[0:03] Good afternoon. This is Jacobi Linsky, chair of the State Medicaid managed carried advisory committee. We'll go ahead and call the meeting to order at 1-01. This is the 28th meeting of the State Medicaid managed carried advisory committee. Members, presenters and staff, please remember to unmute your microphones, turn on video cameras and state your name each time before you speak.

[0:31] and that this time I'll introduce Mr. John Shacone to provide meeting logistic announcements.

[0:39] Thank you very much, Mr. Lensky. Good afternoon. My name is John Shacone.

[0:43] With a Health and Human Services Commission advisory committee coordination office.

[0:48] This meeting is being conducted and compliance with the Texas Open Meetings Act and is open to the public.

[0:53] Today's meeting is being webcast live and is being recorded as a matter of public record.

[0:58] Please do not use jargon and acronyms. Confidential information should not be discussed.

[1:04] For the sake of those viewing the webcasts and to comply with the text of Open Meetings app,

[1:08] we ask that each virtual attendee turn on their video camera and state their name each time prior to beginning their comments.

[1:16] We ask that you speak directly into the microphone of your device, so your voice and comment can be heard.

[1:21] Once you're done speaking, we ask that you turn your camera off and meet your microphone and only unmute what you need to speak.

[1:30] Also, we recommend members and presenters to use headsets if possible to prevent feedback and minimize other noise.

[1:37] We also ask that members that are presenters participating virtually to please put your cell phone on mute or vibrate.

[1:43] If you need to take a call, please turn off the video and microphone options from your view and device so the sound doesn't carry back into the meeting.

[1:51] For members that are present as participating in person, we ask that you speak directly into

[1:56] the microphone so your voice and comment can be heard.

[2:00] This microphones are directional, so they only pick up sound right when you're over the microphone.

[2:06] So we ask that you make sure you speak right directly.

[2:09] This microphones are directional and you can also pick them up a little bit from the base

[2:14] from handling the movement for your comfort.

[2:17] Please put yourself on on me to vibrate.

[2:19] If you need to take a call.

[2:20] please step out of the room and away from the doors so the sound doesn't carry back into the

[2:24] meeting. For members and presenters who plan to utilize a PowerPoint or hand out during

[2:30] their presentation, one of our producers will pull out your PowerPoint or hand out and will

[2:34] advance the slides or pages by you indicating next slide next page.

[2:43] There is time on the agenda for

[2:45] public comment. Members of the public were able to submit written public comment prior to the

[2:53] In addition, members of the public were able to pre-resisture to provide oral public, virtual

[2:58] comments today during today's meeting.

[3:01] We do have one member who pre-resisture to provide virtual comments today.

[3:05] This member will be a place and listen only mode until it's time for them to provide

[3:10] their comments.

[3:11] We ask that members of the public who pre-resisture to provide public comments in person

[3:16] to please check in with the meeting facilitator.

[3:19] Members of the public who are attending in person may also register to provide public comments

[3:24] by completing the public registration form, located at the registration table at the door

[3:29] to the public hearing room. For everyone participating in person, the residents are located

[3:34] off the doors and down the hall to your left and on the left hand side. Note that emergency

[3:40] access are located at the back and at the side of the room where most of you came in from.

[3:44] If there is an alarm, we'll evacuate the building and return only at the direction of

[3:49] security personnel. If you have questions and comments regarding agenda topics presented today,

[3:55] please send any mail message to Ali Dukue at the email address provided in the chat section

[4:01] and at the bottom of the post of public agenda. At this time, I would like to call Role

[4:06] and members when I call your name, please turn on your camera and microphone and respond with

[4:10] here or present and provide a brief one sentence introduction of yourself on responding to

[4:20] the

[4:31] Anthony Bocaro,

[4:40] Ms. Esmeralda Costares-Baglia.

[4:47] Hi, I'm President.

[4:48] Would you care to introduce yourself, ma'am?

[4:51] Yes, I'm Esmeralda Costares-Baglia,

[4:53] I'm a Senior Vice President of Operations for Management,

[4:56] Care Organization Superior Health Fund.

[4:58] Thank you very much.

