Below is the HillCo client report from the May 15 SB 1150 Stakeholder Group meeting.
The group held their first meeting and discussed recommendations as well as the format of future meetings.
HHSC received over 230 recommendations from stakeholders in response to a survey that was sent out. The recommendations were grouped into the following categories: Claims, Credentialing, Forms, Prior Authorization and Other. Subgroups are being formed for each category and will meet with the purpose of prioritizing and organizing the recommendations to report back to the full work group for further action. The group plans to meet every month. See SB1150 Survey Responses attached below.
Claims
- Most of the recommendations within the claims group were in regard to prompt payment; this is already a contractual requirement within the HHSC/MCO contracts
- Many would like to minimize eligibility changes which cause claim recoupment
- Providers would like the ability to submit attachment electronically for provider appeals; SB 1150 specifies this ability; plans will have to come in line with this requirement
Credentialing
- Many MCOs are already using the CAQH database for gathering credentialing information; HHSC is working with others to get them started using CAQH
- Standardize the MCO addendum/request for additional information; HHSC is looking for ways to streamline the process; contract language requiring MCOs to complete this a lot quicker is already in place
- A stakeholder asked if TMHP in fee-for-service instances is in scope for the credentialing process
- Gary Jessee with HHSC: There are differences in how TMHP handles things for STAR; yes it is in scope; there has been a lot of discussion about that issue; many providers are unhappy that MCOs aren’t making retro payments and believe the practice is designed with that in mind
- A stakeholder asked about nurse practitioners being credentialed when their supervising physician is not
- Jessee: Everyone is not in complete agreement with this issue; there is an ongoing discussion about that
- HHSC is discussing the potential centralization of the credentialing and enrollment process; there is a similar system in Arizona; staff has received approval to discuss this with MCOs; could reduce the time it takes a provider to get through credentialing
- A stakeholder noted that Kansas has a standard credentialing form which makes it very easy to get credentialed with multiple MCOs
- A stakeholder noted TDI has standardized credentialing for hospital privileges among other things; the platform may already be in place
- Jessee: There is an issue regarding division of labor between TMHP and MCOs; there is already a standardized application providers can use; many MCOs are already drawing from the CAQH database
- There is a need to address the comprehensiveness of what providers are putting into the CAQH database; it is imperative that providers know where to go to understand the processes (evaluations, credentialing, claims, etc.)
Forms
- Many recommendations were sent in regarding standardizing of authorization and referral forms; there is already a workgroup for this item
- Providers would like the ability to eliminate hand-written signatures on the Title 19 form; would like to able to sign digitally as well as to reduce the number of signatures required
- Would like to focus on the provider directories and how they are managed, how they can be accessed and the ability to sort them by different information; HHSC will not eliminate the paper directory, but create an electronic one as well; it would be current at all times and save money
- A stakeholder asked that HHSC work on making the directory ADA accessible and produce it in other languages than English
- Providers would like DME forms to only be required every 12 months as opposed to 6; HHSC has already submitted a request to the policy development team to begin working on this
Prior Authorization
- Requests to increase or remove the behavioral health limit of 30 visits per year; issue has already been forwarded to the policy development team and behavioral health groups
- There is confusion surrounding the prior authorization issue; many believe prior authorization guarantees payment but it does not
Other
- Lots of groups are concerned about loss of eligibility and want to create a process for continued eligibility; part of the solution will involve statements of eligibility and MCOs assisting members with maintaining eligibility; it benefits MCOs to keep members in the system because they can be held accountable for measures even when members may have only been in the system for a short time period
- A stakeholder brought up SB 1804 (81R), it was an attempt to reduce fraud, abuse and waste in DME; the bill required qualified rehab professional and assistive technology provider certifications; want to ensure that with credentialing and enrollment this process and requirement are maintained
- A stakeholder noted that in an attempt to keep patients in primary care offices instead of emergency rooms, some MCOs are incentivizing providers to see patients beyond traditional office hours; it may be a good idea for all MCOs to look at this program