August 24, 2017 - 9:00am
- Opening comments: Gilbert Handal, M.D., Medical Care Advisory Committee Chair
- Comments from the Associate Commissioner for Medicaid and Children's HealthInsurance Program (CHIP) Services Department, Jami Snyder, Health and Human Services Commission (HHSC).
- Approval of June 15, 2017, meeting minutes (Vote required)
- Texas Medicaid Fee-for-Service Access Monitoring Review Plan
State Medicaid programs must comply with federal rules at 42 C.F.R. §§ 447.203-204 intended to establish a standardized, transparent, data-driven process for states to document that fee-for-service provider payment rates are consistent with Social Security Act § 1902(a)(30)(A), 42 U.S.C.A. § 1396(a)(30)(A). This section of the Act requires states to have methods and procedures to assure payments to providers are "sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area." In its initial plan submitted to theCenters for Medicare & Medicaid Services (CMS) in October 2016, HHSC indicated a follow-up plan in 2017 was necessary to address the requirement of rate comparisons and to present data pertaining tochildren with disabilities. HHSC presents a draft of the 2017 Texas Medicaid Fee-For-Service Access Monitoring Review Plan to the Committee as an informational item and is prepared to take questions the Committee has about the plan.
- Brian Dees, Senior Policy Advisor, Program and Policy Section, Medicaid and CHIP Services Department, HHSC
- Michelle Long, Program Specialist, Medical and Social Services Division, HHSC
- Delivery System Reform Incentive Payment (DSRIP) Program Demonstration Years Seven to Eight
HHSC proposes new rules to Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter D, Division 7, relating to DSRIP Program Demonstration Years seven to eight, including §354.1691, relating to Definitions; §354.1693, relating to Regional Healthcare Partnerships (RHPs); §354.1695, relating to Participants; §354.1697, relating to RHP Plan Update; §354.1699, relating to RHP Plan Update Review; §354.1701, relating to RHP Plan Update Modifications; §354.1703, relating to Independent Assessor; §354.1705, relating to Categories; §354.1707, relating to Performer Valuations; §354.1709, relating to Category A Requirements for Performers; §354.1711, relating to Category B Requirements for Performers; §354.1713, relating to Category C Requirements for Performers; §354.1715, relating to Category D Requirements for Performers; §354.1717, relating to Uncompensated Care Hospital Requirements; §354.1719, relating to Disbursement of Funds; and §354.1721, relating to Remaining Funds for Demonstration Years seven to eight; Chapter 355, Subchapter J, Division 11, §355.8205, relating to DSRIP for Demonstration Years seven to eight; and §355.8206, relating to Funding for DSRIP Monitoring Program for Demonstration Years seven to eight. On Dec. 12, 2011, the CMS approved Texas's request for a new Medicaid demonstration waiver entitled "Texas Healthcare Transformation and Quality Improvement Program" in accordance with section 1115 of the Social Security Act. The DSRIP program is one of the three main components of this waiver. The initial waiver was approved through Sept. 30, 2016, and an initial extension was granted through Dec. 31, 2017. HHSC has requested an additional 21 months that would extend the waiver through Sept. 30, 2019. The framework for DSRIP payments is governed by the Program Funding and Mechanics (PFM) protocol that is referenced in the waiver's Special Terms and Conditions. HHSC developed the draft PFM protocol proposal for the requested additional 21 months (demonstration years seven to eight) and submitted it to CMS on May 17, 2017. These proposed new rules closely mirror the PFM protocol proposal that HHSC submitted to CMS.
- John Scott, Director of Operations, Texas Healthcare Transformation Waiver, HHSC
- Reimbursement Methodology for Certified Registered Nurse Anesthetists
HHSC proposes an amendment to TAC Title 1, Part 15, Chapter 355, Subchapter J, Division 12, §355.8221 relating to Reimbursement Methodology for Certified Registered Nurse Anesthetists.
The proposed amendment adds Anesthesiologist Assistants (AAs) to the reimbursement methodology and adjusts the percentage payment for a supervised anesthesia service for both Certified Registered Nurse Anesthetists (CRNAs) and AAs. CRNAs and AAs will be reimbursed the lesser of the CRNA's or AA's billed charges or 50 percent of the calculated payment for a supervised anesthesia service. For example, if the calculated payment for a supervised anesthesia service is $100, the payment to the CRNA or AA would be $50. Previously, both CRNAs and AAs were reimbursed at the lesser of billed charges or 92 percent of the solo physician's reimbursement. In Texas, CRNAs and AAs may not practice independently and must provide services under the supervision of a physician. There is an estimated fiscal impact for the proposed rule change. Additional rate adjustments related to anesthesia conversion factors are anticipated to be effective Oct. 1, 2017.
- Megan Wolfe, Senior Rate Analyst, HHSC Rate Analysis
- Reimbursement Methodology for Preadmission Screening and Resident Review (PASRR) Specialized Services
HHSC proposes a new rule to TAC Title 1, Part 15, Chapter 355, Subchapter C, §355.315, relating to Reimbursement Methodology for PASRR Specialized Services. Effective Dec. 1, 2017, HHSC plans to implement an array of PASRR Specialized Services for Medicaid clients that reside in nursing facilities as required by the CMS under 42 C.F.R. §§ 483.100 to 483.138. This rule project proposes the reimbursement methodology for those services. HHSC will develop the payment rates for PASRR Specialized Services based upon rates for other programs that provide similar services. If payment rates are not available from other programs that provide similar services, payment rates will be determined using a pro forma approach.
