SMMCAC Subcommittees

The State Medicaid Managed Care Advisory Committee (SMMCAC) originally established five subcommittees on Aug. 13, 2019. On Nov. 19, 2020, two of the subcommittees — Clinical Oversight and Benefits, and Administrative Simplification — were combined. One new subcommittee was approved on Nov. 9, 2023. The five current SMMCAC subcommittees are:

  • Clinical Oversight and Administrative Simplification
  • Complaints, Appeals, and Fair Hearings
  • Network Adequacy and Access to Care
  • Service and Care Coordination
  • Children and Youth with Medical, Behavioral, and Developmental Complexity

Clinical Oversight and Administrative Simplification

Summary/Charge: Seeks to strengthen the oversight of utilization management practices to include prior authorization policies and processes used by manage care organizations (MCOs). Focuses on reducing Medicaid provider burden through administrative improvements in four areas: claims payments, eligibility information, provider enrollment processes and prior authorization submissions.

Prior authorization discussions will focus on provider process issues and Health and Human Services Commission (HHSC) oversight of MCO prior authorization data. Also discusses specific Medicaid medical benefits as needed.

Meeting Dates

  • Feb. 8, 2024
  • May 2, 2024
  • Aug. 1, 2024
  • Nov. 7, 2024

Complaints, Appeals and Fair Hearings

Summary/Charge: Focuses on more effectively leveraging complaints data to identify potential problems in the Medicaid program, opportunities for improved MCO contract oversight and increasing program transparency. Also focuses on appeals and fair hearings processes, including implementation of an independent external medical reviewer.

Meeting Dates

  • Feb. 8, 2024
  • May 2, 2024
  • Aug. 1, 2024
  • Nov. 7, 2024

Network Adequacy and Access to Care

Summary/Charge: Supports a comprehensive monitoring strategy to ensure members have timely access to the services they need. Objectives include accuracy of provider directories, incentivizing use of telehealth, telemedicine and telemonitoring services, reducing administrative burden related to network adequacy reporting and monitoring and integrating network adequacy reporting to include additional measures.

Meeting Dates

  • Feb. 7, 2024
  • May 1, 2024
  • July 31, 2024
  • Nov. 6, 2024

Service and Care Coordination

Summary/Charge: Focuses on improvements related to service and care coordination within managed care. Objectives include assessing best practices for care coordination, addressing state-level barriers hindering MCO deliver of care coordination services, clarifying terminology and definitions of service coordination and service management activities and identifying possible improvements to ensure service coordination and service management is consistent within HHSC contract requirements.

Meeting Dates

  • Feb. 7, 2024
  • May 1, 2024
  • July 31, 2024
  • Nov. 6, 2024

Children and Youth with Medical, Behavioral, and Developmental Complexity

Summary/Charge: Focuses on improvements in the care of children and youth with medical, behavioral, or developmental complexity within Medicaid managed care. Objectives include, but are not limited to, advising HHSC on topics related to the ongoing operation and review of the STAR Kids Medicaid managed care and other managed care programs, assessing best practices for providing care for children and youth with complex needs, customization of and access to specialized care, transitions of care, and improving health outcomes and quality of services. Also collaborates with other SMMCAC subcommittees when a topic pursuant to children and youth with medical, behavioral, and/or developmental complexity within Medicaid managed care falls within another subcommittee’s charge.

Meeting Dates

  • Feb. 8, 2024
  • May 2, 2024
  • Aug. 1, 2024
  • Nov. 7, 2024