[5:00] Ms. Jane Kuncha,

[5:12] Dr. Christina Davidson,

[5:23] Ms. Michelle Lynn Evans.

[5:29] Hi, Michelle Evans, thank you.

[5:34] Thank you very much. This shana clover.

[5:40] Good afternoon, everybody. My name is Shana Glover. I am a class case manager at the

[5:47] Coastal Vincent Center for Independent Living. Thank you very much. Miss Yolanda Haines,

[5:54] Mims.

[5:57] Hi, good afternoon, everyone. I'm Yolanda Haines, Mims and the director of business operations

[6:04] Thank you very much, Mr. Erin Hiddard.

[6:09] Other, I'm Erin Hiddard, I'm the Executive Director for

[6:12] Star Kids Star Class Group and I am President.

[6:15] Thank you very much, sir.

[6:17] Ms. Tyra Hinton.

[6:21] Good afternoon, everyone. My name is Tyra Hinton.

[6:23] I am the Deputy Director of the Services Division here in

[6:28] Harris County, which encompasses the Harris County

[6:30] guardianship program in the Singar Justice Assessment Center.

[6:34] Thank you.

[6:36] Dr. David Lam,

[6:45] Mr. Ramsey Longbatham.

[6:48] I'm Ramsey Longbatham, the Vice Chair of this committee.

[6:51] I also am the Director of the IPA Independent Position Association of Victoria, Texas,

[6:58] with 86 doctors handling 19 contracts.

[7:02] Thank you,

[7:04] sir.

[7:05] Ms. Samantha Moreno.

[7:09] I'm Samantha Marino, I am a service recipient of the Sir Plus Program and I also utilize the Consumer Directed Service option.

[7:22] Thank you.

[7:24] Dr. Shahit Rahman.

[7:31] Ms. Beth Ryder. Good afternoon. I'm Beth Ryder. I am the family member and advocate of an individual receiving services and on the CDS program.

[7:43] Thank you. Dr. Carl Serao.

[7:53] Mr. Jacob Yulinski.

[7:55] Good afternoon. This is Jacob Yulinski. I chair this committee. I also am the Senior Director of Human Services with Aloma Wary, a council of governments in San Antonio,

[8:05] where we housing and serve the community as the local IDD authority as well as to area

[8:13] agencies on aging to aging and disability resource centers and a provider of medical

[8:21] non-emergency medical transportation.

[8:26] Thank you, sir.

[8:29] Dr. Lindsey Vasquez.

[8:35] Hi, good afternoon. I'm Dr. Lindsey Vasquez. I'm the director of maternal women's health

[8:40] And also a practicing OB-GYN in Harris County at a fairly cold Miami tonight.

[8:46] Thank you.

[8:49] Mr. Alfonso Velarde,

[9:01] Ms. Jennifer Vincent.

[9:06] I am a parent advocate, and I'm also the president of Galveston Houston's

[9:10] families exploring Galveston.

[9:13] Thank you very much.

[9:15] Let me go back to make sure anyone else join.

[9:18] Mr. Javier Bagnales,

[9:26] Mr. Anthony Brocado,

[9:33] Ms. Jane Concha.

[9:38] Welcome to

[9:44] you.

[9:44] Thank you very much, producers from uni.

[9:48] Dr. Christina Davidson.

[9:56] Dr. David Lam.

[10:06] Dr. Shahit Raghman.

[10:16] Dr. Carl Soaro.

[10:23] Mr. Alfonso Velarde.

[10:30] Mr. Linsky, you do have a forum of the committee.

[10:32] You have exactly 12 members.

[10:36] Excellent. Thank you, Mr. Shukham.

[10:39] I want to welcome our committee members and the public who are in attendance today.

[10:44] and also introduce our HHSC staff who are here to assist the committee. In particular, we

[10:52] have Ms. Eloici Indiquay, the committee liaison with Medicaid and CHIP services, Veronica

[10:59] Keram, the coordinator, Medicaid and CHIP services, and Basin Dora, Rishandori, for giving

[11:08] me advisory committee coordinator, Medicaid and CHIP services. So we will go ahead and

[11:14] on to our next agenda item, which is consideration of our February 8, 2023 minutes. Members,

[11:24] if you will please locate the minutes in your packet and take a moment to review those,

[11:34] are there any requests for edits or changes to the draft minutes?

[11:47] None, do I have the motion?

[11:49] Sean and Glover motions to approve the minute as written.

[11:54] I have a motion by Sean and Glover.

[11:56] Do I have a second?

[11:58] Just a ramsy long-batham you have a second for me.

[12:02] I have a second from ramsy.

[12:06] Members are there any discussion?

[12:13] All right.

[12:14] Hearing none.

[12:15] Mr. Shaqan, will you please conduct a roll call vote?

[12:19] Yes, sir.

[12:19] Committee members, when you hear your name,

[12:21] you could please indicate approve this approval or abstain

[12:24] to the motion of the floor to approve the February 8, 2023 meeting minutes as presented.

[12:30] So moved by Noshana Glover and seconded by Mr. Ramsey Longbottom.

[12:37] Mr. Javier Banyales.

[12:42] Mr. Anthony Brocado.

[12:45] Yes.

[12:47] Thank you, Mr. Brocado. Would you care to introduce yourself briefly?

[12:51] Yes. This is Anthony Brocado, CFO with Lincoln Healthcare System and Tolka Texas.

[12:57] Thank you very much, Mr. Brocado.

[12:59] Thank you Mrs. Madalda Kassat as baby.

[13:05] Approved.

[13:06] Thank you.

[13:07] Ms. Jane Concha.

[13:13] Dr. Christina Davidson.

[13:18] Michelle Lynn Evans.

[13:21] Approved.

[13:22] Thank you.

[13:24] Ms. Shana Glover.

[13:33] Ms. Shana Glover.

[13:36] I'll apologies.

[13:37] Approved.

[13:38] Thank you very much, man.

[13:39] Ms. Yolanda Haynes Mims.

[13:43] Approved.

[13:44] Thank you.

[13:45] Mr. Aaron Hidd.

[13:48] Approved.

[13:48] Thank you. Ms. Tyra Hinton.

[13:52] Approved. Thank you. Dr. David Lam.

[14:01] Mr. Ranzi Longbottom. Approved. Thank you.

[14:05] Ms. Samantha Moranel.

[14:09] Approved. Thank you. Dr. Shahit Rahman.

[14:18] Miss Beth Ryder.

[14:20] Approved. Thank you. Dr. Carl Saral.

[14:29] Mr. Jacob Yolinski.

[14:30] a proof. Thank you. Dr. Lindsey Boskis.

[14:38] Thank you. Mr. Alfonso Beladade

[14:46] and his Jennifer Vincent.

[14:50] Thank you very much. It being a unanimous vote of the committee, the motion carries

[14:56] I'll turn over to the meeting back to you, Mr. Yulinski.

[15:00] Thank you, Mr. Chicon. We'll go ahead and move on to our next item, which is our advisory committee chair updates from our other health and human services committee, our health and human services commission advisory committees.

[15:15] We are going to take some of these advisory committees out of order to accommodate some travel schedules.

[15:23] So first, we'll go with the Star Kids Management Care Advisory, is Catherine Carlton on.

[15:34] Much for accommodating.

[15:38] Go ahead, Miss Carlton.

[15:40] Okay, thank you so much.

[15:41] So I'm happy to be here as the chair of the Star Kids Management Care Advisory Committee to provide an update.

[15:47] Since our last update, we've had two meetings in December and March.

[15:51] I'll focus on the most recent meeting as you have both in your packets.

[15:56] We had a presentation of the Mac you may know of as the multi assistant center at Morgan's Wonderland focused on health homes.

[16:06] We heard HHSC updates, of course, interest like all of us for the legislative updates focused on both updates of implementation of some from the 86 legislative session, like SV-207 and coordination of benefits.

[16:20] which has been a topic we've been discussing for a couple of years as well as 87th legislative session number 1648 Senate Bill on the health homes and what has been my favorite acronym of late the sheek program, which is comprehensive health homes for integrated care, which is a pilot program that our health homes committee has been very involved in looking at what is a health home and how do we best create that for our star kids.