- Victor Perez, Director, HHSC Rate Analysis
- Amendments to Disallowance Provisions in Directed Payment General Provisions
HHSC proposes amendments to TAC Title 1, Part 15, Chapter 353, Subchapter O, §353.1301, relating to General Provisions. In March of 2017, HHSC adopted a series of rules governing delivery system and provider payment initiatives through Medicaid managed care organizations (MCOs). These initiatives are, generally, funded through intergovernmental transfers from local governmental entities. Given that these programs are not funded with state general revenue, HHSC must ensure, to the greatest extent possible, that no state dollars are at risk through the operation of these programs. A disallowance by CMS is one potential risk to general revenue, unless HHSC can ensure that funds from another source are available.
Section 353.1301(j) describes the procedure HHSC would use in the case of a disallowance. The rule delineates between a disallowance for impermissible provider-related donations and all other disallowances. At present, if there is a disallowance for impermissible provider-related donations, the rule requires HHSC to recover the disallowed amount from transferring governmental entities responsible for the non-federal share of the disallowed payments. If there is a disallowance for reasons other than an impermissible provider-related donation, HHSC reserves the right to recoup the disallowed amount from MCOs, providers, or governmental entities.
In an effort to provide HHSC more flexibility when determining the appropriate entity from which to recoup, HHSC proposes to amend §353.1301 to remove the requirement that it recover only from governmental entities in the case of a disallowance for impermissible provider-related donations. Instead, HHSC will reserve the right to recoup from MCOs, providers, or governmental entities in any disallowance. In order to ensure that there is no risk to general revenue, to the greatest extent possible, HHSC will require that if a recoupment for a disallowance results in a subsequent disallowance, the entity that HHSC initially recouped against will face a recoupment for the subsequent disallowance.
In addition, HHSC will clarify the heading for §353.1301(k) by changing the name from "Recoupment" to "Overpayment."
- Charles Greenberg, Director of Policy, Office of Chief Counsel, HHSC
- Amendments to Uniform Hospital Rate Increase Program
HHSC proposes amendments to TAC Title 1, Part 15, Chapter 353, Subchapter O, §353.1305, relating to the Uniform Hospital Rate Increase Program.
In March of 2017, HHSC adopted rules governing a provider payment initiative through Medicaid MCOs called the Uniform Hospital Rate Increase Program (UHRIP) (42 TexReg 13). Under the UHRIP initiative, a service delivery area (SDA) may apply to receive an increase in certain hospital rates which would vary by class of hospital. Although UHRIP was supposed to begin in September 2017 and be available to any SDA, operational issues necessitated a delay. Such issues included lack of readiness by MCOs, lack of program understanding among providers, and incomplete approvals from the CMS. HHSC proposes to amend the UHRIP rules in three ways.
First, HHSC proposes to amend §353.1305(b)(7) and (8), the definitions of "rural private hospital" and "rural public hospital" to be consistent with a revised definition of "rural hospital" that was adopted earlier this year in §355.8052 (relating to Inpatient Hospital Reimbursement). The definitions in this rule would now refer to the definition of "rural hospital" in §355.8052.
Second, HHSC proposes to add §353.1305(k) which would allow for a limited Dec. 1, 2017, entry into UHRIP for a subset of SDAs. Specifically, if HHSC received an approval from CMS for any particular SDA by April 15, 2017, that SDA would be able to participate in UHRIP for dates of service beginning Dec. 1, 2017.
Third, HHSC standardizes references to SDAs throughout the section.
- Selvadas Govind, Director for Hospitals, HHSC Rate Analysis
- Nursing Facility Applications and Informal Reviews
The Department of Aging and Disability Services (DADS) proposes to amend TAC Title 40, Part 1, Chapter 19, Subchapter C, §19.212, relating to Time Periods for Processing License Applications; and Subchapter X, §19.2322, relating to Medicaid Bed Allocation Requirements.
The proposed amendments clarify the deadline for HHSC to receive a nursing facility license application. The proposed amendments also allow HHSC to pend an application for up to six months to allow an applicant to comply with licensure requirements. The proposed amendments further enable HHSC to pend an application for renewal if the facility is subject to a proposed denial or pending licensure revocation.
In addition, the proposed amendments also allow an existing nursing facility to request an informal review when the nursing facility has been denied an increase in Medicaid bed allocations or was subject to decertification or de-allocation of Medicaid beds.
- Bobby Schmidt, Manager, DADS Regulatory Services
- Public comment
- Proposed next meeting: Nov. 16, 2017, at 9 a.m.
Public comment may be taken on any agenda item.
Contact: Questions regarding agenda items, content, or meeting arrangements should be directed to Suzanna Carter, Committee Coordinator, Medicaid and CHIP Services Department, 512-730-7423, firstname.lastname@example.org.
This meeting is open to the public. No reservations are required, and there is no cost to attend this meeting.
People with disabilities who wish to attend the meeting and require auxiliary aids or services should contact Carter at 512-730-7423 at least 72 hours before the meeting so appropriate arrangements can be made.