Learn about the Medicaid 1115 Transformation Waiver Renewal.
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February 4, 2021 - 1:30pm
Location: Due to the COVID-19 pandemic, this meeting will be conducted online virtually using Microsoft Teams only. There is not a physical location for this meeting.
Attendees who would like to provide public comment should see the Public Comment section below.
- Welcome, introductions, and opening remarks
- Approval of November 5, 2020, minutes (Vote required)
- Approval of revisions to committee bylaws (Vote required)
- Uniform Hospital Rate Increase Program (UHRIP) Reforms (Victoria Grady, Director, Provider Finance Division, and Emily Sentilles, Director, Healthcare Transformation Waiver Team, HHSC)
To continue incentivizing hospitals to improve access, quality, and innovation in the provision of hospital services in Year 5 (State Fiscal Year 2022) of the program and beyond, HHSC is proposing new quality metrics, eligibility requirements, and financing components for the program. HHSC is also proposing these amendments to comply with federal regulations that require directed-payment programs to advance goals included in the state’s managed care quality strategy and to align with the ongoing efforts to transition from the Delivery System Reform Incentive Payment (DSRIP) program.
- Physician Directed Payment Program (Victoria Grady, Director, Provider Finance Division, and Emily Sentilles, Director, Healthcare Transformation Waiver Team, HHSC)
The purpose of the proposed new rules is to describe the circumstances under which HHSC will direct a Medicaid managed care organization (MCO) to provide a uniform per member per month payment, certain incentive payments, and a uniform percentage rate increase to physician practice groups in the MCO's network in a participating service delivery area (SDA) for the provision of physician and professional services. The rules also describe the methodology used by HHSC to determine the amounts of the payments or rate increase.
- Rural Health Clinic Directed Payment Program (Emily Sentilles, Director, Healthcare Transformation Waiver Team, HHSC)
The proposed rules describe the circumstances under which HHSC will direct a Medicaid MCO to provide a uniform dollar amount in the form of prospective monthly payments and rate increases for services tied to quality measurement to rural health clinics (RHCs) in the MCO's network in a participating SDA for the provision of general medical services. The methodology used by HHSC to determine the amounts of the payments and rate increases is described also. HHSC is proposing these new rules as part of the new programs developed to transition from DSRIP, anticipating the increased payments to RHCs to promote improved access to services, better health outcomes, and increased focus on improving quality goals of the Texas Medicaid program.
Update Items Requested by the Chair
- 1115 Waiver update - status of the 1115 extension application
- Update on DSRIP one-year extension request
- Update on Draft Monitoring Plan for Local Funding Sources—comments received and proposed policy
- Update on negotiations/resolution of items with Centers for Medicare & Medicaid Services (CMS) related to Private Hospital Graduate Medical Education update
- Enhanced Federal Medical Assistance Program update and impact of federal Public Health Emergency extension
- Comprehensive Hospital Increase Reimbursement Program/Uniform Hospital Rate Increase Program (UHRIP)-proposed rule and implications of CMS’s State Medicaid Director letter dated January 8, 2021, concerning state-directed payments in Medicaid managed care
- Revision back to Grouper 36 (claims back to September 2020 and subsequently back to 2019). Discussion of this change and any further impact to the Medicaid Managed Care Organization claims or UHRIP.
- Rural Hospital Advisory Committee discussion
- Medicaid funding issues related to Texas hospitals
- Public comment
- Proposed next meeting: June 3, 2021, at 1:30 p.m.
Public Comment: HHSC welcomes public comments pertaining to topics related to eligibility, health and medical care services and policies that govern the administration of the Texas Medicaid program. Members of the public who would like to provide public comment are asked to complete a Public Comment Form here. Members of the public are encouraged to participate in this process by providing written public comment to HHSC by emailing Caroline Sunshine no later than 5:00 p.m. Tuesday, February 2. Please include your name and the organization you are representing, or state if you are speaking as a private citizen.
If you would like to register to provide oral comments, please mark the correct box on the Public Comment form. Instructions for providing oral comment will be emailed to you. Registration should be completed no later than 5:00 p.m., Tuesday, February 2. Members of the public may also use the Microsoft Teams Live Event Q&A section to submit a request to provide public comment. The request must contain your name and either the organization you are representing or that you are speaking as a private citizen, and your direct phone number.
Public comment is limited to three minutes. Speakers must state their name and on whose behalf they are speaking. Public members who are using handouts are asked to provide an electronic copy in accessible pdf format that will be distributed by HHSC staff to members, state staff and for public distribution. Handouts are limited to two pages (paper size: 8.5” by 11”, one side only). Handouts must be emailed to HHSC immediately after registering and include the name of the person who will be commenting.
Contact: Questions regarding agenda items, content, or meeting arrangements should be directed to Caroline Sunshine, Advisory Committee Coordinator, Medicaid and CHIP Services Department, 512-428-1948, email@example.com.
This meeting is open to the public. No reservations are required, and there is no cost to attend this meeting.
People with disabilities who wish to attend the meeting and require assistive technology or services should contact Sunshine at 512-428-1948 or firstname.lastname@example.org at least 72 hours before the meeting so appropriate arrangements can be made.