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Featured, from left, prior to a legislative briefing with Speaker of the House Joe Straus, R-San Antonio, on Tuesday, June 17 at the Edinburg Conference Center at Renaissance, are: McAllen Mayor Jim Darling; Rep. Sergio Muñoz, Jr., D-Mission; and McAllen City Commissioner Trey Pebley.

Photograph By MARK MONTEMAYOR

The House Committee on Appropriations, which includes Rep. Sergio Muñoz, Jr., D-Mission, and Rep. Óscar Longoria, Jr., D-La Joya, on Thursday, March 12, approved the continued funding of Medicaid-to-Medicare parity payments, starting September 1, 2016, in the amount of $460 million. The funding decision is also part of the state legislative agenda of the Edinburg Mayor, Edinburg City Council and the Edinburg Economic Development Corporation. The EEDC is the jobs-creation arm of the Edinburg Mayor and Edinburg City Council. “There is a clear need to address the inadequacy in Medicaid payments,” said Muñoz. “The House Appropriations Committee has budgeted sufficient funds to counteract the growing trend of doctors opting out of Medicaid due to low reimbursement rates. These appropriations will help ensure the longevity of the Medicaid and CHIP services that safeguard the health of millions of Texans and allow us to continue planning for advancements in medical services and technology.” The March 12 action follows requests from primary care physicians statewide and through advocacy organizations such as the Texas Medical Association (TMA) so the state government can retain doctors who participate in Texas’ Medicaid program and CHIP, the Children’s Health Insurance Program, and to ensure that eligible Texans can continue to have access to medical care, according to the TMA. Medicaid and CHIP provide medical coverage for more than 4.6 million low-income Texans as of December 2014. The programs cover half of all children in the state and help provide care for two-thirds of people in nursing homes. In Texas, all CHIP services and most Medicaid services are delivered through managed care health plans under contract with the state, according to the Texas Health and Human Services Commission. The $460 million appropriation, which will be included in the final state budget to be presented for action by the full 150-member House of Representatives, was approved upon the recommendation of the Sub-Committee on Article II – Health and Human Services (HHSC), on which Longoria serves. “Having met with and discussed this issue with many doctors from my district, as well as physicians from across Texas, I, along with my colleagues on the sub-committee, have come to understand the inadequacy of Medicaid payments and the need to pay better to expand access to care,” said Longoria. “We need to invest the necessary resources to improve appropriate and timely access to medical services for Medicaid patients, not only by maintaining higher payments for primary care physicians, but also by ensuring competitive physician payment rates for sub-specialists and CHIP.”

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$460 million plan by House Appropriations Committee, which includes Rep. Muñoz and Rep. Longoria, would help protect Texas Medicaid and CHIP, Edinburg EDC announces

By DAVID A. DÍAZ
Legislativemedia@aol.com

The House Committee on Appropriations, which includes Rep. Sergio Muñoz, Jr., D-Mission, and Rep. Óscar Longoria, Jr., D-La Joya, on Thursday, March 12, approved the continued funding of Medicaid-to-Medicare parity payments, starting September 1, 2016, in the amount of $460 million.

The funding decision is also part of the state legislative agenda of the Edinburg Mayor, the Edinburg City Council and the Edinburg Economic Development Corporation.

The EEDC is the jobs-creation arm of the Edinburg Mayor and Edinburg City Council.

The action follows requests from primary care physicians statewide and through advocacy organizations such as the Texas Medical Association (TMA) so that the state government can retain doctors who participate in Texas’ Medicaid program and the Children’s Health Insurance Program (CHIP), and to ensure that eligible Texans can continue to have access to medical care, according to the TMA.

Medicaid and the CHIP provide medical coverage for more than 4.6 million low-income Texans as of December 2014, Muñoz said, citing statistics by the Texas Health and Human Services Commission.

