AAHomecare weighs in on continuity of care for medically fragile children in Texas

February 23, 2021

AAHomecare has asked the Texas Health and Human Services Commission (HHSC) to implement processes to ensure that medically fragile children covered under the state’s Star Kids program can continue to be served by their current DMEPOS supplier if a change in providers is deemed to potentially subject the patient to unnecessary risk.

The current Star Kids contract with the state allows primary care physicians and other providers to make that determination and directs the MCO to “provide the Member access to those Out-of-Network services through an appropriate agreement with the Out-of-Network Provider” in those cases.

AAHomecare’s letter to the Texas HHSC asks the agency to also implement language from SB 1207 that states:

“The commission shall develop a clear and easy process, to be implemented through a contract, that allows a recipient with complex medical needs who has established a relationship with a specialty provider to continue receiving care from that provider.”

The letter also urges HHSC to take the stated intent of the bill’s lead sponsors that “specialty provider” is taken to include DME providers or any other type of provider that provides specialty goods or services to a medically fragile child. The two lead sponsors of Medicaid legislation in Texas (SB 1207, enacted 2019), Sen. Charles Perry and Rep. Tan Parker are on record noting that maintaining relationships with medical equipment providers for fragile patients was an important objective of that legislation.

HHSC’s Medical Care Advisory Committee hosted a meeting on February 11, 2021 and included the commission’s interpretation of SB 1207. This interpretation not only did not include DME providers as “specialty providers”, but also limited the continuity of care protections to patients under 21 years of age, patients with primary insurance coverage, and limited protection based on the time of enrollment with an MCO. AAHomecare’s senior director of payer relations, David Chandler, provided comments to the committee opposing the commission’s interpretation along with other stakeholders including parents of special needs children. The committee then unanimously passed a motion urging HHSC to further consider the rule based on the testimony provided by stakeholders and state legislators who authored the bill in question.

HHSC published the proposed rule with this same interpretation on February 12, 2021 with a 30 day comment period; AAHomecare has submitted comments to the rule. Comments can be emailed to HHSRulesCoordinationOffice@hhs.texas.gov with the subject line “comments on Proposed Rule 21R032”.

AAHomecare will continue to work with the Texas Medical Equipment Providers Association (TexMEP) and all Texas stakeholders to advocate for a high standard of continuity of care.