March 2017

Changes in Therapy Reimbursement

Blue Cross and Blue Shield of Texas (BCBSTX) is delaying application of therapy rate reductions to avoid retroactive recoveries, but will implement the rate change on April 1, 2017, effective for STAR, STAR Kids and CHIP.

On Dec. 1, 2016, the Texas Health and Human Services Commission (HHSC) announced reimbursement rate changes and updates for Texas Medicaid Therapy Services effective Dec. 15, 2016. The changes and updates will affect STAR, STAR Kids and CHIP programs. The rate cuts have been applied to our rates and we have been paid less for these services in state fiscal years 2016 and 2017.

Rate changes will be applied to the following provider types:

• Comprehensive Outpatient Rehabilitation Facility/Outpatient Rehabilitation Facilities (CORF/ORF)
• Home Health Agencies (HHA)
• Independent Therapists

For more information, you may refer to the HHSC Rate Analysis web page.

BCBSTX has closely monitored stakeholders’ concerns regarding these rate changes since its original proposal in 2015. To support our members and maintain a robust provider network, BCBSTX will delay application of therapy rate reductions to avoid retroactive recoveries. BCBSTX will implement this change on April 1, 2017, effective for STAR, STAR Kids and CHIP. We will continue to monitor this issue and keep our members and providers apprised of developments.

As we near April 1, 2017, information regarding the administration of this rate change will be available on our BCBSTX provider website.