February 11, 2021 - 9:00am

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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.

Join the meeting here.

Attendees who would like to provide public comment should see the Public Comment section below.

  1. Welcome, introductions, and opening remarks
  2. Approval of November 12, 2020, meeting minutes (Vote required)
  3. Medicaid and Children’s Health Insurance Program activities
  4. Directed payment programs (DPPs): An overview
  5. Proposed updated managed care quality strategy

Action Items:

  1. Nurse Aide Training and Competency Evaluation Program (NATCEP)


    Catherine Anglin, Program Manager, Health and Human Services Commission (HHSC) Policy Rules and Training

    The purpose of the proposal is to allow a NATCEP provider to offer components of required training online in a virtual classroom location. Currently, all NATCEP training is provided in classroom and clinical settings. This initiative is a response to a critical shortage in trained nurse aides in nursing facilities (NFs). This proposal aims to increase the number of nurse aides qualified for NF employment. Due to the challenges presented by COVID-19 and the need for greater awareness and emphasis on infection control, HHSC is also proposing NATCEP providers increase infection control training and continuing education requirements for nurse aides.

  1. Nursing Facility Administrator Licensing


    Catherine Anglin, Program Manager, HHSC Policy Rules and Training

    This proposal will amend existing, add new, and repeal portions of the nursing facility administrators (NFA) licensure requirements to correspond with the Nursing Administrators Board (NAB) requirements, including reciprocity. NFAs will be able to take required training and to attain or maintain certification as a preceptor at their convenience and via computer-based training. Allowing reciprocity for individuals credentialed as a Health Services Executive will also streamline the process for obtaining credentialing as an NFA. Due to the challenges presented by COVID-19, HHSC is also proposing that NF providers increase infection control training and continuing education requirements for NFAs.

  1. Preadmission Screening and Resident Review (PASRR) Habilitation Coordination Rule Revision


    Haley Turner, Deputy Associate Commissioner, Intellectual and Developmental Disability (IDD) Services

    This rule describes the new responsibilities of Local IDD Authorities (LIDDAs) regarding IDD habilitative specialized services (IHHS). The amendments, new sections, and repeal make the requirements consistent with new rules being developed for IHHS. HHSC is also clarifying definitions; updating legislative references; adopting person-first respectful language; revising certain responsibilities of the responsible agencies related to PASRR; clarifying and updating training requirements; and revising requirements of a LIDDA regarding transition planning.

  1. STAR Health Continuity of Care


    Meghan Young, Manager, HHSC Policy & Program Development

    The proposed amendments are in response to Texas Government Code §533.00531, concerning Medicaid benefits for certain children formerly in foster care. Section 533.00531 requires HHSC to allow the adoptive parent or permanent managing conservator of a child who participates in the Adoption Assistance (AA) Program or Permanency Care Assistance (PCA) Program operated by the Department of Family and Protective Services and who is receiving Social Security Income or was receiving it before enrolling in AA or PCA to choose for the child to receive Medicaid benefits through STAR Health or STAR Kids, instead of being required to receive STAR Kids. In implementing section 533.00531, HHSC decided to allow a choice between STAR Health and STAR Kids for all other AA and PCA members who meet HHSC’s criteria to enroll in STAR Kids.

  1. Ambulance Service Providers


    Hank Morris, Manager, Acute Based Fee Services, HHSC Provider Finance

    This proposal establishes enhanced supplemental payments to publicly owned ground emergency ambulance service providers. These providers currently receive both fee-for-service and supplemental payments to cover uncompensated care costs. Subject to approval by CMS, the proposed amendment will make publicly owned ground emergency ambulance providers eligible for additional payments for services up to the average rate payable by commercial insurers for those services.

Informational Items:

  1. Coordination of Care from Specialty Providers


    Michelle Erwin, Deputy Associate Commissioner, HHSC Medicaid/Children’s Health Insurance Program (CHIP) Services

    The purpose of the proposal is to implement Texas Government Code §533.038(g),  requiring HHSC to establish a process for a Medicaid managed care organization (MCO) to allow a member with complex medical needs, who has established a relationship with a specialty provider through the member’s primary health benefit plan, to continue receiving care from that specialty provider, whether or not that provider is in the MCO’s network. The proposed rules require an MCO to allow a member to remain under the care of a Medicaid-enrolled specialty provider with which the member currently receives care through a primary health benefit plan—even if the specialty provider is an out-of-network provider for the MCO, if at the time of enrollment into the MCO, the member: (1) has complex medical needs, and (2) has and maintains healthcare coverage under a primary benefit health plan.

  1. Physician DPP


    Emily Sentilles, Director, HHSC Healthcare Waiver Transformation Team

    The purpose of the proposed new rules is to describe the circumstances under which HHSC will direct a Medicaid 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. Currently, Texas's Medicaid physician payments, made through either fee-for-service or managed care models, do not always cover all Medicaid allowable costs for physician and professional services. HHSC is proposing these new rules to align with the ongoing efforts to transition from Delivery Systems Reform Incentive Payment (DSRIP) and the Network Access Improvement Program.

  1. Rural Health Clinic DPP


    Emily Sentilles, Director, HHSC Healthcare Waiver Transformation Team

    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 in rural health clinics (RHCs). The rules also describe the methodology used to determine the payment amounts and rate increases. 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.

  1. Community Mental Health Center DPP


    Emily Sentilles, Director, HHSC Healthcare Waiver Transformation Team

    The proposed new rules describe the circumstances under which HHSC will direct a Medicaid MCO to provide a uniform percentage rate increase and a uniform dollar increase in the form of prospective monthly payments to community mental health centers (CMHCs) in the MCO's network. HHSC is encouraging CMHCs to earn certification as Certified Community Behavioral Health Clinics (CCBHC) to implement processes and delivery of care consistent with the CCBHC model. HHSC proposes these rules to establish a new program developed under the DSRIP Transition Plan, anticipating the increased payments to participating CMHCs to sustain access to services, promote better health outcomes, and increase focus on improving quality goals established in Texas’s Medicaid program.

  1. Uniform Hospital Rate Increase Program (UHRIP) Reforms


    Victoria Grady, Director, HHSC Provider Finance, and Emily Sentilles, Director, HHSC Healthcare Waiver Transformation Team

    To continue incentivizing hospitals to improve access, quality, and innovation in the provision of hospital services in Year 5 of UHRIP 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 DPPs to advance goals included in the state’s managed care quality strategy and to align with the ongoing efforts to transition from the DSRIP program.

  1. Proposed next meeting: June 10, 2021, at 9:00 a.m.
  2. Adjourn

Public Comment:

The Texas Health and Human Services Commission (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 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 9, 2021. 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 9, 2021. 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 say their name and on whose behalf they are speaking (if anyone). 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 the public. 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, caroline.sunshine@hhs.texas.gov.

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 auxiliary aids or services should contact Sunshine at 512-428-1948 or caroline.sunshine@hhs.texas.gov at least 72 hours before the meeting so appropriate arrangements can be made.