“There is a clear need to address the inadequacy in Medicaid payments,” said Muñoz. “The House Appropriations Committee has budgeted sufficient funds to counteract the growing trend of doctors opting out of Medicaid due to low reimbursement rates. These appropriations will help ensure the longevity of the Medicaid and CHIP services that safeguard the health of millions of Texans and allow us to continue planning for advancements in medical services and technology.”

The $460 million appropriation, which will be included in the final state budget to be presented for action by the full 150-member House of Representatives, was approved upon the recommendation of the Sub-Committee on Article II – Health and Human Services (HHSC), on which Longoria serves.

“Having met with and discussed this issue with many doctors from my district, as well as physicians from across Texas, I, along with my colleagues on the sub-committee, have come to understand the inadequacy of Medicaid payments and the need to pay better to expand access to care,” said Longoria. “We need to invest the necessary resources to improve appropriate and timely access to medical services for Medicaid patients, not only by maintaining higher payments for primary care physicians, but also by ensuring competitive physician payment rates for sub-specialists and CHIP.”

Muñoz and Longoria are the only Valley legislators on the 27-member House Committee on Appropriations, and both men have worked closely with TMA leaders and physicians from their House districts to help protect Medicaid and CHIP.

The recent federal funding to increase primary care physician payments expired December 31, 2014. Without the higher payments, many organizations feared that the physician Medicaid participation would again enter free fall.

“Physicians support Medicaid and want to participate,” said Dr. Martín Garza a practicing pediatrician from Edinburg and member of the Texas Medical Association. “Yet, as owners of small businesses, facing ever more costly and demanding federal and state regulatory burdens, many cannot afford to stay in a program that pays less than half their costs.”

From 2012 to 2014, physician participation in Medicaid rose five points, a jump attributable to the temporary two-year primary care physician rate increase paid for with federal funds. Similarly, in 2008, physician participation also increased after Texas lawmakers invested new monies to improve the physician Medicaid network.

Without the programs, the vast majority of Medicaid and CHIP patients would be uninsured, thereby depriving them of access to affordable preventive, primary and specialty care, the TMA contends.

“But a Medicaid card does not access make. Inadequate physician payment rates have forced many physician practices to limit their Medicaid and CHIP participation or cease it altogether,” said Ryan Van Ramshort, M.D. “Medicaid payments are the least competitive among all insurers, ranging from 48 percent to 87 percent of Medicare and 41 percent to 73 percent of commercial insurance payments. These rates are hardly enticing, particularly when many practices can barely keep up with demand for their services from better paying privately insured patients.”

Ramshort is a staff physician (pediatrician) for University Health System in San Antonio, and he serves on the faculty of the Department of Pediatrics at the University of Texas Health Science Center at San Antonio School of Medicine.

Highlights of Ramshort’s testimony in support of the continued funding of Medicaid-to-Medicare parity payments, which he delivered on Tuesday, February 16, to the Sub-Committee on Article II – Health and Human Services (HHSC), follow:

Good morning Chairman (Rep. Walter T. “Four”) Price (R-Amarillo) and committee members.

I am Ryan Van Ramshorst, a San Antonio pediatrician testifying today on behalf of the Texas Medical Association, Texas Pediatric Society, Texas Academy of Family Physicians, and Federation of Texas Psychiatry to urge you to take bold action to improve Medicaid and CHIP patients’ access to needed services by enacting competitive physician payments in these programs.

Medicaid and CHIP together serve more than 4.6 million Texans, people we all know or encounter every day, including hard working, low-income parents and their children as well as people with disabilities and seniors. Without the programs, the vast majority of Medicaid and CHIP patients would be uninsured, thereby depriving them of access to affordable preventive, primary and specialty care.

But a Medicaid card does not access make. Inadequate physician payment rates have forced many physician practices to limit their Medicaid and CHIP participation or cease it altogether.

Medicaid payments are the least competitive among all insurers, ranging from 48 percent to 87 percent of Medicare and 41 percent to 73 percent of commercial insurance payments. These rates are hardly enticing, particularly when many practices can barely keep up with demand for their services from better paying privately insured patients.

