Print 🖨

The Medical Care Advisory Committee held a meeting to hear informational and action items on their agenda. The full agenda can be found here. 
 
Nursing Facility Minimum Payment Amounts Program Transition

  • Allows MPAP participants a one year transition period into QIPP program
    • Participants will be allowed to continue receiving MPAP payments at about 50% of their current payment level
  • Facilities not currently enrolled will not be eligible
  • Appears in the Texas Register on February 19
  • Informational item only

 
QIPP for Nursing Facilities

  • In the place of MPAP, providers will submit Quality Improvement projects to receive funding
  • Open to all nursing facilities that have a source of public funding for the non-federal share and additional payments to nursing facilities are to be based upon improvements in quality
  • Will allow for incentive payments to nursing facilities that meet metrics previously agreed upon between the facility and an MCO as approved by HHSC
  • Informational item only

 
Public Commenter

  • Asks about the issue where CMS will not approve funds going back to the state and federal government, resulting in funds staying with the MCO if provider does not meet metrics
    • Pam McDonald says HHSC is negotiating with CMS
    • Another option is a Quality incentive pool that could hold the money
    • If it does not go through, we will have to re-propose rules, but HHSC is adamant about the money not staying with MCOs

 
Potentially Preventable Readmissions and Potentially Preventable Complications

  • Amendments to rules for PPR and PPC
  • Outlines the ability of a hospital to request its underlying data used in the analysis that determines penalties and incentive payments
  • Identifies a methodology for incentive payments for safety-net hospitals
    • Legislature directed HHSC to take 10% of funds contingent on quality
  • Allows HHSC to establish penalties based on quality of data, but this is not currently planned to be in practice
  • Public comment began Feb. 5 and HHSC hopes to be pushing incentive funds out this FY
  • Informational item only

 
Mariah Ramone, Teaching Hospitals of Texas

  • Socioeconomic factors are an issue because some of the metrics used could be affected more by patients than by the hospital itself
  • Incentives and penalties should be delinked to recognize that they are separate measurements

 
Provider Enrollment

  • Allows providers in Texas Medicaid and Medicare to submit new location information using  Provider Information Change forms as opposed to an enrollment application for each practice location
    • Reduces administrative burden
  • Amendments revise rule provisions to require one enrollment application for each provider, then leverage available Medicare data to ensure practice locations not included in the initial enrollment application are screened and validated
  • PIC  will be accepted for limited-risk Medicaid providers and providers enrolled in both Medicaid and Medicare
  • Informational item only

 
Sampling and Extrapolation

  • In response to SB 207 (Hinojosa)
  • Requires that OIG review its process of sampling and extrapolation
  • Requires OIG to use generally-accepted standards related to sampling and extrapolation in audits and investigations
  • Informational item only

 
Rules for HHSC OIG

  • In response to SB 207 (Hinojosa)
  • OIG will no longer enroll providers on a probationary or provisional basis
  • Clarifies that both providers and provider’s employees are subject to disclosure requirements and review
  • OIG no longer conducts site visits because this function is handled by HHSC’s Medicaid and CHIP division
  • Allows providers 20 business days instead of 20 calendar days to file for reviews of denied applications
  • Going to Texas Register on March 4 for comment
  • Approved

 
CHIP Enrollment

  • Includes consideration of CHIP applications managed care history in algorithm to assign MCO when applicant does not make a selection
  • Allows children to be enrolled in CHIP before paying applicable enrollment fees
  • HHSC proposed to clarify that applicant must pay enrollment fee, if one is due, to complete CHIP enrollment
  • Rules promote continuity of care
  • Approved

 
Medicaid Managed Care

  • HB 1878 (Laubenberg) requires HHSC to reimburse Medicaid providers for school-based telemedicine services
  • SB 760 (Schwertner) requires HHSC to implement several network adequacy initiatives – these specific amendments cover two initiatives
    • Requires establishment of minimum access standards for specific services
    • Requires establishment and implementation of an expedited credentialing process to allow providers to provide services to recipients on a provisional basis
  • Approved

 
HHSC Advisory Committees

  • SB 200 (Nelson) and SB 277 (Schwertner) removed 38 advisory committees from statute and authorized HHSC Executive Commissioner to reestablish committees in rule
  • Committees were either consolidated, continued as they were currently, or discontinued
  • New rules proposed for each committee includes purpose, tasks, and membership
  • Approved

 
Meeting Adjourned