The Texas Association of Freestanding Emergency Centers (TAFEC) issued a press release this week claiming 3,400 requests for mediations in Texas are complaints and have resulted in $750,000 in payments to providers as a result of underpayment by insurance companies. Here is a link to the report requested by Rep. Workman from TDI. TAFEC failed to mention that these 3,400 mediation requests to challenge surprise bills from providers totaled more than $6 million in billing and the ultimate result is that consumers were protected against more than $5 million in over-billing by providers. It is also important to note that as it stands, consumer mediation protections do not apply to FSERs. TAHP pointed out these discrepancies to the Dallas Morning News this week; stay tuned for a piece running later this week.

his week HHS released a proposed rule that takes steps aimed at stabilizing the individual and small group health insurance markets. The proposed rule “would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.” Read more from AHIP here.

.HAC started meeting this week with presentations by the Legislative Budget Board. On Wednesday the LBB provided an overview of Medicaid. Total Medicaid funding in the 2016-17 adjusted base is $26.3 billion GR and $64.6 billion in AF. This includes an estimated $1.2 billion in GR funds above the 2016-17 Budget to complete fiscal year 2017 expenditures, which includes revenue adjustments, transfers, and assumed supplemental funding. House Bill 1, as introduced includes $27.0 billion in GR funds and $65.5 billion AF for Medicaid in 2018-19, which is an increase of $0.7 billion in General Revenue-Related Funds and $1.0 billion AFs. The committee had many questions about Medicaid managed care, capitation rate setting and savings, and STAR Kids. TAHP staff immediately started meeting with offices to educate them on the value of managed care and will continue meetings over the next several weeks.  LBB Recommendations for HB 1 can be found here.

This week, TAHP, TAB, TALHI, TAHU, and TORCH launched a coalition to raise awareness about freestanding ERs, their exorbitant pricing and misleading advertising that are confusing consumers and contributing to a serious emergency care cost crisis in Texas. Texans For Affordable Healthcare (TAHC), a healthcare advocacy coalition, seeks to educate the Legislature and Texas consumers about the non-transparent, anti-consumer tactics frequently used by freestanding emergency rooms, as Texas is home to more than half the nation’s FSERs. TAHC will be reaching out to Texans who have experienced surprise bills and confusions at FSERs and are willing to share their stories with others and the Legislature. Our coalition is seeking the following solutions to better protect consumers: