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Below is the HillCo client report from the August 14 Senate Health and Human Services Committee hearing.

The Senate Committee on Health and Human Services met to discuss Charge 7 and Charge 4. Please see the presentations attached and the notes below.
 
Charge #7 – Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services, 83rd Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:

  • Monitor implementation of initiatives aimed at improving the quality and efficiency of Medicaid long-term care services and supports, including the redesign of services for individuals with intellectual and developmental disabilities.
  • Monitor implementation of initiatives aimed at reducing fraud, waste, and abuse in Texas Medicaid and other health and human services programs.
  • Dental Board Reforms: Monitor implementation of initiatives aimed at improving the State Board of Dental Examiners' ability to protect public safety, including strengthening the Board's authority and enforcement powers, improving the complaint review and resolution processes, and increasing staffing to improve the Board's ability to respond to complaints and potential fraudulent activity. Determine whether there are additional changes necessary to ensure that the Board is able to regulate the practice of dentistry and ensure public safety.
  • Cancer Prevention and Research Institute: Monitor implementation of initiatives aimed at restructuring the governance structure, eliminating conflicts of interest, and increasing transparency at the Cancer Prevention and Research Institute of Texas (CPRIT).

 
Charge #4 – Identify cost-effective alternatives to Medicaid and the Affordable Care Act to better connect low income individuals to health care services through private market-based solutions, including Medicaid block grants and waivers. Recommendations should strive to encourage cost sharing, promote personal responsibility, reduce uncompensated care costs, contain increasing health care costs, improve access to care, address access to emergency department care issues in rural areas, promote the use of existing private coverage or employee sponsored coverage, reduce non-emergency use of emergency departments, and reduce the need for federal approval to the state Medicaid plan.
 
 
SB 7 Discussion
Chris Traylor, Deputy Commissioner HHSC

  • Nelson – the goal of SB 7 was to integrate services – are we on track for September and March?
    • Yes
  • Schwertner – is there network adequacy in rural areas – it is empirical that the networks are adequate
  • Traylor – we are working hard to ensure continuity of care
    • There has been 10x more education for this rollout
    • 60% of the IDD population has chosen their MCO
  • Rodriguez – how many providers in far west Texas?
    • The MCOs will have an adequate network and use of telemedicine
  • Nelson – Will the nursing facility carve in be seamless?
    • Additional quality based payments
    • One portal to HHSC
    • Once any problems are identified, they will work hard to fix it
  • Traylor
    • The IDD RFP will be out by the end of the year
    • Attendant and Habilitation service will now be available  to folks in STAR PLUS
    • Nelson – what is the status of the proposal with CMS
      • Poised to have an agreement with them in very short order
  • Traylor – The Dual Demonstration Pilot begins in March, 2015
    • Many Advisory Committees were created through SB 7, and HHSC hosted Managed Care information sessions across the state as well as provider training sessions
    • Pay for quality initiatives have been implemented that provides for incentives or disincentives for MCOs
      • 4% of MCO capitation is put at risk
      • Measured by PPRs, PPEs, PPAs, etc.
      • HHSC and DADS created quality indicators for nursing facilities, and are currently working on quality measures
      • MCO report cards are given to new enrollees

 
Fraud, Waste and Abuse Discussion
SB 8
Doug Wilson, OIG

  • The OIG has the authority to prevent, detect, audit, inspect, review and investigate fraud, waste and abuse in all HHS programs
    • Formed an investigative unit and employed 5 peace officers
    • Nelson – when will this be fully operational?
      • Waiting on 2 hires, but efforts are underway
    • Established utilization management and Review unit
    • Conducted 5 site visits with the STAR PLUS MCOs
    • Reviews will begin in FY 2015
    • Periodic reviews of prior authorization processes

 
Joseph Schmider, EMS Director

  • Moratorium ends August 31, 2014
    • Rural exception
  • New medical director requirement for all EMS providers
  • There have been 0 applications, even with the moratorium ending
  • Zaffirini – the moratorium provided a break to update rules and establish checks and balances
  • The federal and state moratorium end at the same time
  • Anticipate better quality applicants going forward
  • Nelson – if state and federal OIGs know we have fraud, why is it hard to prosecute?
    • Criminal cases can take up to 4 years before trial