[16:50] We also had a discussion about private duty nursing reimbursement rates, utilization, and the use of LVNs and RVNs, and had some conversation about that, and that will be on our next agenda item as well.

[17:04] Same repeat item from March that will be at our next meeting, which is in June, on DME, durable medical equipment.

[17:10] Just to remind this group, we have three robust committees that are doing the work in between our advisory committee meetings.

[17:20] The committee that I chair is our assessment and service delivery.

[17:23] That's had a couple of name changes as we try and focus on different types of service delivery that we at our SKSA assessment tool, DME, coordination of benefits, private duty nursing, utilizing CFC and how we can best get that.

[17:40] incredible resource to kiddos with mental health diagnoses as well as other diagnoses and

[17:47] star kids and that committee most recently met and focused on our annual report that we did

[17:55] and our recommendations and prioritizing those recommendations with HHSD staff looking at what

[18:00] would require legislative action, what could the state do with those recommendations and help prioritize

[18:05] What we can accomplish this year and moving into next year fiscal year that is we also have the health home subcommittee

[18:14] That is the committee working on the chic program and really looking at what is a true health home for our families and what are best practices as well as looking at some quality metrics for that

[18:25] That pilot program focused on

[18:28] the ACEs kids act and meeting those requirements. Finally, our transition subcommittee, which is led by Elizabeth Tucker, who I know many of you all know as the previous chair whose shoes I try and fill.

[18:45] She has been doing an incredible job with her transition committee on outlining some best practices for star kids moving into adult services that critical transition age.

[18:55] And what are some best practices we can use with the MCOs and our HHSC partners to help our

[19:01] start kids in that age range.

[19:04] And they too are working on prioritization of the recommendations.

[19:08] A lot of the transition recommendations have been repeat recommendations that we are trying

[19:13] to tackle and so prioritizing those.

[19:18] We meet again in June on the 14th and welcome any questions or updates.

[19:24] We are finalizing that agenda and you should see it posted shortly.

[19:32] Great.

[19:33] Thank you, Ms. Carlton.

[19:34] Members, do you have any questions?

[19:41] Hearing none.

[19:42] Thank you very much for your time and we wish you safe travels.

[19:50] Next, we will move on to the,

[19:53] or I'm sorry, the hospital payment advisory committee did not meet and will be tabled.

[19:59] The meeting was canceled due to implement weather.

[20:02] Our next update will be from the Intellectual and Developmental Disability System Redesign Advisory Committee.

[20:11] Ms. Carroll Smith.

[20:15] Good afternoon. Can everyone hear?

[20:19] Yes, ma'am.

[20:20] I see that some people can't hear, so I'm just checking.

[20:26] Since the good afternoon, I am the current chair for the intellectual and developmental disability system

[20:36] redesigned advisory committee. Since the last update that we provided, I think I had reported in November

[20:46] that the committee had 11 seats on which appointments or reappointments were pending at our January

[20:55] 26, 2023 meeting. Eight new members were appointed and one member was reappointed. Unfortunately,

[21:03] however, at that meeting also two members had resigned to two other commitments. So currently,

[21:11] There are seven members who, let's see,

[21:16] Charns have expired, and these members, as I'm assuming

[21:20] in the other committees on here today,

[21:24] will serve until the commission appoints

[21:26] the individuals to fill their seats.

[21:30] Concerning our activity since November,

[21:34] we had heard, and I think I had reported previously

[21:38] about the notice of intent to award-start-plus contracts and in February the Commission did

[21:48] issue a notice of intent and the doctor and I prepared for you I have listed those

[21:56] entities that receive this notice. We still at this point have not heard of any final notice

[22:04] of confirmation, and it's my understanding that the commission is waiting until after session

[22:14] to do so, because there are quite a few legislative bills out there that could impact some

[22:20] of this. If someone knows something differently, please, please advise. But that's what we've

[22:27] as I had previously reported.

[22:30] It also given the change in all the dates of when the notice and intent to award would be made.

[22:40] It changes the start date of the start-plus pilot program, which was cited to start September 123, and then was changed to February 2024.

[22:57] And without trying to step on toes, because I know that Susan Murphy is there or is here to talk about the StarPlace pilot program.

