Update in Texas: Nerves rattled as contract's start date approached

AUSTIN, Texas - The state Medicaid program may have forced Superior HealthPlan to modify its contract with Medline for DME and supplies, but providers say, in reality, they fear not much has changed.

During a hearing in August that prompted the modifications, provider Barry Johnson says the state and Superior HealthPlan agreed that Medicaid recipients would be able to opt out of the contract with a simple phone call to the managed care organization.

“They're being told they have to fill out an opt-out form specifically from Superior,” said Johnson, president of Texas Medical in Duncanville, Texas, and executive director of the state HME association. “Why are they making this more difficult than it has to be?”

In August, Superior HealthPlan, part of Centene Corp., which has more than 12 million members in 28 states, agreed to recast the contract with Medline as “preferred provider,” as opposed to “single source.” It also agreed to delay the start date of the contract from Sept. 1 to Oct. 1.

Last week, Johnson said “some” of his patients had gone through the opt-out process.

“I'm sure there will be some that never do—their caregivers work all the time; they get their mail infrequently; when they call, they're told they haven't filled out a personal medical information form to have a conversation,” he said. “There are a lot of barriers, and we can't get the prior authorization unless there's an opt-out form.”

Adding insult to injury: Johnson said he noticed way at the bottom of Superior HealthPlan's opt-out form that it's good for only one year.

“So a year from now, we're going to have to go through this same exercise,” he said.

Provider Victoria Peterson said she echoes a number of providers when she says little has changed about Superior HealthPlan's approach to the contract.

“In letters sent to patients, they are not encouraging patient choice, but encouraging patients to switch to the 'preferred provider,'” said Peterson, an administrator for Respiratory & Medical Homecare in El Paso, Texas. “It's their right to direct patients as they wish, but I don't believe they're strictly adhering to the state's intention in demanding that Superior conserve patient choice.”

Rattling nerves further, on Sept. 22 Superior HealthPlan posted information to its website about a forthcoming request for proposal for a new value-based DME network. It says its goal is to “establish a limited network of high performing DME providers capable of delivery services and supplies in a timely, efficient and cost effective manner.” It says in the coming months an RFP will be released to interested providers who meet certain criteria.

“It's just another way to reduce the number of suppliers and the Medicaid allowables,” Johnson said. “Medicaid is already discounted 15%, which is pretty much at or below the cost line.”

Peterson worries the RFP, like the Medline contract, will put the majority of providers at a disadvantage.

“I don't want to speculate too much, but we are concerned that the RFP will include inane and absurd requirements that only large providers could feasibly accommodate,” she said. “This is an unusual twist in the whole Superior/Medline debacle.”