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Below is the HillCo client report from the May 23 Health and Human Services Commission Council Meeting.

Update by Commissioner Traylor:

  • Developing a strategic plan that is now on the website
  • Will hold a video conference June 3rd for statewide stakeholder input
  • 4 Sunset reports were released yesterday for DARS, DADS, DFPS and DSHS
    • Hearings will be in late June
  • HHSC Sunset report will be released in October, with the hearing in November
  • Terminated Xerox contract with TMHP do to their faulty prior authorization process that resulted in the overutilization of orthodontia in Medicaid
    • Accenture took over as the lead contractor
    • HHSC is looking into a re-procurement plan

 
View details of the HHSC Legislative Appropriations Request 2016-17 Potential Exceptional Items.
 
Informational Items
Regarding Transitioning Foster Care Youth Medicaid Eligibility
Information on emergency rule amendment proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapters 366, §366.611.

  • No Testimony

Regarding Adding Anesthesiologist Assistants to the Fee Schedule as a Medicaid Provider
Information on rule amendments proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 354,  §354.1064, §354.1065.

  • Carla Cox, Texas Association of Nurse Anesthesiologists
    • Anesthesiologist Assistants (AAs) do not need to be specified as a separate Medicaid provider
    • They are not licensed by the state
    • Supervised by physician anesthesiologists and are under no Board rule
    • This rule differs from CMS guidelines for AAs
  • The committee is concerned with this rule, and asked for the rule to be brought back to the Council at the next meeting so they can review all public comments

Related to Waiver Payments to Hospitals, for Physician Services, and other Providers
Information on rule amendments proposed in the Texas Register in Title 1, Texas Administrative Code, Chapter 355, Part 15, Subchapter J, Division 4,  §355.8202. and §355.8203.

  • Due to stakeholder demand, changed the original rule to allow for a facility to ask for an increase in HSL
  • HHSC added a second back end reconciliation to ensure what a facility is asking for aligns with their actual need

Regarding Medical Transportation Program Non-Emergency Transportation Services
Information on rule amendments in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 380, §§380.101, §380.201, §380.205 & §380.207, §380.209, §380.301, §380.401, §380.501 and §380.502.

  • Kenneth Jones, Coastal EMS, Texas Ambulance Association
    • If it is truly medical transportation, the patient needs to go by ambulance
    • HHSC – Changes are due to the implementation of SB 8, some of which have already been in place in Dallas and Houston but are now going statewide
    • This rule would allow for illegal transportation under Texas law
    • If the transport requires a stretcher, an ambulance must be used
  • Dudley Wate, Schertz EMS
    • Rely on a number of non-ER providers when demand exceeds supply and they need assistance
    • SB 8 did a lot to reduce fraud
      • The definition of “Non-emergency” ambulance opens a pathway for fraud and confusion from the public
      • The public will just see an ambulance and expect they can provide emergency care
  • HHSC held a forum yesterday to hear from stakeholders, and will hold another next week to collect further comments

Action Items Related to Rules
Related to Out-of-State Provider Eligibility
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 352, §352.17.

  • Approved

Regarding to Three-Day Payment Window to Providers
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 354, 354.1072.

  • Needed to catch up to the reimbursement rule on the program side
  • Approved

Regarding Potentially Preventable Complications and Potentially Preventable Readmissions 
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 354, §354.1446.

  • Included a transition period to include all pediatric population under 18
  • Penalty amounts will remain the same in the rule despite recommendations from HPAC and MCAC
  • Will be meeting to discuss socioeconomic risk factors
  • HHSC will host a robust education campaign for providers
  • Maureen Milligan, THOT
    • Want incentives for reducing PPRs and PPCs, not penaltyies
    • Would like an appeals process
    • Believes that this would penalize safety net hospitals
    • There needs to be a fair, socioeconomic risk adjustment taken into consideration
  • HHSC will have an email address where providers can submit concerns that will be monitored by 3 HHSC staff members
  • Approved with the caveat that HHSC will provide regular updates to the Council on implementation

Regarding CHIP Out-of-Network Providers
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 354, §354.1832.

  • Approved

Related to CHIP Balance Billing
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 370, §370.4 and §370.453

  • Approved