[23:07] I'm going to have to just go ahead and insert that with regard to all of this sadly, even though the commission had requested funds and is exceptional items request to fund the pilot.

[23:25] The Senate did not fund the request and the House funded it at a reduced cost, and unfortunately on Monday when the conference committee met, they did not fund the pilot at all.

[23:43] So there are a lot of unknowns right now as to where we're going to go with this and perhaps Ms. Murphy might add a little more detail on that.

[23:52] I did provide you the language that was in wider 158 and the house side related to the pilot in the reduced cost.

[24:06] The committee has met twice since November and met in January and again in April and will meet again in July.

[24:16] We continue to receive updates on what our subcommittees are doing, as well as the Home and Community

[24:27] Base Services Weaver Renewal electronic visit verification and the new individualized

[24:33] skills and socialization service, as well as dental services, and of course, what's going

[24:41] on the session,

[24:45] and I'm going to let students and Ms. Perfrey get into what the start-plus

[24:50] pilot program what we're busy doing, but the subcommittees for the system redesign advisory

[24:58] committee have just continued to refine the pilot design recommendations and other things

[25:07] related to their responsibilities under Chapter 534 and the Texas Government Code.

[25:15] More recently, we are now immersed in preparing recommendations for the statutory required

[25:23] annual report that the commission must submit in September of this year to the legislature.

[25:31] As I said, that the committee continues to meet quarterly, and then we also meet jointly with the

[25:39] start-less pilot program work group. I have provided dates on when dates that our committees

[25:47] have met since November, and we don't have full, we haven't really scheduled beyond June yet,

[25:58] So I don't have any other dates to share with you.

[26:02] If anyone has any questions, I'll be glad to answer them.

[26:07] Thank you, Ms. Smith.

[26:08] Committee members, any questions?

[26:24] All right, hearing none, we will go ahead and move forward.

[26:28] Thank you, Ms. Smith, for your presentation.

[26:31] Our next committee is the Medical Care Advisory Committee.

[26:35] Mr. Doug Sven.

[26:37] Thank you, sir.

[26:38] This is my first time presenting here.

[26:40] So if I fumbled on a little bit, I'll apologize.

[26:43] We met on February the February, the February the night.

[26:48] We did not have a corn.

[26:49] We currently have three current appointed members that were absent.

[26:53] And we had three vacant positions

[26:55] and because it was no form of the item,

[26:58] that's not in the work discussed with the vote.

[27:01] Gradle input was given.

[27:03] I presented a summary of what happened during the meeting.

[27:06] It included a presentation by Emily Salkowski.

[27:09] and talk about autism services, new collaborative care, model of care,

[27:16] triage, triage and treatment, and they try to support model,

[27:19] carve in case man or for children and pregnant women.

[27:22] The implementation of federal regulations regarding the home care

[27:25] services.

[27:28] We focus on ensuring that people with disabilities

[27:31] receive the service integrated into community care as

[27:33] as a person's center.

[27:34] And then also, we discussed the ending of the continuous Medicaid eligibility.

[27:42] We had a little bit of discussion about what was coming to the Texas legislature, start

[27:46] was part of the 10th.

[27:48] We had an item which reference was referencing quality and improvement in programs.

[27:58] We see information from Ms. Jordan and the rules.

[28:04] We're glad the HFCC will bring to us earlier in the process.

[28:09] New regulations are rules that are being considered.

[28:12] We've had some discussion in the past and the committee that.

[28:16] If we get the rules on the tail end of the process then often there's too much invested in the answer that are that proposal that is difficult to go back and make changes.

[28:26] So Mr. Dixon, notifies that we'll be getting information

[28:31] earlier in the process.

[28:33] Some of the rules that we discussed

[28:34] were the minimum standards for telecommunications

[28:37] and managed period systems.

[28:40] There was some feedback related to that.

[28:43] But one thing in particular we're going to have,

[28:45] they're going to create a managed period manual,

[28:47] not put all the changes in the standards themselves.

[28:51] And there is a process that'll go through for monitoring.

[28:55] their participation. We talk about telecommunications and the assessment process, except that

[29:02] these give me the service coordination process. And there was one of our members, who is Dr.

