TAFP to HHSC: Address insufficient payment for COVID-19 testing

Tags: COVID-19 testing, HHSC, 87th Texas Legislature

By Jonathan Nelson

TAFP joined five other physician associations last week in calling on the Texas Health and Human Services Commission to ensure adequate reimbursement for COVID-19 testing. The organizations sent a letter to HHSC Executive Commissioner Cecile Young on Feb. 16, bringing attention to a problem Texas physicians face: payments by some Medicaid managed care organizations for COVID-19 tests often do not even cover the cost of the tests.

A recent New York Times article quoted a Texas pediatrician who said he offered rapid coronavirus tests that cost $37 each, but the Medicaid MCOs covering his patients paid only $15 to $19. The article stated that because of the low payments, some doctors are deciding to stop testing, which hinders the nation’s effort to control the pandemic.

In the letter, the organizations urged the commission to issue “strong guidance” for Medicaid and CHIP MCOs to reimburse physicians enough to at least cover the cost of the tests. They also suggested the commission revise the Texas Incentives for Physicians and Professional Services proposal to include direction to the MCOs to ensure adequate payment for the tests. The TIPPS proposal is designed to leverage federal regulations to contractually require MCOs to set a minimum fee schedule for certain services.

“It is vital that this issue be resolved quickly so that physicians in Texas can Continue providing appropriate testing to their patients for the duration of the COVID-19 crisis,” the letter said.

The organizations that joined TAFP in sending the letter are the Texas Medical Association, the Texas Pediatric Society, the Texas Chapter of American College of Physicians Services, the Texas Association of Obstetricians and Gynecologists, and the American College of Obstetricians and Gynecologists District XI (Texas).

Read the Feb. 16, 2021 letter.

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