Home Health Agencies Sue Texas Over Reimbursement Halt

A group of home health agencies is suing the Texas Health and Human Service Commission (HHSC) for allegedly halting reimbursements for telemonitoring services. The agencies claim they will go out of business and deprive Texans of necessary care if the court doesn’t step in.

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, according to an article in Law360.

HHSC administers the Texas Medicaid program. The lawsuit alleges that the agency illegally discontinued the billing code for telehealth, in turn preventing home health agencies from being reimbursed for the telemonitoring services they provide to Texans with diabetes and high blood pressure.

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Telemonitoring — which allows patients in remote areas or who have trouble traveling to be monitored — is especially useful in Texas, as the Lone Star State covers more than 260,000 square miles, much of which is rural.

According to the lawsuit, the issues began January 1. Despite communicating plans in December to expand Texas’ home telemonitoring program, which became part of the state Medicaid program in 2011, HHSC has done the opposite, the agencies allege.

It implemented a special bulletin, effective at the start of the year, which changes the billing code and makes reimbursements effectively impossible.

“The consequences have been dire,” the home health agencies allege in the lawsuit. “In the two weeks since implementation of Special Bulletin 15, hundreds (if not thousands) of patients throughout Texas are no longer receiving home telemonitoring services, which is a vital part of their physician directed overall medical care.”

The lawsuit comes just a couple months after federal policymakers proposed a rule to expanded access to telehealth services through Medicare Advantage (MA) plans nationwide.

The changes, which would go into effect in 2020 if implemented, would give MA plans more flexibility to offer government-funded telehealth benefits to all enrollees, urban and rural. It would also allow MA enrollees to receive telehealth services from home.

Meanwhile, a hearing to address the Texas home health agencies’ temporary injunction request was set for Thursday.

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