Texas children's therapy providers face dilemma over offering services

Ask Mike Davis what he and his staff did to keep a program helping children receive therapy services alive, and he’ll tell you: They cut, and cut, and cut.

The CEO of the Behavioral Health Center of Nueces County said his organization tried to cut travel expenses by having therapists hit two or three patient homes per outing and cut back on office supply orders. But the group last year still lost $300,000 trying to make ends meet offering therapy services through the Early Childhood Intervention program to more than 340 children in the area. The organization often served dozens more children than they had the budget for but were legally required to do so anyway. 

In January, Davis wrote a letter to tell the Texas Health and Human Services Commission that, after 37 years, the center would stop offering those services June 1. The agency will need to find a new provider.

“I think it’s just a growing trend,” Davis said. “It’s sad because at the end of the day, a lot of people that are bidding on these services are going to ask for more money.”

The Texas House Appropriations Subcommittee on Article II, which focuses on health care and other services, is set on Wednesday to discuss Medicaid therapy rate cuts and the state’s Early Childhood Intervention program, which serves 50,000 children under 3 years old who have developmental issues including autism, speech delays and Down syndrome.

Davis’ organization is one of several Texas providers in recent years that have struggled to decide whether to put their own financial survival first or bleed thousands of dollars to continue offering state-funded speech, occupational and physical therapy services for children. Since 2010, the state has gone from 58 providers in the program to 44.

The Texoma Community Center is also working to withdraw from the Early Childhood Intervention program. It was supposed to end services Feb. 20, but the Texas Health and Human Services Commission couldn’t find a new provider for five of the six counties, so the center is staying on until May 31. 

Previous legislative hearings on the topic have typically been filled with testimony from providers pleading for more funding and tearful families begging legislators to take action that helps their kids.

A $350 million cut to Medicaid children's therapy services went into effect in December 2016, prompting fears from parents that providers would stop offering services and leave eligible Texas children without therapy they're entitled to receive under federal law. During the 2017 legislative session, House Speaker Joe Straus and other members of the lower chamber fought to reverse the cuts — but the Senate resisted those efforts during budget negotiations.

Ultimately, the chambers agreed to give therapy providers a 25 percent restoration of their Medicaid payments in 2018 and 2019. Advocates found some luck when legislators coughed up an additional $4 million for the Early Childhood Intervention program for the rest of the 2016-2017 budget cycle.

However, advocates like Stephanie Rubin, CEO for the advocacy group Texans Care for Children, have expressed disappointment that legislators did not fund the Health and Human Services Commission's request for $20 million to partially cover the Early Childhood Intervention program’s expected enrollment growth in the next two years.

Rubin said she is “not surprised” about the series of closures and providers in the ECI program putting in their notice. She said the Legislature’s increase for Early Childhood Intervention paled in comparison to what providers need to just break even.

“It’s pretty clear that programs continue to serve more kids than they are funded to serve,” Rubin said. “I think what we'll hear at the upcoming hearing is that the ECI programs will explain how challenging it is to provide support for kids at these funding levels.”

Advocates and therapy providers have also decried a Texas Health and Human Services Commission rule that went into effect in September that canceled out the partially reversed funding and cut reimbursement rates to therapy assistants.

The state agency has previously said the new rule saves Texas $17.9 million over the next two years, standardizes the state's reimbursement rate for all "acute therapy" based on federal billing guidelines and eliminates incentives for one type of therapy over another. As of Sept. 1, 2017, therapists are reimbursed on a per-patient basis and based on 15-minute increments of care.

Besides getting flak over the new rule, the agency is also responsible for trying to find new organizations to take over for Early Childhood Intervention providers that want out of the program.

Carrie Williams, a spokesperson for the Texas Health and Human Services Commission, said in an emailed statement that agency workers "absolutely recognize that these services are critically important to children and their families" and that federal laws require that all eligible children be served.

"We’re researching and pursuing all possible avenues to stay in alignment with federal expectations of the grant, but it takes contractors who can provide the services within the available funding and federal parameters," Williams said. 

For now, Davis said families have taken the news about therapy services ending at the Behavioral Health Center of Nueces County better than expected. He said he wishes he understood why legislators would accept an outside organization coming in to offer services instead of using a group that already knows the families, community and program well.

“Why would you not want them to run the program if they’ve been successful?,” Davis said. “Why would you want to pay someone outside to come in and do the same thing?”

Disclosure: The Texas Department of Health and Human Services has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.