Below is the HillCo client report from the September 3 House Human Services hearing.
House Human Services convened their last official interim meeting on Wednesday with an oversight hearing of HHSC, OIG, DFPS, DADS and DARS. Please see attached for the legislative presentations and below for a summary of the hearing.
Chris Traylor, Deputy Commissioner HHSC
Update on Dual Eligible project
- Will serve 131,000 dual eligible individuals in 6 counties
- Implementation date is March 1, 2015
- Fully integrated managed care model for individual who are enrolled in Medicaid and Medicare
- 3 way contract between the state, CMS and the MCOs
- Will allow for shared savings between the state and federal government
- Zerwas – How is this different that the PACE programs?
- In PACE, the number of individuals served is limited and serves more as an adult day care
- This demonstration serves a larger population across the spectrum
- Zerwas – how will the shared savings work?
- This demonstration will finally allow the state to share in savings, not just the federal government
- Believes the amount will be significant
Public Testimony
Rachel Hammond, Texas Association of Home Care and Hospice
- There is a lack of transparency on the operational process for the demonstration
- The provider community can provide significant questions that HHSC can take to CMS
- Not all Medicaid providers are Medicare providers and vice versa
- Appreciates the Chair suggesting a town hell forum with the legislator, agency and stakeholders
Bob Kafka, ADAPT
- An integrated LTSS system has been their goal for many years
- Medicare part D came to light, and other individuals realized that they were dual eligible
- They have suggested enrolling other populations into the demonstration but it was decided to just use STAR+PLUS
- We can better integrate all populations, SB 7 was a really good start
Kevin Warren, Texas Healthcare Association
- On March 1, 2015 a big rollout of managed care in STAR+PLUS will coincide with the dual demonstration rollout and this can present a lot of complications
- Concerned with the ability to successfully process cross-over claims
- Other states have had problems processing timely
- Raymond – the reality is that we will not change the Marc 1 rollout – what we need to do is give them everything they need beforehand to be successful
- Have there been problems in other states?
- 3 states dropped out
- Inability to negotiate the 3 way contract
- Difficulty processing claims
- MCOs dropping out
- 3 states dropped out
Doug Wilson, OIG
- Discussed the provisions of SB 1803 that give providers due process in investigations of fraud, waste and abuse
- Received 17 new FTEs and 76 Informal Resolution Meetings have been held since the implementation of SB 1830
- Providers can post a surety bond in lieu of payment holds
- The OIG website has been updated with educational materials
- Raymond – how do the investigations work?
- Investigation, 2 informal reviews, SOAH hearing, ability to ask for a continuance
- Cannot control when the SOAH meeting is set
- Have settled 14 cases for 14M
- Investigation, 2 informal reviews, SOAH hearing, ability to ask for a continuance
- Fallon – Would more investigators help?
- Would allow them to act more quickly – but the process to get a SOAH hearing is still lengthy
- Fallon – how many investigators are in the Medicaid Fraud unit?
- 76
- Florida is the largest state with fraud waste and abuse, so when we identify a trend it usually has happened in Florida so the Medicaid Fraud Unit is in constant communication with Florida
- Fallon – what’s the longest sentence someone has received for fraud?
- DME company, 25 years in jail
- Raymond – Talk to us about Xerox
- Texas sued Xerox in the Billions in reference to orthodontia – the OIG isn’t directly involved since it is more in the AG’s hands
- Zerwas – what happens when practices are targeted?
- They are put on a payment hold or they can put up a bond
- Their data analytics system identifies outliers and prompts investigation
- They only do about 100 investigations every year, even though there are 78,000 Medicaid providers in Texas
- Raymond asked how many investigations have occurred in the past 5 years, how many were sent to the Medicaid Fraud Unit, and how many were adjudicated
- Will get the Chair that data
- The average process takes about 4 years just for the OIG’s portion
- Fallon – so more investigators can shrink that time frame
Public Testimony
Rachel Hammond, Texas Association of Home Care and Hospice
- Referenced a provider that went through an investigation and audit that resulted in 0 findings, but it took five years
- Investigations can be started just for paperwork errors liken not putting a member ID on every page of a claim
- Believes this is a misapplication of policy by the OIG
- Fallon – does the OIG have discretion?
