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Below is the HillCo client report from the October 20 Region 7 Medicaid & CHIP Regional advisory Committee meeting.

The Region 7 Medicaid & CHIP RAC met to present updates to stakeholders on issues that affect those programs.
 
 
Update on Affordable Care Act

  • Hospital-based Presumptive Eligibility
    • Proposed rules implement federal requirements where hospitals have the option to make presumptive eligibility determinations whether the state chooses to provide presumptive eligibility or not
    • Proposed rules allow a hospital to determine eligibility for children, parents and caretaker relatives, former foster care children and pregnant women
    • Proposed rules set out eligibility requirements for individuals who qualify for presumptive eligibility, requirements for providers and HHSC responsibilities for oversight
  • Changes to HHSC Renewal Process
    • HHSC no longer mails paper renewal packets for benefits; HHSC now attempts to renew based on information already provided, then mails a renewal letter before benefits end

 
Update on Dual Demonstration Project

  • Objectives
    • Make it easier to receive care
    • Promote independence in the community
    • Eliminate cost shifting between Medicaid and Medicare
    • Achieve state and federal cost savings through improvements in coordination
  • Passive enrollment will be used and the project will begin April 2015; communications to clients regarding the updates will begin January 2015

 
Update on Managed Care Expansion initiatives

  • Intellectual and Developmental Disabilities
    • As of September 1, IDD clients receive acute care services through STAR+PLUS
    • Dual eligible patients living in state supported living centers are not included in the project but will be at a later time
  • STAR+PLUS Expansion
    • As of September 1, STAR+PLUS expanded to the Medicaid rural service area and became available statewide
  • Nursing Facilities
    • Starting March 1, 2015, people in nursing facilities will receive acute and long term services through STAR+PLUS
    • Dual eligibles will receive acute care through Medicare and long term services through STAR+PLUS
    • Health Plans must pay nursing facilities within 10 days of clean claim submission
    • STAR+PLUS MCOs can now begin contracting with nursing facilities

 
 
 
 
Update on Home and Community Based Services Rules

  • CMS has released a final rule to ensure people receive Medicaid HCBS in community integrated settings and to ensure people receiving services have access to community resources equal to that of people not receiving HCBS
  • The rule also works to ensure people receiving HCBS have the ability to choose where they live and who provides them services
  • HHSC is asking for stakeholder input as well; federal rules will be effective in January and the state will have time to catch up after they are implemented
  • Many changes will be made to Texas programs to include person-centered planning initiatives

 
Update on Medicaid and CHIP Quality Efficiency Improvement Efforts

  • Pay-for-Quality Program
    • Replaces the At-Risk and Quality Challenges programs
    • Creates incentives and penalties for MCOs based on performance on certain quality measures
    • MCOs will be eligible for bonuses of up to 4% of capitation rates; there will also be penalties of up to 4% for MCOs that do not meet their measures

 
Update on Texas Healthcare Transformation and Quality Improvement Waiver

  • In Region 7, Austin and Central Texas, there are 77 DSRIP projects for a total of over $700 million
  • Projects include mobile clinics and increased numbers of psychiatric beds

 
Update on Prescribed Pediatric Extended Care Centers

  • Sb 492 (83R) directed DADS to create a new licensure and Medicaid-payable benefit for PPECCs
  • PPECCS provide non-residential facility based care as an alternative to private duty nursing for individuals under 21 who are medically or technologically dependent
  • HHSC will present rules and rates at the November Medical Care Advisory Committee meeting as well as the November HHS Council meeting
  • MCO contract amendments will be effective March 1, 2015; PPECCS must be licensed by DADS
  • MCOs should be able to credential and contract with PPECCs before the June 1 start date of the benefit

 
Update on Sunset Process

  • If certain Sunset recommendations are included in Sunset legislation, Medicaid and CHIP RACs would be abolished
  • Would like stakeholder feedback on ideas for better meeting structure and content of meetings