According to TMA’s biennial physician survey, in the year 2000, 67 percent of Texas physicians accepted all new Medicaid patients. Today, that number is 34 percent. The good news is that increasing physician Medicaid payments actually reverses the decline in participation.

From 2012 to 2014, physician participation in Medicaid rose five points, a jump attributable to the temporary two-year primary care physician rate increase paid for with federal funds. Similarly, in 2008, physician participation also increased after Texas lawmakers invested new monies to improve the physician Medicaid network.

Unfortunately, the recent federal funding to increase primary care physician payments expired December 31. Without the higher payments, our organizations fear that physician Medicaid participation will again enter free fall. Physicians support Medicaid and want to participate. Yet, as owners of small businesses, facing ever more costly and demanding federal and state regulatory burdens, many just cannot afford to stay in a program that pays less than half their costs.

Over the past 18 months, there has been considerable attention paid to Texas’ “broken” Medicaid system, with particular interest in the plummeting physician Medicaid participation rate and the impact that exodus is having on patients’ ability to obtain timely, medically necessary care.

We agree that Medicaid needs a facelift. We want to work with you to continue to identify common sense changes that will benefit patients and the provider network while also improving patient outcomes and lowering costs. But while the federal government contributes to challenges facing Texas Medicaid, it is the Texas Legislature, not Congress, that determines how much Medicaid and CHIP pay physicians.

As you write the 2016-17 budget, we urge you to invest the necessary resources to ensure Medicaid and CHIP patients can access timely physician services they need to be healthy and productive.

Specifically, we urge you to support the following:

• Reinstate the Medicaid to Medicare parity payments for primary care physicians (PCPs). For the past two years, PCPs received the higher payments as a result of federal funding. But the payments expired December 31, 2014. At least six other states, including Alabama, have voted to sustain the higher payments to ensure an adequate physician network for their Medicaid beneficiaries;

• Extend the parity payments for primary care to services provided to CHIP;

• Establish competitive Medicaid and CHIP payment rates for physician specialties not included in the Medicaid to Medicare parity increase;

• Reverse the so-called Medicare “equalization” cut from 2011. Under the policy, Texas generally no longer pays physicians the 20 percent Medicare Part B coinsurance for patients poor enough to qualify for Medicare and Medicaid; and

• Reverse the eight percent payment reduction for Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs) practicing under physician supervision. The cut, which took effect earlier this month, will undermine Texas’ efforts to promote team-based models of care, an essential element of reforming the Medicaid delivery system.

We know our request will entail significant new costs. But fixing a Medicaid system widely acknowledged to be in need of repair must begin with bold action by Texas leaders.

(See more at: http://www.texmed.org/Template.aspx?id=32971#sthash.XoyfdQRs.dpuf)

Medicaid and Medicare are two different programs.

Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.

Medicaid is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines.

CHIP is health insurance designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy private health insurance. To qualify for CHIP, a child must be under age 19, a Texas resident and a U.S. citizen or legal permanent resident. CHIP enrollment fees and co-payments are based on the number of people in the family and the family’s income and assets. Enrollment fees doe not exceed $50 for each six-month term of eligibility and some families pay no enrollment fee. Most co-payments for doctor visits and prescription drugs range from $3 to $10.

For more information regarding Medicare and its components, please go to:

http://www.medicare.gov.

For more information regarding Medicaid, please go to:

http://www.medicaid.gov

For more information regarding CHIP, please go to:

http://www.hhsc.state.tx.us/chip/families/

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The Edinburg Economic Development Corporation is the jobs-creation arm of the Edinburg City Council. It’s five-member governing board, which is appointed by the Edinburg City Council, includes Mayor Richard García as President, Fred Palacios as Secretary-Treasurer, and Felipe García, Dr. Havidán Rodríguez, and Steven Edward Cruz, II. For more information on the EEDC and the City of Edinburg, please log on to http://www.EdbgCityLimits.com or to http://www.facebook.com/edinburgedc

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