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Texas Health and Human Services Commission held a meeting of the SB 1150 Stakeholder Workgroup to discuss implementation of provisions of that bill. This meeting focused on the prior authorization provision.

Sunset Update

  • The workgroup was given an update on the Sunset Advisory Commission findings on issue #5 regarding provider enrollment and credentialing
  • Findings include the process is fragmented, administratively burdensome, delays, etc
  • Recommendations include streamlining the process
  • Next steps include a public hearing on December 10 to decide on recommendations and what material will make it into the legislative process for the 84th Session
  • HHSC staff noted almost all Sunset recommendations require a change in law – in regards to issue #5 will need statutory changes to accept Sunset recommendations
  • Jamie Dudensing, Texas Association of Health Plans, noted they are working with Sunset members to coordinate standardized credentialing 

 
Prior Authorization/ Proposed Standardized LTSS P.A. Form

  • Prior authorization is scheduled to take effect for Sept. 1, 2015 but did not cover long term care services
  • Rachel Hammond provided a draft form for starting comments and recommendations from stakeholders
  • Health care plans and providers are being reached out to formulate the form
  • The form was supposed to be for everyone but need to denote the difference between waiver and non-waiver clients
  • Don Langer, United Health Care, noted the form appears to only address PAS
    • Upon further discussion the final suggestion was made that the form start off with PAS, and clearly state that focus, in an attempt to standardized the services and after feedback possibly moving into Phase II which would expand the form to include other LTSS services
  • George Ledbetter was concerned the form could be cumbersome if needed for all prior authorizations include renewals and new
    • May need something on the form to clearly denote the difference between waiver and non-waiver
    • Thinks the form may be good for initial authorization but better to use a roster for renewals  
  • It was suggested the form may be rolled out as a pilot
  • Carl Kidd, Molina, suggested capturing the key questions and see what commonality exists while being mindful of the automation processes in place or being put into place
  • Ledbetter agreed that dealing with the essential elements is a big step
    • Roster possibly for volume of request and form for outliers
  • HHSC staff reiterated that they are not locked down to form but looking for core set of data elements
    • Looking to create a level of consistency and liked idea of phased in approach
  • Stanley Fisch, TMA, asked if coming together with common data set, where does it end up?
    • HHSC staff noted the intent is to move towards electronic solution but still have some who use paper forms
  • HHSC staff restated recommendations of workgroup: for MCO’s to work out a set of common elements and find consistency
  • Langer pointed out that possibly more important is what the backend looks like – information needs to be clear what is authorized
  • Yasser Zeid asked if MCO’s would be interested in a common exchange, he would like one portal/exchange for providers to go to
    • Dudensing said in looking at the credentialing exchange this may also be an option
  • HHSC staff restates the next steps:
    • Will be a phase in approach
    • Leveraging existing solutions and establish a sense of commonality
    • Will need to work on renewal portion (roster possibility)
    • Flexibility with MCO’s
    • Phase II would include all services
    • Phase III would look at consistency in existing interface with single website or solution option
    • Langer adds would also like to see comments on output as well
  • Goal is to have at least the core elements identified “before session”
    • Subgroup will meet now to work out common elements and bring to working group during a mid-January meeting
    • Ledbetter said would also be good at the subgroup meeting to include expected outcomes on the provider side
  • Comment that there needs to be communications during rollout that this is a collaborative effort- HHSC staff will work on this communication
  • Discussion ensued about response time on prior authorization to which HHSC staff noted that response time is complicated but is being reviewed internally and will be addressed 

 
Survey Responses

  • There are 236 responses to the HHSC survey and they are trying address every single one
  • Target is to provide that in a few weeks

 
Future Meetings

  • The plan is to establish quarterly meetings with the thought that the meeting in January will be a “one-off” meeting since it addresses a specific issue