Report details durable medical equipment use in Texas Medicaid and CHIP
The OIG issued a new report detailing how clients enrolled in Texas Medicaid or the Children's Health Insurance Plan (CHIP) access durable medical equipment. Along with requirements for suppliers, the report contains statistics on different categories of equipment and how claims are distributed across different areas of the state.
For qualified clients, equipment and supplies can be accessed through several methods, including the state's fee-for-service model, which pays providers directly to care for newly enrolled members awaiting assignment to an insurer. Clients already assigned to managed care organizations receive equipment through the provider network developed by their insurer. Additional considerations and payment systems based on individual client needs are detailed in the report.
Within the report, equipment providers can find information explaining Medicaid rules and procedures that detail requirements for prior authorization, along with changes in eligibility status and how to receive reimbursement for shipping and delivery of equipment. It also includes valuable data for stakeholders, including the amount of claims for each category of supplies in 2022. Incontinence supplies led the way with $145.9 million in reimbursements, followed by nutritional products with $145.5 million and respiratory medicines and services at $84.3 million.
The report also includes the geographic distribution of DME claims. The Harris County service area, which encompasses Houston, leads the state, but given the area population and Medicaid enrollment pool, auditors determined their claims were in line with statewide averages. In contrast, claims from the Hidalgo County region, in the Rio Grande Valley, were considerably higher than other regions based on the enrolled Medicaid client population. Additional statistics dive deeper into vendor billing and claims submissions.
To learn more, visit the OIG website for the full report.