- Small level
- Invaluable information about fraud waste and abuse was posted on the OIG website for the provider community, and they are very thankful for this
Dr. Paul Dunn – Self
- Dentist
- Was told he owed 2.7M for preapproved orthodontia in the past
- Destroy practice after 40 years
Dr. Chad Evans
- Dentist
- OIG is using program violations like paperwork errors for payment holds
- Should only be able to use when fraud is evident
- Believes these errors didn’t cost the taxpayers’ dollars, but were mere clerical errors
Dr. Bizari – Houston
- Placed on a payment hold during an investigation, and SOAH ruled that there was no evidence of fraud
- 2 years later they are still on a 100% payment hold
- Need to revisit due process provisions in SB 1803
Dr. Juan Villarreal
- Harlingen family dentistry
- 2011 payment hold
- Found to have not committed fraud in 2013, but it has been 3 years and the funds have not been returned to the practice
Judge John Specia, DFPS Commissioner
- Prevention and Early Intervention
- Recommendation by Sunset that they are already implementing
- Contracting with community organizations to provide evidence based child and family support services
- Established Healthy Outcomes through Prevention and Early Support (HOPES)
- Used money from Rider 30 to target high risk communities
- Have 8 contracts
- There will be need for additional resources to expand the program
- Some counties are angry they aren’t receiving the service
- Money is only good for 14 months
- CPS Transformation
- Already making changes on Sunset Recommendations
- Completely rewriting policies
- Focusing on getting caseworkers more time with families
- Great focus on retention and streamlining policy and practice
- Must report to Sunset in October on progress
- Zerwas asked about salary adjustments
- Have made changes and it has helped with retention
- Merit raises are possible, especially in rural areas but they need to identify more funding
- Hired a full time retention specialist in the last 6 months
- Building leadership training
- Want to bring turnover rate down to 24%
- Rose – are there incentives for workers wo have been there longer?
- 10% merit raises a year for 3 years
- Makes retention difficult after that
Public Testimony
Stacy Ford, Parent’s Coalition
- A lot of data at the agency is in narrative and not searchable
- Need to update IMPACT
- Want to know the number of kids in foster care with disabilities
- Need data more expeditiously
- Specia is having the same problem – updating the system will take at least a year
Veronda Durden, DARS Commissioner
- Rider 28 from the 83rd session requires DARS to evaluate the cost-effectiveness of the family cost share provisions of the Early Childhood Intervention program, and to make changes to improve cost effectiveness if needed
- Evaluating the family cost share system
- Established a Family Cost Share Team
- Collecting data from contractors to assess their administrative costs
- Analyzing additional information such as third party collection amounts and the number of children served per county
- Will issue a report by December 1, 2014
- DARS modified the Autism Program for FY 15 to offer two distinct treatment services:
- Comprehensive ABA Service
- Children 3-5
- 16-20 treatment hours a week
- Maximum of 24 consecutive months
- Focused ABA Services
- Children 3-15
- 30 treatment hours a month
- Maximum of 24 nonconsecutive months
- Children may access services at various milestones of development
- Will pilot an innovative treatment program in FY 2015
- Comprehensive ABA Service
- Rider 30 Report regarding Centers for Independent Living (CIL)
- Submitted to the legislature
- Includes:
- Actual and estimated number of consumers served by each state funded CIL 2014-2015
- Types of services provided by each CIL
- Strategies to improve the measurement, collection and reporting of outcome data related to CILs
- Coordinate and enhance the output and outcome of data collection, measurement and reporting
- Improve instructions and guidance to promote consistency in federal reporting
- Reduction of the waiting list for the Comprehensive Rehabilitation Services (DRS) Program
- Phase 1
- Conducted a project to improve cost projections and budgeting processes, increase accountability, manage the waiting list and enhance data collection
- Phase 2
- Implement improvements to the service delivery structure
- Better define service array based on research review
- Develop a uniform rate setting methodology
- Recommend a utilization review process
- Propose revised outcome measures
- Phase 1
Chris Adams, Deputy Commissioner for DADS
- Balancing Incentive Program
- Applied late 2012
- Assisting states to expand and enhance community based health care services
- Currently Texas spends about 60% of Medicaid LTSS funds on community based services
- By September 30, 2015 Texas must implement:
- A “no wrong door” eligibility and enrollment system
- Core standardized assessment instruments
- Conflict-free case management activities
- Raymond discussed Sunset Recommendations for DADS
- Original recommendation was to close the Austin SSLC and 5 other facilities
- Sunset decided that there would be the creation of a closure commission that will study the operations of other SSLCs and make recommendations back to Sunset and be voted on formally by the Legislature
- Recommendations for additional closures wouldn’t be voted on until the 85th Legislative session