursement codes, effective Jan. 1. The new codes must be filed by a physician, leaving home health agencies without a way to submit claims and be repaid for services.

Telemonitoring allows patients in remote areas or who have trouble traveling to be monitored at home rather than in hospitals. The services are used by thousands in the Lone Star State — which covers more than 260,000 square miles, much of which is rural — and, usually, are reimbursed under Texas Medicaid.

But since Jan. 1, HHSC has denied reimbursement requests filed by home health agencies because they were not filed by physicians, according to allegations in the lawsuit.

As a result, home health agencies have laid off hundreds of workers and discharged an unknown number of telemonitoring patients, according to the American-Statesman.

In the meantime, HHSC is working on a solution to the problem, the paper also reported.

Both sides are expected to appear in court again on Wednesday.