Assessment and Recommendations Regarding Out-of-Network Reimbursement, Usage Standards and Resolution Processes
September 2004
Texas Health and Human Services Commission
Lewin contact: Lisa Chimento
The Texas Health and Human Services Commission retained The Lewin Group to assist in developing appropriate out-of-network payment rates and related policies, in accordance with the requirements of HB 2292, 78th Legislature. In Texas, considerable time and energy, on behalf of state staff, health plans, providers and other stakeholders, have been focused on out-of-network usage and reimbursement in the STAR and STAR+PLUS programs for the past several years. Lewin's objective was to take what the state had already learned, understand the successes and shortcomings, and develop a solution to move the program forward in a positive direction.