[29:09] Sales Responding, he is a physician, he's also a medical director for one of the

[29:14] managed peer companies, I'm not sure, I don't know which one. And he brought some ups and

[29:18] concern that we weren't going to be following, or we weren't allowing some flexibility

[29:25] and the service coordinating rule that was presented, and we're just going to continue

[29:30] by the legislature.

[29:32] Ms. Eric Brown talked with us about it, and the in-person assessment helping to ensure that

[29:37] the CFR is maintained, and particularly their assurances, there was not much discussion

[29:46] and they were really, really, just finally as the one you had to make most of this discussion.

[29:52] As far as the hospital payment and bathroom committee, there was a meeting schedule and on

[30:00] We were second, but it didn't take place because there was an inclement weather, and was scheduled again to happen in June of 2023, and we see,

[30:13] there was no public comment those taken, and we adjourned.

[30:17] As for me, if I can answer any questions,

[30:20] I'm taking that, I'm doing this in lieu of Ms. Mary Hill

[30:24] and Teacon who is our Acting Chair of our Committee.

[30:29] We would like to also piggyback on what Cheryl said in a go.

[30:34] We've had these three vacancies for quite a while

[30:36] and would encourage the commission to act swiftly

[30:39] on replacing those at all possible.

[30:43] Thank you, either any questions?

[30:46] Thank you, Mr. Sven.

[30:48] Committee members, any questions?

[30:58] Right, hearing none.

[30:59] We will move on.

[31:00] You guys are quiet today.

[31:03] Next, we have our Paranatled Advisory Committee.

[31:07] Dr. Patrick Ramsey.

[31:09] Thank you, Mr. Chairman.

[31:11] I'm Patrick Ramsey.

[31:12] I'm the current chair of the Paranatled Advisory Council.

[31:15] As you recall, the Paranatled Advisory Council was charged with crafting

[31:20] language for neonatal and maternal designation to levels of care and I was completed the most recent

[31:28] iteration of the maternal rules were just published in the Texas Register last fall and became active

[31:34] on January 8th and currently the neonatal rules are undergoing final revision of the

[31:40] and should be implemented published in Texas Registry later this year and implemented by really

[31:45] 2024. So currently the pack is focusing on best practices and trends in maternal and new

[31:52] NATO designation, as well as exploring what data elements would be important for our programs

[31:59] to look at to see if visitors having the intended impact. Some of the last speaker, we've had

[32:05] some delays in having reappointments to our council. At our last meeting, we had, or in September

[32:11] first of 2021, we had six terms expired and we've replaced four members and two members were re-appointed.

[32:20] So far, and there's another set being reviewed currently, so awaiting final decisions on that.

[32:24] But that has some significant vacancies in the council.

[32:28] Our council has met a twice since our last update to you all.

[32:32] December 7th and March 3rd.

[32:35] During our December meeting, we heard reports related to the designation program, including the rules revision update.

[32:42] update from the Texas Collaborative for healthy mothers and babies or state per need of quality

[32:46] collaborative to give and update on the development of a per needal data system to inform care

[32:52] in the state.

[32:54] We also heard from the RACPCR Alliance to giving their perspective on a statewide database

[32:58] as well that's needed for per needal.

[33:01] At our March 23rd meeting, we received additional updates from the SAHS on the designation

[33:06] program.

[33:06] We had a long discussion about neonatal back transfers when a baby gets up,

[33:14] transfer to a higher level of care, and become stable at what point and how can we facilitate

[33:19] transfer back to the referring facility to bring the baby closer to mom and cause less expenses

[33:27] for the family.

[33:27] So that's something that we've asked the Medicaid office in HHSC to look at and see if that's possible.

[33:34] We had that last meeting, we also had a discussion about a legislative writer related to funding of a

[33:39] perennial data system, and we had a long discussion about that in the need for that to inform care and the work for

[33:45] or consult going forward.

[33:47] The second minute of 2023, we are next meeting in January 15th, we will be hearing report from the

[33:53] neonatal and strategic review subject committee to give an update on recommendations of changes in the

[33:59] internal need and rules that may be beneficial to improve care in the state and

[34:03] to improve access. And based it interested our current strategic review documents are at

[34:09] the links on our report and I encourage you to take a look at that if interested. And that concludes

[34:14] my report today.

