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Below is the HillCo client report on the July 18 State Medicaid Managed Care Advisory Committee meeting.
 
Report by HHSC Network Adequacy working group

  • Internal workgroup established in April
  • Want standard access enhancements for MCOs
    • Within 30 minutes for PCPs and hospitals
    • Within 70 minutes for specialists
    • Within 30 minutes for dentists and behavioral health specialists
    • Looking at reducing others to less than 75 miles
    • Using a ‘secret shopping vendor” to look at provider availability and wait times
    • The workgroup will be ongoing, taking projects on in stages – currently addressing this first wave and hope to have first recommendation in a month or so
  • Gary Jessee addressed concerns with network adequacy and the carve in of the IDD population
    • HHSC is asking MCOs to take current IDD providers and contract them into their network
    • Will be sharing an updated provider list in the near future, but he is pleased with their progress
    • Some providers or hospital systems will not contract with MCOs, period, even though they can still be accessed as an out of network provider
    • Member asked if there were benchmarks or standards on what the match rates should look like?
    • Jessee –  hard because HHSC cannot force providers to contract with MCOs or participate in Medicaid
      • There are no incentives for MCOs to restrict provider participation either though
      • Feel very confident in that there are no shortages in any network providers that supply LTSS

 
Presentation by MAXIMUS

  • Enrollment broker for Medicaid
  • Presented and overview of their operations for 2014
  • Please see the attached presentation for more details
  • Dennis Borel asked about the participation levels for Medicaid buy in for children
    • Less than 500
    • Wants to recommend promoting participation
    • Out of 107k packets delivered, 40k made a choice in one week

 
Ombudsman Program

  • Please see the attached presentation for the overview of the operations for the Office of Ombudsman
  • 50-60 FTEs
  • Helpline has 10 FTEs, does not have wait times and has the capacity for more volume
  • A member asked “Who reviews reports from the office?
    • Trends are monitored internally by staff in the operations and reporting unit

 
Dual Eligible Project

  • Fully integrates managed care model
  • Beginning March 1, 2015  – a 3 year demonstration ending in December, 2018
  • Will be a demonstration in the 6 most populous counties in Texas
  • Finalized the Memorandum of Understanding in May with CMS
  • Enrollment will be passive with a 6 month ramping up period
  • Public comment on the program is due Friday, July 26th

 
Community First Choice

  • Basic attendant and day habilitative services delivered in a cost effective manner
  • Ensure access
  • Working on a state plan amendment to include these services – due to CMS in September
  • SB 7 requires coordination with LMHAs that provide these services
  • STAR Kids RFP is out today, will identify vendors 9/15 with a start date of 9/16
  • HHSC has an Exceptional Item on their LAR to fully fund the interest lists

 
SB 1150 – Provider Protection Plan

  • Streamlining processes to make it easier on providers
  • Workgroup was formed to determine what they can do with only creating rules, and to discover what might need legislation
    • Looking into credentialing
      • Common application process
      • Working with the Texas Association for Health Plans
    • Looking in standardizing prior authorization
      • TDI is creating forms but they do not cover LTSS – the workgroup is looking into if they can adopt and use the form as a model for STAR PLUS plans to use too

 
1115 Transformation Waiver Update

  • Please see attached for the HHSC overview of the 1115 waiver
  • Currently there are 1275 approved and active 4 year DSRIP projects

 
Coordination with other Advisory Groups

  • Discussion of the documents attached that give the scope of other HHSC workgroups – voiced the desire to find a way to work together
  • Committee members voiced the desire to take up quality issues in this advisory group as well

 
Public Comment
 
Colleen McKinney – Hogg Foundation

  • The number of licensed counselors and social workers (LCSW) have dropped since 2010
    • 1376 to 1018 which is a 30% decrease
  • LCSWs are leaving managed care because of the low reimbursement rates and the increase in administrative work
  • Asked for HHSC to raise managed care behavioral health performance indicators
  • Asked for the MMC health plan profiles to be updated online in a timely and continuous manner

 
Marina Hench, Texas Home Care and Hospice

  • Wants this advisory group to develop solid network adequacy recommendations since they are such a big deal
    • Asked for a list of all specialty providers
    • Asked for a list of providers that are accepting new clients
    • Asked for data on how long the wait times are for all providers
  • Are the provider rates adequate to have a solid network of providers?
    • Depends on the service
    • Would like data for certain services
    • Believes that EVV is an unfunded mandate

 
General Discussion

  • The groups wants to create some really solid recommendations next meeting in October that will be in Edinburg
  • Members are looking at specific recommendations to submit to HHSC by the next meeting
  • Would like the recommendations to fall in one of three categories:
    • Network adequacy
    • Provider experience
    • Consumer experience