Texas HHSC Public Rate Hearing

Texas Health and Human Services Commission (HHSC) has released rate packets for upcoming rate hearing on November 10, 2025.  TexMEP urges members to review proposed rate reductions and testify.

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Providers are encouraged to testify in person on November 10th.  If in-person testimony is not feasible, please sign up to testify virtually. Be sure to join our prep call on November 7 - register here: TexMEP Rate Hearing Prep Call

This  rate hearing  will be conducted both in person and online. After registering, you will receive a confirmation email containing information to join the webinar. Use the following registration link and Webinar ID to attend this online meeting:

• Register for the rate hearing here.
• Use the following webinar ID: 456-324-635

For more details, please review the public hearing notice.

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The rate hearing packets were posted on the PFD website on Oct. 24, 2025.

• Review Rate Packet

According to the rate packets, Texas Medicaid seeks to reduce reimbursement by double-digit percentages for the following:

• E1390 (oxygen concentrator) - -35.75%

• E0424 (stationary gas oxygen) - -39.47%

• E0431 (oxygen portable) - -18.66%

• E0601 (cpap machine) - -20.58%

• B9002 (feeding pump) - -44.61%

• B4153 (adult metabolic formula) - -51.06%

• B4155 (modular formula) - -85.11%

• E0143 (Walker) - -28.65%

• E0260 (hospital bed) - -39.3%

• E0445 U4 (tabletop pulse oximeter) - -78.25%

These rates would be effective September 1, 2026 and would be further reduced as per a company's contracted rate through the Managed Care Organization (MCO).  They are not the only rate reductions.  Please review the rate packet carefully to see how these changes will affect you.

These proposed reductions are tied to federal funding rules established under the Consolidated Appropriations Act (2016), 21st Century Cures Act (2016), and the Social Security Act. These laws prevent states from reimbursing Medicaid DME at rates higher than Medicare’s aggregate limits.

During the American Rescue Plan Act (ARPA) period, states had temporary flexibility and enhanced federal funding. With ARPA funding ending, Texas HHSC is now realigning DME rates to comply with these federal requirements.

While federal law sets reimbursement limits, states have discretion in how those limits are applied. Providers are encouraged to highlight in their testimony how such deep rate reductions would affect patient access and the long-term viability of DME services across Texas.