The Medical Care Advisory Committee held a meeting to act on their posted agenda.
Comments from the Associate Commissioner for Medicaid and Children's Health Insurance Program (CHIP): Gary Jesse spoke on behalf of Kay Ghahremani, Health and Human Services Commission (HHSC)
- Sunset hearing is coming up- next week will be opportunity to make public comments
- Session will officially begin in January and run through May 2015
- Election results announced- many new members and all but three are Republicans
- Pre-filing starts Nov. 10
Approval of August 2014 Meeting Minutes
- Motion unanimously approved
Announcement of Proposed Slate of Candidates for Medical Care Advisory Committee Executive Committee: Michael Vaclav, DDS.
- Dr. Gilbert Handal, MCAC Chair
- Colleen Horton, Vice Chair
- Mary Helen Tieken, member at large
- Motion unanimously approved
*Presentation on the Transformation Waiver Overview: Gary Jesse first and then Lisa Kirsch, Chief Deputy Director, Medicaid and CHIP
- Medicaid delivery map illustrates transition of system from FFS to MCO
- Biggest managed care product is STAR
- 19 health plans that coordinate benefits across the state
- In regards to PCP question – goal of PCP is central point of coordination
- STAR+PLUS is predominately for adults
- Service coordination is key
- Recently expanded remaining counties and carved in various services
- 5 MCOs deliver
- State plan amendment submitted to implement benefit
- Services for rehabilitation – Community First Choice will offer entitlement benefit
- Because it is a state plan benefit it will not apply to cost ceiling of waiver
- Will also be carving in nursing services next year – nursing facilities transition
- Next March will implement dual demonstration in 6 populous counties
- Monitoring and oversight is important
- Able to attract and hire individuals with extensive experience
- Enrollment is a focus and managed closely
- Complaints and appeals is an important part of management and supports its own fair hearing process
- Have division that provides support for providers around complaints
- Can help to identify systemic issue
Lisa Kirsch, Chief Deputy Director, Medicaid and CHIP – DSRIP Focus
- UC pool is rough replacement for UPL
- DSRIP pool to support coordinated payment
- Trend towards more DSRIP and a little less UC
- Local and state entities through IGTs are putting up non-federal share for both of the programs
- 1492 active DSRIP projects across the state
- 309 DSRIP providers
- Waiver expires Sept. 30, 2016
- Transition plan for two pools will need to be submitted Sept. 2015
- Will get broad stakeholder input on what HHSC is proposing
- There is a renewal survey available currently for the public to fill out
- Texas is at forefront of DSRIP renewals – HHSC expects some negotiation and there are a lot of unknowns
- UC side there is significant tightening up from federal level but anticipates there will need to be a stronger case made if Texas wants to keep both pools at current level
- Thinks there will be some room for new projects with money in the renewal
- Had statewide summit in September but heard from stakeholders request for more time to really share what is or is not working – so in August will be building in more cross sharing of information along the regions
- Many are already doing informally
INFORMATIONAL ITEMS:
*Amendments to Title 1, Part 15, Chapter 355, Subchapter D, §355.456, concerning Reimbursement Methodology
- Texas Association for Home Care & Hospice – submitted written testimony and provided oral testimony based written comments
- Was told it would be for small ICF’s and rate methodology needs to express it is small ICF (6 beds or less)
- Actually would recommend a 4 bed facility
- Recommends focus on individual instead of project being localized for facility
- Was told it would be for small ICF’s and rate methodology needs to express it is small ICF (6 beds or less)
- Staff noted language will state it is limited to small ICF’s – maximum six beds homes
*Informal Dispute Resolution for Assisted Living Facilities
- No public testimony
NOTICE OF PROPOSED RULES/ACTION ITEMS:
*Transition Assistance Services
- Dr. Handal said he thought the fiscal impact is negligible
- Elizabeth Tucker – Every Child – excited to see some changes in the rule, amount is small with max at $2500 but helps to get essential necessities
- Made comment that assistance could be given regardless of where they were coming from – this comment was not accepted
- Texas Association for Home Care and Hospice – submitted written testimony and oral testimony
- Supports Tuckers comments
- Want to continue to work with department on rule
- HHSC staff noted there is a federal limitation but willing to continue discussions
- Motion was approved unanimously
*Home and Community-based Services and Texas Home Living
- This is companion rules to rule just presented under 62 because they would add transition services
- Allowed agency flexibility under certain corrective action situation
- Majority of expenses are transition to HCS
- Elizabeth Tucker – excited for rules and rules include ability for home modifications (would like to see that happen in other waivers and other assessments made)
- Motion approved unanimously
*Community Living Assistance and Support Services (CLASS)
- Dr. Handal asked how are outcomes measured – rule is very processed oriented without focus on outcomes he stated
- Colleen Horton was very concerned about restraint rules
