TX Medicaid Speech Therapy CCP Changes Jan 2014

[Mosaicspeech]

I am a speech-language pathologist in private practice in Texas.  Effective January 1, 2014, speech-language pathologists in private practice will not be allowed to bill medicaid for any services in the state of Texas.  This change was posted on the TMHP website on November 15, 2013.  Please see attached for the November 15 TMHP new article and find the weblink below.  The change specifically states "Claims for speech evaluations and therapy that are submitted directly by an independently practicing speech-language pathologist will be denied unless the speech-language pathologist is an ECI provider."

I was shocked to read this change in TMHP news but thought that surely there was some way I was misinterpreting this change.  A phone conversation a TMHP provider representative, on December 10, confirmed that speech-language pathologists in private practice will not be able to bill medicaid for their services after January 1, 2014 in the state of Texas.  The provider representative suggested that I contact The State Office of the Ombudsman and encourage them to change this legislation. 1-800-787-8999.

http://www.tmhp.com/News_Items/2013/11-Nov/11-15-13%20PT%20OT%20and%20ST%20Benefits%20to%20Change%20for%20CCP%20for%20Texas%20Medicaid%20Effective%20January%201.pdf

[PMRNC]

That's certainly How I was reading it too and if you go to google it's all over for Texas Medicaid. I didn't see any other states make that change?

[shanbull]

Wha?? We did have a recent change in MN, but it went in the complete opposite direction:

Effective July 1, 2013, medical authorization is no longer required for outpatient rehabilitative and therapeutic services: physical therapy, occupational therapy and speech-language pathology. Authorization requirements were suspended for service dates July 1, 2011, through June 30, 2013. Rehabilitative and therapy services are now subject to post-payment review which could result in a provider being required to request authorization for certain services.

All that is required is a referral from an MD.

[StephD]

Mosiacspeech, I bill for ST's in private practice who see Texas Medicaid CCP children.  I was also shocked to see the changes that were posted on the website too.  I put in a call to provider relations.  They have posted updated information on TMHP's website regarding the changes that they were trying to implement for 2014.  The latest update was posted Dec. 31st.  SLP's in private practice are NOT being excluded from rendering therapy now. 
One of my therapists received an update from TSHA that they were meeting with the TX HHS regarding the drastic changes and it looks like they revamped the changes. 
I do think it will be harder to get therapy authorized beyond 6 months to a year.  They also have new forms in place to request therapy authorizations effective Jan. 1st.  The new forms replace the TP1 and TP2.

[StephD]

Well, it turns out that they are NOT implementing the new therapy authorization forms after all.  They have decided to go back to the TP1 and TP2 forms. 

[PMRNC]

Don't you just love that? LOL
Wait till we all learn ICD-10 and they delay it again. LOL

[StephD]

It has just been the craziest thing I have ever seen!     They sent out long and lengthy updates with so many changes it made my brain hurt!  They were going to implement new forms.  Then, on Dec. 31st, they basically came back and said starting Jan. 1st they were switching things around AGAIN.  They ended up going back to the old forms and did not implement most of the changes.  The update should have been titled "Never Mind About Changes, We Were Just Kidding!!" 
Yeah, I can't wait to see what is in store with the ICD10 changes!  I try to look at this stuff as job security.  If I can help my clients navigate the changes and jump through the hoops in order to get reimbursed, then they are happy with my services and my business continues to grow!