Therapists who work with disabled children in their homes saw a glimmer of hope this year, when Texas lawmakers decided to restore some of the funds they cut for such services in 2015.
It was short-lived.
Now these care providers argue new policies the state's top health agency is implementing could not only cancel out those restored funds — they could actually deepen the cuts.
The new rules standardize the state's reimbursement rate for all "acute therapy" — an effort, Texas' Health and Human Services Commission says, to level the playing field and eliminate incentives for one type of therapy over another. Starting Sept. 1, therapists won't be reimbursed on a per-patient basis; they'll be reimbursed based on 15-minute increments of care.
But critics — including providers who work with kids in their homes, sometimes in far-flung or rural locations — say they lose out, because the time they must spend to travel to a patient isn't considered in their reimbursement.
Jennifer Riley, vice president of business development at Sage Care Therapy in Dallas, said the changes to the reimbursement structure came as a shock. “You’re driving an average of 40 minutes and you can only bill some of these patients for maybe 30 minutes — it’s a losing endeavor,” Riley said.
Kelli Weldon, a spokeswoman for the health commission, said in an email that the new reimbursement policy for occupational and physical therapy was based on federal billing guidelines. "Unit-based billing more accurately records and reimburses for the specific therapy service being delivered and is standard practice in other outpatient settings," Weldon said. "Speech therapy will continue to be reimbursed per session."
Asked about therapists' concerns that they might be further forced out of business, she said the agency would be "closely monitoring access to care, tracking complaints and concerns, and analyzing information about provider terminations and utilization trends specific to therapy services."
Therapy providers have been feeling the squeeze for years. After the Texas Legislature approved a $350 million cut to funding for speech, physical and occupational therapists in 2015, some clinics were forced to shut their doors, and advocates have testified repeatedly about the loss of care providers and inability to meet the needs of Texas families, particularly in their homes. This spring, legislators restored about 25 percent of those cut funds.
Riley said waitlists for care have already grown because so many therapy providers have not been able to make enough money to stay in business. That's about to get worse, she said.
“I think what we’re going through effective Friday is, we’re not realizing any of the 25 percent of the rate restoration that the Legislature intended," she said.
These latest adjustments, Weldon said, are a result of the 2015 spending cuts, which directed the health commission to save at least $50 million through rate reductions and $25 million through medical policy initiatives. She said the new policies save the state $17.9 million over the next two years.
In a letter to the health commission this week, two state lawmakers — Reps. Donna Howard, D-Austin, and Matt Krause, R-Fort Worth, requested that the new policies be reconsidered, and delayed for a minimum of 45 days.
“We find it unwise to take these additional steps, which will make it even more difficult to get medically-necessary services,” they wrote. They say the health commission has yet to respond to the letter.
The new state policies don't just change the rate structure; they also cut reimbursement rates to therapy assistants, who often make little more than minimum wage in positions that can require a bachelor's degree level of education.
“We’ve already seen assistants that left the health care industry to work for Buc-ee's Gas Station because they can get better benefits than helping a child learn to speak," said Jerre van den Bent, owner of Therapy 2000 in Dallas.
Van den bent said the reimbursement for a therapy assistant trends around $20 per visit. “That’s $20 for about 90 minutes of work, for somebody who has a bachelor’s degree,” he said.
Dustin Thompson, director of KidsCare Therapy, which is based in Dallas but serves areas throughout the state, said in the past couple of weeks, his facilities have seen a “mass exodus” of therapists — two or three resignations a day.
"When the reimbursement policy is so drastic that it costs money to provide any service, let alone the hard-to-reach services, that’s when you’re going to have major access problems," Thompson said.
Riley said families will ultimately feel the impact of the new policies. And threats to their access to therapy put parents on edge. For years, Suzette Fields' eight-year-old daughter Chloe has been receiving speech, occupational and physical therapy in her Cedar Park home for a chronic mitochondrial disease.
Fields said the physical therapy has allowed Chloe to navigate her wheelchair on her own.
"Her therapy is just critical," Fields said. "We're now at the state of having independence for her. She has made more progress than we thought she ever could."