Public Hearing Notice:
The Health and Human Services Commission (HHSC) is to implement Senate Bill (S.B.) 1648, 87th Legislature, Regular Session, 2021, that amended Texas Government Code §533.038(g) and added new subsections (h) and (i) to §533.038. HHSC proposes amendments to Title 1, Part 15, Texas Administrative Code (TAC) §353.4, concerning Managed Care Organization Requirements Concerning Out-of-Network Providers; and 1 TAC §353.7, concerning Coordination of Benefits with Primary Health Insurance Coverage.
May 16, 2022
11:00 am – 12:00 pm
Virtual Public Hearing Access:
Due to the declared state of disaster stemming from COVID-19, this public hearing will be conducted online using GotoWebinar only. To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance here. The webinar ID is: 195-070-731. There is not a physical location for this public hearing.
This public hearing will be archived. Members of the public may view a recording of this meeting at https://texashhsmeetings.org/HHSWebcast after the meeting.
Notice of Public Hearing: The Texas HHSC welcomes public comments pertaining to an amendment to chapter 353 of the Texas Administrative Code . The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on May 16, 2022, at 11:00 AM to solicit feedback and receive comment on the amendment of sections 353.4 and 353.7 of part 15 of title 1 of the Texas Administrative Code . This amended rule will direct managed care organizations (MCOs) to allow a Medicaid managed care recipient with complex medical needs to continue receiving care from a specialty provider with whom the recipient has an established relationship, regardless of whether the recipient has primary health benefit plan coverage in addition to Medicaid coverage; and to allow the provider to continue to be reimbursed at the fee-for-service rate until (1) an alternate reimbursement agreements, including a single-case agreement, has been reached; (2) the member or member’s legally authorized representative agree to select an in-network specialty provider; or (3) the member is no longer enrolled in the MCO. The amendment to the rule also adds that if a member wants to remain under the care of a Medicaid enrolled specialty provider that is not in the MCO’s network, the MCO must make a good-faith effort to negotiate a single-case agreement with that out-of-network specialty provider using a simple, timely, and efficient process developed by the MCO. Lastly, the amendment clarifies that a single-case agreement entered into under this provision is not considered accessing an out-of-network provider for the purposes of Medicaid MCO network adequacy requirements.
Attendees who would like to provide public comment or testimony should see the Public Comment section below.
- Welcome and call to order
- Public hearing to receive comments from interested persons concerning Amendment of §353.4 and §353.7 of the Texas Administrative Code
- Public comments
Public Comment or Testimony: The Texas HHSC welcomes public comments pertaining to Amendment of §353.4 and §353.7 of the Texas Administrative Code. Members of the public who would like to provide public comment may choose from the following options:
- Oral comments provided virtually: Members of the public must pre-register to provide oral comments virtually during the public hearing by completing a Public Comment Registration form no later than 9:00 am, May 16, 2022. Please mark the correct box on the Public Comment Registration form and provide your name, either the organization you are representing or that you are speaking as a private citizen, and your direct phone number. If you have completed the Public Comment Registration form, you will receive an email the day before the public hearing with instructions for providing virtual public comment. Public comment is limited to three minutes. Each speaker providing oral public comments virtually must ensure their face is visible and their voice audible to the other participants while they are speaking. Each speaker must state their name and on whose behalf they are speaking (if anyone). If you pre-register to speak and wish to provide a handout before the public hearing, please submit an electronic copy in accessible PDF format that will be distributed to the appropriate HHS staff. Handouts are limited to two pages (paper size: 8.5” by 11”, one side only). Handouts must be emailed to email@example.com immediately after pre-registering, but no later than 9:00 am, May 16, 2022, and include the name of the person who will be commenting. Do not include health or other confidential information in your comments or handouts. Staff will not read handouts aloud during the public hearing, but handouts will be provided to the appropriate HHS staff.
Members of the public may also use the GotoWebinar Q&A section to submit a request to provide oral public comment only. The request must contain your name, 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.
- Written comments: A member of the public who wishes to provide written public comments must email the comments to firstname.lastname@example.org no later than 9:00 am, May 16, 2022. Written comments may also be submitted by U.S. mail to the Texas Health and Human Services Commission, Attention: Heather Kuhlman, STAR Kids Lead Policy Specialist, Medicaid CHIP Services Division Mail Code H600, 701 West 51st Street, Austin, TX 78751. Please include your name and the organization you are representing or that you are speaking as a private citizen. Written comments are limited to two pages (paper size: 8.5” by 11”, one side only). Do not include health or other confidential information in your comments. Staff will not read written comments aloud during the public hearing, but comments will be provided to the appropriate HHS staff.
Note: These procedures may be revised at the discretion of HHSC
Contact: Questions regarding agenda items, content, or public hearing arrangements should be directed to the Managed Care Initiatives at email@example.com.
This public hearing is open to the public. No reservations are required, and there is no cost to attend this public hearing.
People with disabilities who wish to attend the public hearing and require auxiliary aids or services should contact Heather Kuhlman at firstname.lastname@example.org at least 72 hours before the public hearing so appropriate arrangements can be made.