August 12, 2021 - 9:00am

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Meeting Site:
Microsoft Office Teams Live Event

Due to the COVID-19 pandemic, this meeting will be conducted online virtually using Microsoft Teams only. Join the meeting here.

There is not a physical location for this meeting.

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

  1. Welcome, introductions, and opening remarks
  2. Consideration of June 10, 2021, meeting minutes (vote required)
  3. Medicaid and Children’s Health Insurance Program (CHIP) activities
  4. 1115 waiver update

Action Items:

  1. State Medicaid Managed Care Advisory Committee (SMMCAC)
    Michelle Erwin, Deputy Associate Commissioner, Health and Human Services Commission (HHSC) Medicaid/CHIP Services

    The primary purpose of amending Title 1, Texas Administrative Code (TAC), §351.805 is to implement changes recommended by SMMCAC in March 2020 and to make additional changes recommended by HHSC staff. These edits reorganize and format the rule so that the SMMCAC rule is consistent with other HHSC advisory committee rules established under Texas Government Code §531.012.
  2. Electronic Visit Verification (EVV)
    Erica Brown, Deputy Director, HHSC Office of Policy and Program

    SB 1991, 86th Legislature, Regular Session, 2019, amended Chapter 531, Texas Government Code, by adding new §§531.1131(f) and 531.1135 requiring HHSC to adopt rules describing the due process procedures an MCO must follow to recoup an overpayment made to a health care provider related to missing EVV information; and requiring that, as part of the process to recoup such an overpayment, an MCO gives a provider at least 60 days to correct a deficiency in a claim before the MCO begins any efforts to recoup overpayments.  Texas Government Code §531.1131(e) requires HHSC to adopt rules describing due process procedures an MCO must follow when engaging in recoupment efforts related to fraud or abuse.
  3. HHSC Interest Lists waiver programs
    Dana Williamson, Director of Policy Development Support, HHSC Medicaid/CHIP Services 

    The primary purpose of the proposed amendments is to implement Texas Government Code §531.0601, Long-term Care Services Waiver Program Interest Lists.  That section provides that individuals who are enrolled in but become ineligible for the medically dependent children (MDCP) waiver program may have their names returned to the interest list or placed on that of Home and Community-based Services, Texas Home Living, Deaf-Blind with Multiple Disabilities, or Community Living Assistance and Support Services programs. The proposed amendments describe the circumstances under which these actions may be taken. They include the following sections: §9.157 in in TAC, Title 40, Chapter 9, Subchapter D, Home and Community-Based Services (HCS) Program and Community First Choice (CFC); §§9.158, 9.566, and 9.567  in TAC, Title 40, Chapter 9, Subchapter N, Texas Home Living (TxHmL) Program and Community First Choice (CFC); §§42.202, 42.211, and 42.402 in TAC, Title 40, Chapter 42, Deaf Blind with Multiple Disabilities (DBMD) and Community First Choice (CFC) Services; §45.202 and 45.211 in TAC, Title 40, Chapter 45, Community Living Assistance and Support Services and Community First Choice (CFC) Services; and §353.1155 in TAC, Title 1, Chapter 353, Medically Dependent Children Program.

Informational Items:

  1. Disaster Rule Flexibilities for Community Behavioral Health Providers
    -Lizet Alaniz, Rules Coordinator, HHSC Behavioral Health Services Operations

    The purpose of this proposal is to allow HHSC flexibility to waive certain requirements for the delivery of services in response to a declared disaster. The proposed new rule is based on the existing emergency rule created in TAC, Title 26, Subchapter Z, §306.1351, relating to COVID-19 Flexibilities. This proposal creates a standing rule, allowing providers subject to the rule to operate with the same flexibilities afforded by the emergency rule and it ensures continuity of services for individuals receiving community-based behavioral health services.
  1. Medicaid Bed Reallocation
    Diana Conces, Director of HHSC Long Term Care Policy & Rules

    This proposed new rule is to implement Texas Health and Safety Code §533A.062, as amended by HB 3117, 86th Legislature, Regular Session, 2019, requiring HHSC to develop a process to redistribute Medicaid beds in existing intermediate care facilities for individuals with an intellectual disability or related conditions as per the authority of the State Plan for Individuals in Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities  (ICF/IID). Adding a new rule to TAC, Title 26, Chapter 261 will enable HHSC to reallocate available beds reverted to HHSC due to provider closure or expiration of beds in suspension. With the addition of new §261.220, ICF/IID providers can apply to HHSC to request up to a maximum of six additional beds if they choose. This new rule formalizes the current process for Medicaid bed reallocation authorized by the Long-Term Care Plan for Individuals with Intellectual Disabilities and Related Conditions, based on Texas Health and Safety Code §533A.062(b-1).
  2. Hospital Augmented Reimbursement Program (HARP)
    - Eva Dorman, Financial Analyst, HHSC Provider Finance Department

    The proposed new rule describes a new program to preserve financial resources many Texas hospitals depend on to provide access and quality care to Medicaid clients and the uninsured. Subject to approval by the Centers for Medicare and Medicaid Services (CMS), HARP would be created through the Medicaid state plan. State plan programs and services do not impact 1115 Waiver budget neutrality. HHSC intends to submit state plan amendments to CMS requesting authorization to make payments as described under new TAC, Title 1, §355.8070 to non-state government owned and operated hospitals and to private hospitals.
  3. Pediatric long-term care facility reimbursement
    Samuel West, Director, HHSC Provider Finance for Long-term Services and Supports

    This proposal amends the payment rate methodology for pediatric nursing facilities, to base the methodology upon the unadjusted federal per diem rate for rural Medicare skilled nursing facilities for the most recent federal fiscal year. The proposal removes language related to the pediatric nursing facility rate methodology currently in TAC, Title 1, §355.307, and moves this language to a new rule in the same subchapter at §355.316. The amendment separates the pediatric care facility reimbursement methodology from the reimbursement methodology used for nursing facilities in general. The proposal also makes general edits to improve clarity. The reimbursement methodology revision will lead to higher reimbursement rates than exist under the current methodology, leading to higher quality and greater access to care for medically fragile children in Texas.
  4. Public Comment
  5. Proposed next meeting: November 10, 2021, at 9:00 a.m.
  6. Adjourn

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 to provide public comment are asked to complete a Public Comment form at:

Members of the public who would like to provide written public comment to HHSC may email  Caroline Sunshine at no later than 5:00 p.m. Tuesday, August 10, 2021. Please include your name and the organization you are representing, or that you are speaking as a private citizen. Staff will not read written comments aloud during the meeting, but comments will be forwarded to State staff and Committee members for their consideration. Comments should not include confidential information or protected health information.

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, August 10, 2021. Members of the public may also use the Microsoft Teams Live Event Q&A section during the meeting 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. Do not include confidential information or protected health information in comments.

Public comment is limited to three minutes. Each speaker must state their name and either the organization they are representing or that they are speaking as a private citizen. Public members who are using handouts are asked to provide an electronic copy in accessible PDF format. 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. Do not include confidential information or protected health information in handouts. Staff will not read handouts aloud during the meeting, but handouts will be provided to Committee members and State staff. It is not permissible for public speakers to interject or ask questions to Committee members during the rest of the meeting.

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,

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 at least 72 hours before the meeting so appropriate arrangements can be made.