[34:17] Thank you, Dr. Ramsey. Members and questions.

[34:24] All right, hearing none. Thank you

[34:25] for your time, Dr. Ramsey. We'll see you next time. Next is our policy counsel for children and

[34:31] families, miss Lisa Gordon.

[34:41] I am Lisa Gordon the chair of the policy council and I want to

[34:46] share information from our last meeting which was a while back because we have not been able

[34:53] to keep quorum and we had to cancel our April meeting so there's not just a whole lot of new

[34:58] information but I want to share what's in place. So our purpose is to improve the coordination

[35:04] between the state's health, education and human services systems to ensure that children with

[35:09] and their families have access to high quality care.

[35:12] We also worked toward improving long-term services and supports,

[35:16] including community-based supports for children with special health

[35:21] and mental health care needs, as well as children with disabilities

[35:24] and their families receiving protective services from the state.

[35:27] We also work on addressing emergency issues affecting the quality

[35:30] and availability of services available to children with disabilities

[35:33] and their families, aligning resources with services for children

[35:38] and improving the star kids managed care program.

[35:42] So information that is maybe some information you've received before,

[35:48] but I wanted to go ahead and reiterate that we completed our legislative report for November

[35:54] of 2022.

[35:55] And some of those recommendations that came out of that report were strengthening and expanding

[35:59] the community attendant workforce, addressing waiver, interest, list, access, eligibility

[36:05] funding to increase the number of children grow up in families and set of institutions, those

[36:09] white lists are extensive years and years and years. Increasing the threshold allowance for Medicaid

[36:15] buy-in for children adults to 300% of the federal poverty level, providing physician-assist education

[36:22] for a transition of care planning from the pediatric situation to adult, improving access to

[36:29] applied behavioral analysis services for children with autism disorder by increasing funding for

[36:35] IBA services and addressing challenges with access to care.

[36:39] Supporting children with disabilities and their families with child care needs by providing

[36:44] training for lessons, child care facilities to increase awareness of the requirements of

[36:49] ADA in that many times our children are released from services based on their disabilities.

[36:56] And increasing funding for early childhood intervention programs to improve the amount of

[37:01] provider support available to care for children's disabilities and improving data facilitation

[37:07] between providers to allow for timely referral and a continuity of care.

[37:12] We are in kind of the same situation.

[37:15] The appointment of new members has been lengthy, so we have not made a forum for several meetings

[37:23] and due to that, our April meeting was cancelled, and we're now in the process of hoping to get some...

[37:30] New members, so that we can schedule a new meeting. We can't make any decisions much without quorum, so we're helping to get that process in place, so that we can schedule our meeting for the summer. Does anybody have any questions?

[37:48] Thank you, Ms. Gourmet, members and questions.

[37:55] Hearing none, thank you again for your time.

[37:58] All right, thank you.

[37:59] Our next presentation is from the start-plus pilot program work group, Mrs. Susan Murphy.

[38:17] Producer, this is John Checkland, it's Ms. Murphy still in the platform, I know she had joined him.

[38:31] Ms. Murphy, this is John Checkland, can you please send me yourself and turn on your video camera?

[38:36] Will you see that you're in the platform?

[38:45] John, do you see that she is still there, but she's coming in as a guest.

[38:53] Producer, can you please go ahead and call her and just have a retone again?

[38:58] I will.

[38:59] Thank you.

[39:02] Mr. Linsky, if you could we can go to the next agenda item and when the smurf

[39:07] comes back, we can go back to hearing her update.

[39:12] Absolutely. We'll go ahead then onto our next agenda item.

[39:18] We flip my pages here, which is our state Medicaid managed care advisory committee

[39:24] up committee.

[39:26] I have to say that she's coming in as a guest.

[39:32] So, please go ahead and call her and just have a retowing again.

[39:38] Thank you.

[39:39] Ms. Murphy is unmuted.

[39:42] She's alive now.

[39:43] Could we go up to the next agenda item when this Murphy comes back to call her?

[39:47] Can you hear me now?

[39:49] This is Susan Murphy.

