As was reported in the Austin American Statesman back on May 25th, the Texas Health and Human Services Commission is seeking tens of thousands of dollars in advance from dentists who wish to go before the State Office of Administrative Hearings for either a Medicaid payment hold or overpayment hearing.
Attorney Tony Canales portrayed the large amounts of the advance payments as “abusive.”
SB 1803 opened the door to having providers advance security
This situation comes from a provision in last session’s due process rights legislation for Medicaid providers which requires providers to advance security for the payment of 50% of the SOAH hearing costs. An administrative judge can change the amount for good cause after the hearing and the legislation does not state the amount of the advance. However HHSC is generally looking for tens of thousands of dollars as security, which presents a substantial barrier to a hearing for these dental Medicaid providers.
SOAH worried about collecting from Medicaid providers and made an agreement with HHSC
SOAH is also under Sunset Review this legislative session and TDMR recently went through their self-evaluation report which sheds some light on this “advance” situation.
What has occurred is that SOAH has made an arrangement and signed an inter-agency contract with HHSC for HHSC to bear all of the SOAH court costs for hearings because SOAH was concerned about getting paid from Medicaid providers for their 50%. The other part of the agreement is that HHSC collects the 50% from the providers.
“SOAH is currently authorized to hear cases from the HHSC involving payment holds in fraud cases. Therefore, those are not a new category of cases for SOAH. The cases involving recovery of Medicaid overpayments would be a new category of cases referred to SOAH by the HHSC. The Act’s requirement that the provider be responsible for one-half of SOAH’s costs in these cases could have affected SOAH’s funding source and was cause for concern for SOAH.
However, SOAH and the HHSC have entered into an interagency contract whereby HHSC will pay SOAH its full costs, and HHSC will recover from the provider the portion of costs allocated to the provider. That arrangement has alleviated some of SOAH’s concerns about payment for its services for these cases.” (from page 84)
So it appears, HHSC is taking steps to ensure collection of the anticipated 50% before any hearing is held.