Health and Human Services Commission Council – 2/28/2014

Below is a report from the HHSC Council Meeting on February 28.

Executive Commissioner’s Status Report

• 83^rd legislative session interim charges have been announced
• House
  • County Affairs – HB 3793 and the 1115 waiver
  • Human Services – implementation of BIP, implementation of SB 7, foster care redesign
  • Appropriations – Rider 51 cost containment, funding for behavioral health
  • House Defense and Veterans Affairs – Mental Health of our veterans
  • Insurance – ACA and the availability and affordability of private health insurance, transparency in the healthcare marketplace
  • Public Health – Electronic health information exchange and HB 15
• Senate Health and Human Services Committee
  • Recent hearing on Women’s Health and CPS
• Sunset Review
  • First organizational meeting, HHSC is working with Sunset staff
  • Sunset bill during next session
    • Clean up and recodification of HHSC Enterprise
• Veterans Project
  • Peer to Peer Mental Health Program
    • Funding from mental health dollars appropriated to DSHS
  • Treatment for 2 groups of veterans, 100 total
  • Assessment, treatment for PTSD, post assessment to see what progress is made
  • Outside report to determine if medications and treatments hold promise in improving veteran’s mental health
• CSM Moratorium
  • Home health Medicaid providers in Dallas and Houston
  • Houston area ground ambulance supplier enrollments in its Medicare, Medicaid and CHIP operations
  • Fraud trends warranted a moratorium in these geographic areas. 
  • Signs of a disproportionate number of providers and suppliers relative to beneficiaries and extremely high utilization
  • Expected to last through July
• ACA
  • 2014 marks the full implementation
  • Working hard to see how HHSC can make the rollout go easier
  • CMS refused HHSC to test healthcare.gov before the October 1, 2013
  • 114,000 files backed up at healthcare.gov that need to be sent to Texas
  • Of the 12,000 files received by HHSC, 1/8 are actually eligible for Medicaid
  • Governor Perry directed Janek to ask CMS for more flexibility in Medicaid
    • Putting final touches on the amendment to the state waiver
    • Will stay underneath the cost curve, but would like flexibility on the other requirements under Medicaid
    • Believes Texas can build and operate a more efficient program
• Every state is different and needs flexibility to operate under their own system for their unique population

Affordable Care Act

• Have transferred more than 100,000 individuals from HHSC to the marketplace
• Have specialized eligibility staff, cost for these staff is already built in to the agency’s budget
• Currently HHSC is receiving about an application per minute
  • CMS predicts that it will accelerate to about 5 applications per second
  • Staffed up and ready for the varying influx of applications
• How long does it take to work up an average eligibility determination?
  • Average 17-20 days
  • Usually have to request information from a client and have it returned to HHSC
  • Federal law requires determination be made within 45 days

Legislative Appropriations Request Process and Timeline Overview

• 5 years of financial information, 2013-2017
• Total revenue for 2016-2017 will be based on the baseline amount used in 2014-2015
• Exceptional items above baseline limit and riders will be determined
• Will include:
  • Allowable caseload growth
  • Continuation of rate adjustments
  • Cost containment initiatives
• Initiated LAR process in January
• Developing exceptional items, strategies and performance measures  – will submit in late April
  • Next council meeting HHSC will present the identified exceptional items
• June – August HHSC will submit their baseline for 2014-2015 which will be used to determine baseline for 2016-2017

Information Items Related to Rules
a.      Regarding Emergency amendment to the Medicaid for Transitioning Foster Care Youth (PDF)
Information on emergency rule amendment proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter §366.611.

• No questions or testimony

b.      Regarding Medicaid and Children’s Health Insurance Program Eligibility (PDF)
Information on emergency rule amendments proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 366, Chapter 370, and Chapter 375.

• Rule hearing on March 5^th
• Restoring the asset limits to what they were before the ACA, maximum of $2,000
• There are some exemptions for vehicles that wouldn’t count toward the asset limit
• HHSC will get a list of possible asset exemptions to the Council

c.       Regarding Hospital Specific Limit (PDF)
Information on rule amendments proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 355, Subchapter J, Division, 4, §355.8066.

• Expedited timeline
• Tied in with an ongoing lawsuit that has a trial date next Tuesday
• Have previously received comments from a hospital that does a lot of care for dual eligible, and have asked for HHSC to strike the word “commercial” from the rule language
  • Language tracks exactly what SB 7 says, so they haven’t changed the rule language

Action Items Related to Rules
d.      Regarding Inpatient Hospital Reimbursement (PDF)
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15,  Chapter §355.8052.

• Addresses a drafting error in the publication of the adopted rule and to avoid erroneous payments to children’s and rural hospitals
• Conforms to HHSC’s calculation of inpatient hospital reimbursement rates
• Revises the methodology used to calculate the inpatient reimbursement rate assigned to new rural hospitals
• No public testimony
• Approved

e.      Regarding Managed Care Expansion (PDF)
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 353.

• Adds nursing facilities to managed care under the STAR+PLUS program
• Includes APRN as PCP carve in
• Have aligned rule to SB 7 language and legislative intent
• Texas Association of Home Care and Hospice
  • Have asked for provisions of SB7 regarding accessibility of services to be included
  • This language will be in the next rule set and will be implemented by 12/2014
• Written testimony from Disability Rights Texas
• Approved

f.        Regarding Waiver Payments to Other Performers (PDF) 
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 355, Subchapter J, Division 11, Chapter 355, §355.8201, §355.8202, and §355.8203.

• Comments received previously were to allow hospitals ask for increases to their HSL
• HHSC is not inclined to make these changes:
  • Do not have the ability to verify the accuracy of changes to the HSL before distributing UC funds, would delay payments
  • Do not have the ability to react to an overpayment once the funds go out
    • Cannot go back and fix it unless the payment was above the HSL
• UC funds come from where?
  • IGT and federal funds 40/60
• Isn’t there a fraud statute to fall back on if a hospital was overbilling?
  • It would be an enormous task and would result in recoupments
• Janek – changing the rule would be a benefit to the larger players who rely on the money less
  • The smaller players rely on this money heavily and delaying payments would cause a huge disruption
• John Berta, THA
  • The pool in 2013 is $3.9B, believes the demand will be above $5B
  • Majority of the state shares come from large public hospitals
  • The demand exceeds the availability of funds so they don’t foresee the need for a recoupment
  • Want to look at more significant changes that hospitals have had in 2013 that would reflect 2014 payments
• Approved

g.      Regarding Reimbursement Methodology for Physicians and other Practitioners (PDF)
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 355, §355.8085, §355.7001, and delete §355.8081.

• Clean up rule that consolidates statute
• No questions or public testimony
• Approved

h.      Regarding Substitute Physicians (PDF)
Consideration on a new rule to be proposed in the Texas Register in Title 1, Texas Administrative Code, Part 15, Chapter 354, §354.1060 and §354.1062.

• Needed to align with federal Medicaid statute
• Allows for a substitute physician to bill for 14 days (was previously 60 days)
• Locum tenens agreement extended from 60 days to 90 days
• Approved

Janek – Today is Steve Aragon’s last day on the job as HHSC Chief Counsel, wanted to recognize his service