HOUSTON (CN) — Texas’s Medicaid reimbursement policy violates federal rules and should be put on hold because it leaves some health care providers “holding the bag,” a federal judge ruled.
The Texas Children’s Health Plan denied about 2,000 claims that Legacy Community Health Services submitted for emergency, out-of-network care, the nonprofit said in its original complaint. It sued Dr. Kyle Janek, in his capacity of executive commissioner of the Texas Health and Human Services Commission, in January 2015. (The new commissioner, Charles Smith, took office in June and was automatically substituted at the defendant.)
Texas Children’s Health Plan is a third-party, private organization that both Legacy and the state contract with to administer Medicaid payments.