November 16, 2017 - 9:00am

Health and Human Services Commission, John H. Winters Human Services Complex, Public Hearing Room
701 West 51st St.
Austin, TX 78751

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  1. Opening comments: Gilbert Handal, M.D., Medical Care Advisory Committee Chair
  2. Comments from the Associate Commissioner for Medicaid and CHIP Services    Department, Jami Snyder, Health and Human Services Commission (HHSC)
  3. Approval of August 24, 2017, meeting minutes (Vote required)
  4. Reform of Cost Reporting Process for Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Providers

    HHSC proposes amendments to Texas Administrative Code (TAC) Title 1, Part 15, Chapter 355, Subchapter A (relating to Cost Determination Process) § 355.102, §355.105, and §355.112; Subchapter D (relating to Reimbursement Methodology for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) §355.456; and Subchapter F (relating to Reimbursement Methodology for Programs Serving Persons with Mental Illness or Intellectual or Developmental Disability) §355.722, and §355.723.

    Effective January 1, 2018, HHSC plans to implement a cost report reform initiative for HCS and TxHmL and ICF/IID providers by requiring only even-year cost reports beginning with the providers’ 2018 fiscal year cost reports.  These proposed amendments are at §355.105(c)(1) for ICF/IID providers and at §355.722(a) for HCS and TxHmL providers.  This change requires HHSC to also propose amendments to §355.102(d) so that all providers attend state-sponsored cost report training every other year for the even-year cost report.  Current language requires providers to attend cost report training for odd-year cost reports.

    A proposed amendment to 1 TAC §355.112(h)(2)(B) requires ICF/IID and HCS and TxHmL providers to submit an Attendant Compensation Report for odd years beginning with the rate year that starts September 1, 2017.  An amendment to §355.112(j) updates a citation related to completion of cost reports functioning as Attendant Compensation Reports in the ICF/IID program. Additionally, an amendment to §355.112(t)(2) updates language regarding provider requests for recalculation of recoupment.

    Finally, HHSC proposes to adopt new rule text at §§ 355.456(j)(8) and 355.723(f)(10) that will in effect repeal the Total Medicaid Spending Requirement in the ICF/IID reimbursement methodology and the HCS and TxHmL reimbursement methodology beginning September 1, 2017.  Providers who chose to receive the Medicaid rates in effect on August 31, 2015, (i.e., providers who chose to “opt out” of the September 1, 2015, rate increases in order to be exempt from the Total Medicaid Spending Requirement) will receive the rates that were adopted effective September 1, 2015, effectively eliminating the rate differential between providers who “opted in” and providers who “opted out.”

    - Victor Perez, Director, HHSC Rate Analysis for Long-Term Services and Support

  5. School Health and Related Services (SHARS)

    HHSC proposes to amend Texas Administrative Code (TAC) Title 1, Part 15, Chapter 355, Subchapter J, Division 23, §355.8443 (relating to Reimbursement Methodology for School Health and Related Services (SHARS)). 

    SHARS is a joint program of HHSC and the Texas Education Agency that allows school districts to obtain federal Medicaid reimbursement for the provision of health-related services to students in special education. The proposed amendment will update the rule language to allow HHSC to retain one percent of the total certified Medicaid allowable costs for direct medical services and transportation services in the SHARS program to fund HHSC administrative activities, such as increased oversight of the SHARS program by HHSC. This amendment is being proposed to comply with the 2018-19 General Appropriations Act (S.B. 1, 85th Legislature, Regular Session, 2017 (Article II, HHSC, Rider 34(a)(11))) and is intended to improve the quality and consistency of SHARS program compliance monitoring and audits and to provide school districts with enhanced technical guidance and feedback on SHARS program issues.

    This proposed amendment is intended to reduce financial liability to HHSC and will allow HHSC to establish and maintain a SHARS audit reserve fund.

    - Nadia Bobb, Rate Analyst, HHSC Rate Analysis for Acute Care Services

  6. Nursing Facility Life Safety Code

    HHSC proposes amendments to TAC Title 40, Chapter 19 (relating to Nursing Facility Requirements for Licensure and Medicaid Certification) to implement the Centers for Medicare & Medicaid Services (CMS) adoption of the 2012 edition of the National Fire Protection Association (NFPA) 101 - Life Safety Code (LSC) and 2012 edition of the NFPA 99 - Health Care Facilities Code.  The CMS rules  adopting these resources eliminate all references to the previously adopted 2000 edition of the LSC and require a nursing facility to comply with the 2012 NFPA 101 and 2012 NFPA 99.

    The proposal replaces references to previous editions of NFPA 101 and NFPA 99 and revises and reorganizes most rules in Chapter 19, Subchapter D, relating to Facility Construction.  The proposal also revises 40 Tex. Admin. Code § 19.1701, relating to Physical Environment, and 40 Tex. Admin. Code § 19.2208, relating to Standards for Certified Alzheimer's Facilities, to make the rule language consistent with the new federal language in the Code of Federal Regulations. The proposal places divisions in Subchapter D to further organize the subchapter. This reorganization makes the rules easier for nursing facilities and surveyors to navigate by having the applicable rules for a particular facility in one place.

    - Calvin Green, Director Policy, Rules, and Training, LTC Regulatory, HHSC

  7. Public comment
  8. Proposed next meeting:  February 15, 2018, at 9:00 a.m.
  9. Adjourn

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,

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.