- Horton said allowing restrain rules to be put into behavior plans will put the clock back
- Other board members indicated there was no therapeutic value to restraint and possibly contraindicative
- Horton said she did not think restrains had any place in the plans
- Texas Association for Home Care and Hospice – high level of concern on language regarding restraints
- Person can be over-restrained and traumatized
- Rule is refocused on process and not on quality of life issues
- MCAC members discussed if individuals had tools they needed to work with if having to use restraints and if individuals were being rushed out of facilities
- In regards to a question on what precipitated the rules, staff noted surveys were sent out and had questions regarding restraint
- Comment from MCAC members again revolved around if maybe families are doing care without proper equipment/training
- MCAC members discussed several motions from sending the whole rule back to removing the complete section on restraints to removing restraints references
- The item was postponed until after agenda item 17 with the caveat that staff would re-work language
- The item was brought back up after agenda item 17
- Starting on page 10 of 132 restraint language was removed
- Protective devices language was kept in
- Motion approved unanimously
*Reimbursement Methodology for School Health and Related Services (SHARS)
- Motion approved unanimously
*Community First Choice Services
- March 1 implementation
- State Plan amendment was submitted on October 10
- This plan will get services to those who were on interest list much sooner
- Motion approved unanimously
*Reimbursement Methodology for CFC Services
- Staff noted there is just approval for the methodology of setting rates, rates will not be proposed until further down the road
- The language is still a work in progress
- MCAC members did request language clean up before submitting to the Texas Register to address things such as typos, etc.
- Texas Association for Home Care and Hospice suggested that one blended rate is where the agency should ultimately go
- Gary Jessee with HHSC noted that they are not taking about blended rates at this time but looking at equalized rates
- Staff noted they will be looking at the possibility of blended rates later and will continue to work with stakeholders
- Motion approved unanimously
*Prescribed Pediatric Extended Care Centers
- Texas Association for Home Care and Hospice noted the bill language had a provision which clarified PPECC could be in addition to private-duty nursing (PDN) and would like it added to the rule so intention is clearer
- Motion approved unanimously
*Reimbursement Methodology for PPECC
- David Rimer testified that part of the reimbursement should include transportation and dietary services
- Staff said the rate will be limited to a reimbursement rate to no more than 70 percent of the average hourly PDN rate and there is no intention at this time to cover transportation and dietary costs
- In regards to members questions regarding why HHSC is not reimbursing for a service it is mandating (transportation and food) staff noted the rule is not effective until July so there is “ample time for the legislature to redirect” their intention
- Motion approved unanimously
- Discussion ensued on determining eligibility
- The standard of 95% is strict noted several board members
- Based on rule language hospitals have one business day to submit – staff noted that based on the automated system it should be possible
- Staff hopes that since it will take up to 11 months for the disqualification process they can work on the corrective action plan with the hospitals
- Motion approved unanimously
*Texas Dual Eligibles Integrated Care Demonstration Project
- There is no final savings estimate available at this point
- Members asked if the project was too ambitious
- Mary Tieken, MCAC member asked if they should just start out and test the waters
- There is a very aggressive timeline in place but there are several events scheduled across the state to help inform providers stated staff
- Texas Association for Home Care and Hospice had two witnesses testify
- There are rumors that MCOs are dropping all dual eligibles
- Also recommended that rule language be add specificity that speaks to passive enrollment
- Concerned agency is biting off too much and would recommend they scale back the demonstration
- Providers need to be made aware of this project
- Concern on implementation timeline and again recommends delay rollout or reduce size of rollout
- Letters need to go to nursing facilities as well as SSI individual addresses
- SB 7 protections should be included in the rules
- Discussion ensued on high rates of those participating out of network because rates are low
- Network adequacy discussion then ensued
- All 5 MCOs are participating
- Jessica Cassidy – Attorney Texas Legal Services Center
- Recommended to note member have access to acute care
- Was concerned how counties were selected
- In appeal rules need to clarify 60 days and 90 days as those two dates seem contradictive
- Staff noted the counties were selected based on those that had the most dual eligible in them
- Staff will look at enrollment and disenrollment to see if clarity is needed
- It was noted a legislative session is coming up in hopes that some of these things could be addressed before motion to approve was made
- Motion approved unanimously
Proposed Next Meeting: Thursday, February 20, 2015 at 9 a.m.