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HHSC held a stakeholder meeting to provide updates on programs and initiatives in Medicaid and CHIP. This is the first time HHSC has held a comprehensive stakeholder meeting for all Medicaid/CHIP programs.
 
Executive Commissioner’s Update – Charles Smith

  • The recent managed care stakeholder meeting with industry groups went very well
    • Received over 100 recommendations on every aspect of managed care
    • 60 of these are in the process of being implemented
    • Have published responses to each recommendation on the HHSC website
  • It is critical to address existing issues in managed care as the state further expands the reach of the managed care model
  • Want the agency to be focused in on health outcomes; the HHS vision will be people getting services they need in a timely and complete manner
  • Want a system that is responsive to the needs of the clients while treating them with dignity and respect
  • Still have to be responsible stewards of public funds; need to ensure there are appropriate rates and that services being contracted for are being delivered as a quality product
  • Want to ensure providers of all kinds are being heard and that the agency is responsive to all providers
    • The Medicaid program requires a robust network and HHSC needs to build a program that providers want to be a part of

 
1115 Transformation Waiver

  • Up to this point HHSC did not involve managed care to the extent the agency would have liked in waiver programs
    • Working hard to remedy that as the waiver is being extended
  • A 15 month extension was granted by CMS with level funding; still working on a longer term extension
  • If no agreement is reached the UC pool will be reduced and the DSRIP pool will be phased out at a rate of 25% per year
  • Health Management Associates and Deloitte are helping the agency with the UC study required by CMS
    • The initial draft was submitted by the July 15 deadline
  • Working on strategies for continued services for the uninsured as well as integrating managed care into DSRIP and value based purchasing
    • This will be a focus of the August 30 1115 waiver collaboration meeting

 
Program Updates

  • For each of the following programs, agency staff reviewed enrollment numbers and discussed ongoing and future initiatives within each program; enrollment data can be found in the attached document

 
CHIP – Program Update

  • Not many changes within the CHIP program lately
  • Working on new rules to allow individuals enrolled in Medicaid who lose eligibility because of increasing income to auto-enroll into CHIP
  • Hoping to publish rules within the next few months

 
STAR – Program Update

  • There have been no major changes in the STAR program

 
Medicaid Dental – Program Update

  • Focusing on improving the main dental home concept
  • Taking steps to ensure it serves the needs of both members and providers
  • Working with OIG to ensure solicitation is addressed
  • Working to ensure necessary orthodontic treatment is available for patients with cleft palate and craniofacial anomalies
  • Trying to focus on safe and effective use of sedation and general anesthesia
    • Working on a policy to require prior authorization of procedures requiring level 4 sedation for patients 1-6 years old; expected implementation is Fall 2016

 
STAR Health – Program Update

  • Superior is the only MCO servicing STAR Health program
  • Adding several value-added services to the program
    • Caregivers can receive certain medications for lower prices
    • Providing free Boys & Girls Club memberships
    • Providing free physicals for sports and summer camps
    • Created a program to divert youth from inpatient facilities
    • Additional trauma focused services such as equine therapy
  • This fall HHSC will be implementing a new initial assessment process

 
STAR+PLUS – Program Update

  • There are a few contract changes pending CMS approval
    • MCOs will have a specific timeframe to reassess and reauthorize services for individuals with significant changes
    • Changes in notification requirements for MCOs when service coordinators change
  • Have made some changes to STAR+PLUS rules to get ready for implementation of STAR Kids
    • Will be updating the TAC as the program moves forward

 
Dual Demonstration/MMP – Program Update

  • Will be starting monthly passive enrollment; individuals can opt out
  • CMS is also now allowing for rapid reenrollment
  • CMS has allowed an extension of the demonstration for 2 years
    • During the extension, the counties being served in the program will not be expanded

 
Medicaid Initiatives

  • STAR Kids
    • Have heard rumors that HHSC will be cutting services and access to doctors through the program; this is not true
    • The cornerstone of the new program will be the initial needs assessment; services coordinators will be in contact with the family to discuss current services being utilized, issues the family is dealing with, just want to get a general picture of what they are experiencing; this information will be used to create a service plan for each program member
    • Service coordination is the key aspect of the program
    • On track for the rollout and will begin to organize informational sessions around the state for members and providers
    • Providing flexibility in the program by extending the continuity of care provisions
    • TDI is allowing providers outside of a member’s service area to be on their provider lists and they will be considered in-network providers
    • Waiving the requirement for a Medicaid PCP for children with an existing relationship with a PCP through private insurance
  • Adoption and Permanency Care Assistance
    • Will be carving into managed care early 2017
    • Will facilitate the adoption of children with special needs and those children who are in permanency agreements with DFPS
  • Medicaid for Breast and Cervical Cancer
    • Full Medicaid managed care benefits will be provided for women with a diagnosis of breast or cervical cancer
    • Must meet eligibility criteria; 200% FPL with no other creditable insurance and not otherwise eligible for Medicaid
    • Any provider can perform the initial screening and diagnosis and refer eligible women to the program
    • Expecting a population of about 5,000 women
  • IDD Pilot
    • The legislature authored a pilot program to test one or more service delivery models for managed care LTSS for IDD
    • Participation must be voluntary; pilot can go for up to 24 months
    • Required to take stakeholder input during development of the pilot; have already held multiple stakeholder meetings
    • Posted a draft RFP in May of this year; working on finalizing the RFP to post in the near future
  • SB 760 Implementation
    • Implementing changes in the September contract amendment; also considering additional comments received by the agency and expecting to make additional changes in the May 2017 contract amendments
      • Requiring directories to be posted on MCO websites; must be updated weekly and must be compatible on mobile devices
      • Expanding expedited credentialing to certain provider types; considering additional behavioral health providers for expedited credentialing as well
      • Making numerous updates to network adequacy standards; revising some standards presented in the June meeting such as aligning OB/GYN standards with primary care standards instead of specialty; expect to have this new proposal ready for comment in August

 
Additional Updates

  • The therapy rates that have been in the news which are currently on hold are for FFS only; MCOs are not on hold for making adjustments in their rates
  • As required by legislation, have created a standard prior authorization form; have heard that some MCOs have begun requiring an addendum to the form; this was not the intent of the legislation; have also heard that the form hasn’t been as useful as hoped so the agency will be reworking the form
  • The agency is in the process of procurement for a new provider enrollment system
  • TAHP is in the process of creating a credentialing repository that will work across health plans
  • HHSC asked that providers submit their Medicaid reenrollment by July 17 so that application deficiencies could be addressed and applications could be pushed through by September 24; if applications are turned in now they can probably still be pushed through by that deadline

 
Future Procurements for Programs and Operational Start Dates

  • CHIP Rural & Hidalgo  – 9/1/18
  • STAR+PLUS Tarrant and Dallas Service Areas – 2/1/19
  • Medicaid & CHIP Dental – 3/1/19
  • All of these procurements are re-procurements for current programs; do not expect much change in the programs