Electronic Visit Verification (EVV) Update
- Statewide implementation in STAR+PLUS and STAR Health is expected to begin June 1, 2015
- An RFP was issued by HHSC and approved vendors will be selected by March 2014
- All EVV systems must be ADA compliant
- After vendors are approved providers will select a vendor
- Providers will incur no cost of implementation
- An EVV rule will come out in May which will be followed by a comment period
- EVV implementation will begin with STAR+PLUS and STAR Health for personal attendant services and nursing services in-home or in-community
- EVV implementation for fee-for-service will begin in personal care and nursing services in-home or in-community
- HHSC is working closely with DADS to ensure the compliance plan is in place and all requirements are met before EVV implementation
Dual Demonstration Project Update
- The project will be moving forward January 1, 2015 in the following counties: Bexar, Dallas, El Paso, Harris, Hidalgo and Tarrant
- Notifications to members will be sent out no later than 60 days before implementation informing members of the option to opt-out
- HHSC is working on an education component for the demonstration counties
- The demonstration will last 3 years and end December 31, 2017
- The memorandum of understanding with CMS is expected no later than the end of February 2015
Long Term Services and Supports Update
- HHSC staff reviewed utilization rates
- Attached as “Long Term Service and Supports Data”
- A stakeholder asked a representative from Amerigroup why it looked like utilization rates in Lubbock County were so low
- Amerigroup responded that Lubbock County is a new market and implementation kinks are being worked out; the population is also new to managed care so utilization is low
Attendant Rate Enhancement
- HHSC staff and health plan representatives discussed health plan’s actions thus far regarding configurations for rate enhancements
- Most plans have loaded rates effective September 1, 2013 and have begun paying accordingly
- Plan representatives noted that providers will have to bill for the enhanced rate or they will be paid based on the billings
- Provider stakeholders expressed concerns that they have not been paid according to enhanced rates
Service Coordination
- The service coordination carve-in has not been very simple
- Some MCOs implement higher standards than are required by HHSC regarding service coordination
- A service coordinator will be provided to any member who wishes to have one but is not required to have one if the member makes the request; HHSC did not want to inundate families with multiple coordinators so the requirement is not very broad
- MCOs should be reaching out to providers to inform them of their service coordination plans
- Language was included in rules to require MCOs to notify members within 15 days of a new service coordinator
- A stakeholder mentioned that MCOs should be notifying providers as well as members
Administrative Simplification update
- Most recommendations from providers and MCOs were regarding claims processing, contracting, prior authorization, forms and credentialing
- HHSC is working to streamline strategies for work groups such as how many there will be and what they will cover
- HHSC hopes to have simplifications in place by September or shortly thereafter
Health Plan Management Update
- HHSC staff reviewed complaint data for the first quarter of fiscal year 2014
- Attached as “FY14Q1 Complaint Data”