A House Bill was proposed into Texas legislation to require Texas Medicaid to cover cranial remolding helmets for plagiocephaly, brachycephaly and scaphocephaly. (Synostosis is already covered.) The bill (HB 2134) is currently in the Insurance Committee. Chair of that committee is Rep. Tom Oliverson. Two things need to happen by next week for this bill to continue in the process.
Representative Oliverson has to call for a vote on the bill in his committee and
the vote has to pass.
The bill will DIE IMMEDIATELY if these 2 things do not happen!
Because our legislative body is only in session until end of May, this all moves very quickly. If a vote is not called for by next week, we will run out of time for the rest of the process to happen. THIS WEEK we need everyone TO CALL the following committee members and make this statement (or similar): Good afternoon, my name is (BLANK) and I am a (INSERT POSITION HERE) who treats infants in need of a cranial remolding orthosis.
I am calling today to let Rep. (INSERT NAME HERE) know that I support HB 2134 and want to see it voted out of committee as soon as possible.
Texas babies need to have their helmets covered by Medicaid. (TELL THEM YOUR STORY.) HERE ARE THE NAMES OF THE REPS ON THE COMMITTEE
These Reps currently have not decided for support of the bill: Rep. Tom Oliverson (Chair) (512) 463-0661 – most important on this list because he controls “calling for a vote” Rep. Hubert Vo (Vice Chair) (512) 463-0568 Rep. Lacey Hull (512) 463-0727 Rep. Mayes Middleton (512) 463-0502 Rep. Dennis Paul (512) 463-0734 Rep. Scott Sanford (512) 463-0356 These Reps already favor the bill, but need re-assuring: Rep. Jessica Gonzalez (512) 463-0408 Rep. Celia Israel (512) 463-0821 Rep. Ramon Romero (512) 463-0740 If we get enough advocacy from the profession and from patient families to we can progress forward with this bill. There will be many more hurdles to jump. I will keep everyone up to date with the progress and what needs to happen next. Please do this now so we will have more days to fight! Thank you, Catherine Mize, CPO
PS - please share this information with your patients that are willing and able to assist with this effort!
Number:DME103.007 Effective Date:03-01-2020 Coverage: *CAREFULLY CHECK STATE REGULATIONS AND/OR THE MEMBER CONTRACT* Use of an adjustable cranial orthosis may be considered medically necessary following cranial vault remodeling surgery for synostosis. Use of an adjustable cranial orthosis for synostosis in the absence of cranial vault remodeling surgery is considered not medically necessary. Use of an adjustable cranial orthosis as a treatment of persistent plagiocephaly or brachycephaly without synostosis may be considered medically necessary when all of the following conditions have been met: • The patient is between 3 and 18 months old; • Documented failure of conservative therapy (repositioning and/or physical therapy) of at least 2 months duration; and • Either one of the following sets of measurements or indications: 1. Asymmetrical appearance confirmed by a right/left discrepancy of greater than 6 mm in any craniofacial anthropometric measurement; or 2. Brachycephalic or dolichocephalic disproportion (comparison of head length versus head width) confirmed by a cephalic index of 2 standard deviations above mean or 2 standard deviations below mean. Use of an adjustable cranial orthosis is considered not medically necessary for all other indications not outlined above. NOTE 1: Measurements are usually obtained by the physician or orthotist fitting the helmet or headband. EXCEPTION: TEXAS CHIP and Medicaid (STAR) contracts only: The following directives are required when reviewing patients under the Texas Children’s Health Insurance Program (CHIP) or Medicaid State of Texas Access Reform (STAR) Program: • CHIP – Cranial remolding orthotics are a non-covered service or benefit. • Medicaid STAR – Per Texas Medicaid Bulletin Number 240, March/April 2012, page 14, “Cranial remolding orthosis…, is no longer a benefit for the treatment of positional plagiocephaly as position plagiocephaly is considered cosmetic. Cranial remolding orthosis is allowed for synostotic plagiocephaly.