 
Texas State Board of Dental Examiners
Julie Hildebrand, ED

  • Schwertner – last session we heard about the maltreatment of pediatric patients
  • Hildebrand – the basic infrastructure was weak but it has gotten better
    • Patient abuse is referred to the Board
    • Cannot regulate corporate entities regulating the practice of dentistry
    • Have the ability to regulate the dentist
    • Can only place a cease and desist order on the corporation if they are an improper owner
  • Schwertner – you cannot prosecute the other entity no regulate them?
    • Correct
  • Schwertner – do you believe there is a corporate practice of dentistry in the state?
    • Yes
  • Schwertner – but you cannot do anything about it, unless any wrongdoing is done by a dentist
    • There are recent rules to clarify that action can be taken against the dentist owner
    • DSOs have control of the records – some dentists cannot get them back
  • Schwertner – terribly troubling
    • To be fair there are DSOs that do administrative services and dentists are still in control of the practice
    • DSOs handle billing – dentists need to be aware
  • Rules were proposed last Friday and could be voted on in November, adopted, or re-proposed
  • Nelson – will it take legislation?
    • The Board can penalize the dentist and do a cease and desist on a non-dentist owner
  • Zaffirini – what have you done exactly to implement HB 3201?
    • Collecting surcharges
    • Created a dental review panel
    • Hired a dental director
    • It is a very different agency than what it was a year ago – increased investigators, record collectors and attorneys
    • Getting better at investigating and have deterred some wrongdoing by DSOs
    • We can control what contracts the dentist enters into
  • Schwertner – HB 3201 makes dentists disclose if they have a contract with a corporate entity, list the address of the location and list all dentists at each location
    • The Board has raw data and they are forming a DSO list

 
 
CPRIT
Wayne Roberts, CEO

  • CPRIT was created by a constitutional amendment
  • Have a new oversight committee
    • 3 medical doctors
  • Merit based peer review grants for research and development
  • Had to address the transparency of operations last session
  • CPRIT is very complex
    • Moved meetings to inside the capitol
    • Post all materials on their website
    • Post compliance, affidavits and contributions on their website too
    • Have 103 pages of administrative rule
  • Schwertner – Where are we going forward?
    • The oversight committee is creating programs – will discuss at the next board meeting
    • The state gives CPRIT 300M a year, need to make it a priority to get a bang for the buck
  • Schwertner – has CPRIT met its original goal?
    • A cancer has not been cured yet, but have made enormous advances
    • Recruited 64 premiere young scientists
  • Nelson – is there any hole that we have not plugged before CPRIT can get about its business?
    • No
  • Nelson – we have the smartest people in the world working here to prevent cancer

 
Medicaid and ACA
Commissioner Rathgeber, TDI

  • TDI monitors network adequacy
  • Regulates carriers
  • Handles the consumer complaint process

Katrina Daniel, TDI

  • There is little data available on Medicaid enrollment from the ACA
  • The most timely data comes from HHS
  • 743K Texans signed up through the federal exchange, but we don’t know if they paid their premium or how many of them were previously uninsured
  • Do not have good data on the employer funded plan
  • Census on the uninsured in Texas reflected 24.6% or 6.4M
  • Data from 2013 should be more accurate, so the numbers might change
  • Nelson – many of the most important questions we have can’t be answered due to lack of data
  • Schwertner – have we seen the number of employers providing coverage for their employees drop?
    • Don’t have the data
  • The Prompt Pay Penalty Funds used to fund the high risk pool, but with that eliminated they are evaluating the best way to now use the funds
  • Nelson – is there a consumer insurance literacy program?
    • Many people are in the dark
    • Texashealthoptions.com
    • PSAs

 
Commissioner Janek, HHSC

  • Discussed the current Medicaid program
    • The ACA increased the FPL to 133%
  • Please see the attached presentation “Medicaid and ACA” for graphs and detailed data
  • The greatest cost increase is in poverty-related children ~250 per member per month
    • Pregnant Women ~600 per member per month
    • Aged and disabled ~ 1200 per member per month
  • Nelson asked for data on retention rates
  • Discussion about the 1115 waiver
    • RHPs, IGT, DSRIP and UC
    • 1274 4 year projects
    • 217 3 year projects
  • Worked closely with hospitals to get proper DSH payments
    • Have now finalized the formula
  • Nelson asked about metrics from the DSRIP projects
    • Data is just now starting to role in

