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Below is the HillCo client report from the February 10 Medicaid & CHIP Regional Advisory Committee meeting.

Update on Medicaid and CHIP Eligibility Changes Under the Affordable Care Act

  • Beginning January 1, 2014 the state began providing Medicaid coverage to the following populations:
    • Children 6-18 whose family is between 100-133% of FPL
    • Former foster care youth who meet all of the following:
      • 18-25 years old
      • In Texas foster care on their 18th birthday or later and were receiving Medicaid when they aged out of foster care
      • US citizen or qualified alien status
  • New eligibility requirements apply to regular Medicaid programs as well as the Medically Needy Program for pregnant women and children, Emergency Medicaid, Presumptive Medicaid for pregnant women, CHIP and Refugee Medical Assistance
  • Household income and composition are based on federal income tax rules
  • Assets tests and most income disregards are eliminated
  • HHSC may still collect information regarding assets and resources but applicants will not be denied based on this information
  • Application changes have been implemented as well
  • If a client applies for Medicaid benefits and is turned down, their application will be sent to the federal health insurance marketplace
  • A committee member expressed concern that some clients are being denied both Medicaid and insurance on the exchange because of a disconnect between the state and federal systems

 
Update on Medicaid Tele-monitoring Benefit

  • Fee-for-service and managed care clients with diabetes or hypertension have access to home tele-monitoring benefits as of October 1, 2013
  • The benefit will end September 1, 2015 without action by the legislature
  • Home health agencies and hospitals are the only possible providers of the benefit
  • Authorization will be for 60 days at a time
  • HHSC will not provide equipment for the benefit but will pay a one-time $50 setup fee and will pay around $10 per day for transmissions
  • Proposed rules will be published in the Texas Register by the end of February

 
Update on Personal Care Service Rules

  • HHSC has proposed rule amendments relating to Personal Care Services provided through the Texas Health Steps Comprehensive Care Program
  • Amendments are the result of a 2012 study by the state auditor which recommended strengthening processes for obtaining documentation to establish need for services

 
Update on Major Medicaid Managed Care Initiatives

  • Nursing Home Carve-in for STAR+PLUS
    • HHSC is developing the carve-in curriculum to train those who will be helping with enrollment during the expansion
    • Health plans will be required to pay claims within 10 days of a clean claim submission
    • The contract effective date will be in late winter of 2014
  • Intellectual and Developmental Disability Carve-in for STAR+PLUS
    • HHSC will begin providing acute care services for IDD individuals who are Medicaid eligible
    • Clients may live in community based settings or receive services through an ICF-IID  waiver program
    • Individuals in state supported living centers and dual eligibles are not included in the carve-in
    • Changes will take effect September 2014
  • STAR Kids
    • Will provide services for children with disabilities who are Medicaid eligible
    • Program is expected to improve coordination, customization of care, access to care, health outcomes and cost containment
    • No service area has been announced yet
  • STAR+PLUS in Medicaid Rural Service Areas
    • HHSC announced tentative contracts with Amerigroup, HealthSpring, Superior and United to provide STAR+PLUS MRSA services
    • Agreements are contingent upon successful execution of contracts
    • When the program begins, clients will no longer be approved for STAR
  • Behavioral Health Carve-in
    • HHSC will begin providing services such as targeted case management and rehabilitative services through STAR and STAR+PLUS
    • The only population not included in the carve-in are clients receiving services through the NorthSTAR program in the Dallas Service Area

 
Update on Therapy Changes for January 2014

  • Beginning January 1, 2014, benefit criteria for physical therapy and occupational therapy changed
    • Therapy must be prescribed by a licensed physician
    • Medical necessity documentation must indicate a condition that requires ongoing therapy or rehabilitation
    • Documentation must show there will be progress

 
Update on Requirement for National Drug Codes (NDC) on Clinician Administered Outpatient Drugs

  • Beginning January 1, 2014, Texas Medicaid and Children with Special Care Needs Program will only reimburse providers for clinician-administered drugs and biologicals which participate in the CMS Drug Rebate Program
  • Providers submitting claims for clinician-administered drug procedure codes must include the NDC number

 
Update on Texas Women’s Health Program

  • No update

 
Update on Related Programs and Policies

  • Status of Primary Care Rate Increases
    • Supplemental payments will be made to providers who complete an attestation form for services provided starting January 1, 2013; attestation forms must be submitted by April 1, 2014
    • Attestations submitted after April 1 will only allow providers to receive rate increases from the day the attestation is submitted and onward
  • Texas Health Steps Changes for January 1, 2014
    • No update
  • Senate Bill 8 – Provider Marketing Requirements
    • The bill prohibits marketing activities that involve unsolicited personal contact with a client or parent whose child is enrolled in Medicaid or CHIP that are intended to influence the choice of provider
    • The bill does not prohibit marketing activities intended to influence the choice of provider which are conducted at community or nonprofit events
    • HHSC will adopt rules to enforce the provisions
  • Provider Administrative Simplification
    • No update

The next Medicaid & CHIP Regional Advisory Committee meeting is tentatively scheduled for May 12.