Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include:

• Personal Care Services (PCS)
• Private Duty Nursing (PDN)
• Therapies for Children in the Home
• Therapy Assistants

TCHP is in the process of implementing the updates in our claims system and once completed, all impacted claims will be retro adjusted for dates of service on or after September 1, 2019. Providers will not need to appeal the claims related to this rate change. How this impacts providers:  There is a delay in the implementation of the new rate, which will likely affect accurate payment of claims for these services; however, TCHP will reprocess impacted claims within the time-frames outlined by the Uniform Managed Care Contract (UMCC) for any Medicaid-implemented rate change. We appreciate your patience and your partnership through this process. Next steps for providers: Please review the Texas Medicaid and Health Partnership (TMHP) Online Fee Schedule for updated fee schedule reimbursement rates. Texas Medicaid Healthcare Partnership (TMHP) bulletin: Reimbursement Rate Changes and Updates for Texas Medicaid effective September 1, 2019If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.