 
County Indigent Health Care Project

  • Small program
  • 7 counties in 2013
  • 269,000
  • Help for the poorest individuals in Texas
  • Available to counties that spend more than 8% of their GR levy tax on indigent health care

 
Mental Health and Substance Abuse

  • Will not go in depth because it will be a major discussion tomorrow
  • Nelson asked about Veterans
    • Veterans have complete access to state services
  • 9.9M grant to establish a chronic disease management program to address chronic disease with individuals with behavioral health problems

 
Women’s Health

  • Target to serve 170,000 women a year, and they have already served over 100,000
  • Janek – we need to streamline all women’s health programs and providers – still working on a web portal

 
Health Care Options Survey

  • HHSC is compiling a list of options for low-income, uninsured Texans through 2 surveys
  • Trying to identify all existing sources of care

 
Public Testimony
 
SB 7 Testimony
George Lineal, provider of long term care services

  • Was opposed to SB 7
  • The ACA is going to have a significant impact – will need higher reimbursement
  • Network adequacy is an issue
  • Need guidelines on how to talk to residents on how to choose a MCO

Rachel Hammond, TAHCH

  • Managed care contracts include continuity of care, but there are problems
  • EVV is a concern – HHSC needs to start working with providers immediately
    • Implementation in 2 weeks

 
Jeff Miller, ARC Texas

  • Is very involved with the implementation of SB 7
  • Thanked HHSC for working hard
  • Lessons they have learned will help out in future efforts

 
Stacy Mayfield – personal story
 
Peter Henning, People Provider Network

  • Concern with the IDD carve in
  • Need to continue to focus on the network adequacy piece
  • Hard to find new doctors that will participate

 
Leslie Lucia – personal story
 
Ilene Robinson, advocate

  • Wants an ombudsman for community based services
  • Wants freedom of religion for the IDD population

 
Linda Johnson, advocate

  • Concerned about IDD and lack of oversight in the community

 
Sandy Frizzel, PACSTX

  • Right now it is a sit and wait game
  • Concerned with implementation timelines

 
Ruth Mason – personal story
 
Colleen Horton – HOGG Foundation

  • Her daughter is an IDD
  • Praised HHSC
  • Is sure that there will be bumps in the rollout

 
SB 8 Testimony
Dr. Vivian Teagarden, dentist

  • Very little has changed with due process rights of providers
  • Her employees have been called by the OIG to ask if they had witnessed any fraud
  • State held 1M and wouldn’t return it
  • Schwertner asked about the business
    • Her boss is the sole owner and employees are contracted

 
Dr. Chad Evans, Dentist

  • Medicaid is broken
  • Went on a payment hold after not getting any clarity from the OIG on incentives
  • Had to lay off 120 employees
  • Schwertner asked about the business
    • 7 offices
    • The federal regulation in 2002 said that dentists could spend up to $10 per visit on incentive, but wanted to know if there was state regulation
    • Named Smile Magic PLLC
    • Hires the dentists
    • Advertises with flyers, community health fairs

 
Dr. Paul Dunn, Dentist

  • Practice serves 90% Medicaid patients in a rural area
  • In 2013 the OIG put him on a payment hold, but he proved them wrong and they still wanted 2.7M
  • TMHP approved braces that now the OIG says is fraud

 
Jason Wray, used to work for AG

  • OIG is strong arming dentists
  • Discussed some fraud cases

 
CPRIT Testimony
Dale Eastman, Breast Cancer Foundation

  • Have made recommendations to CPRIT and the legislature and they were not implemented

 
ACA Testimony
Sonia Tershay, NLLR

  • Has long advocated for low cost high quality insurance
  • Latinos are the most uninsured population
  • Need access to basic health care
  • Expand Medicaid
  • Taylor questioned her about where the money comes from and the national debt

 
John Hawkins, THA

  • Encourages private market coverage expansion
  • We have the advantage of re-negotiating the 1115 Waiver with CMS – maybe we could use it as leverage
  • Local governments are maxed out – DSH, IGT, UC, 1115

 
Dale Eastman, Breast Cancer Foundation

  • Expand Medicaid

 
Will Francis, National Association of Social Workers – Texas

  • Recommend Texas cover the gap
  • Utilize federal tax payer dollars
  • Expand Medicaid
  • People need access to mental health professionals

 
Texas Organizing Project

  • In favor of Medicaid Expansion and greater access to affordable health care
  • Need to close the coverage gap

 

Attachments