[39:51] We'll go ahead.

[39:53] Yes, ma'am.

[39:54] Can you hear you?

[39:54] I can hear Ms. Murphy on the line letting us know she's here.

[40:01] Ms. Perfecto, this is John Checkwon. Can you turn on your camera?

[40:07] Yes, I think so.

[40:10] Hello, can you see me?

[40:12] Yes, Mr. Yelens, can we go back to?

[40:15] Yes, sir. We will go back.

[40:17] Thank you, Ms. Murphy, for joining us.

[40:19] Ms. Murphy, again, has the update from the Star Plus pilot program work group.

[40:26] Okay, thank you. Thank you for allowing me to provide an update today. The Star Plus

[40:33] pilot program work group is a work group specifically charged with the development operation

[40:41] and evaluation of the new Star Plus pilot program. It was originally expected to be operational

[40:51] September of this year, 2023. And then there was a little bit of a tweak on that to be expected to be operational by February of this coming year 2024.

[41:08] And thank you to Miss Smith for mentioning, you know, all that is pending right now because the activities

[41:19] the eligibility, the benefits, the evaluation, all of the above are going to require resources.

[41:30] So it is a little disappointing to have worked on something for four years in good faith.

[41:38] And then by that, I mean, really the state agency

[41:41] all kinds of lay-asans and subject matter experts

[41:45] and all of the members which constitutes

[41:51] local intellectual and developmental authorities,

[41:55] providers, managed care companies, advocates,

[41:59] it's a good and diverse stakeholder group.

[42:03] And now we're at the point of still awaiting,

[42:06] And I would say having holding out for some hope that there might be some resources found to implement the pilot.

[42:20] So the updates here are that the quality subcommittee continues to focus on person centered practices, goals, and performance measures.

[42:32] And the assessment committee links to the system redesign advisory committee in that the assessment work that has been done some of it focused specifically on assessments for a pilot program participants who were expected to be people with intellectual and developmental disabilities and people with similar functional needs.

[42:58] And so the work on that would be quality measures and goals and assessment, which are related to quality, to really identify better than we do now on what people's needs are and what their preferences are.

[43:19] So anyway, a lot of work has gone into that.

[43:24] The state has been working toward a decision

[43:28] around using different assessment tools

[43:31] for people who are not in the pilot,

[43:35] but who receive intellectual and developmental disabilities,

[43:38] a community and institution services.

[43:43] And also the assessment that the pilot would use

[43:49] which we worked a lot on that being the same assessment, the thing that has been more recent

[43:56] on the assessment piece is trying to having some work done to figure out so you have

[44:04] assessed a person's need. What does that mean in terms of the scope of services or resources,

[44:11] resource, lemon, et cetera, that people would get. So now we were preparing, you know, education

[44:21] and outreach to all stakeholders to really explain what the pilot is eligible, who gets to opt

[44:33] to the pilot and who is in or needs to opt-out. So all that work is going to be on pause until

[44:43] there are some final legislative and HHSC decisions on that. I know that HHSC is Ms. Smith has already mentioned.

[44:54] a dead ask for what was needed in the legislative appropriation request.

[45:00] And so some of that was step-to-tory required. Some of that were more optional. Things in terms of services in particular.

[45:13] So I would say that, you know, the jury is still out on that. We still collaborate a lot with and divide the work between the star-plus pilot program work group and the system readers on advisory committee.

[45:27] I will say that right now, all the committees are starting to work on the annual report.

[45:35] I know that Ms. Smith mentioned that.

[45:38] And some of the Star Plus pilot program work, great members are active on that too.

[45:46] We're just starting.

[45:47] We have a pretty short timeline.

[45:50] We will be talking about that again and the kind of getting into how to participate

[45:56] that people want to, there are members that participate in little subgroups that help develop

[46:02] recommendations. There are also subject matter experts. So, if anybody listening today has

[46:09] an interest in anything about that work, working toward a new annual report, please let me or Ms. Smith

[46:18] know, we always welcome additional stakeholders.

[46:23] So our next meeting is coming up on June 1st,

[46:28] and it will be a joint meeting with the Star-Plus

[46:34] pilot program work group and the system redesign

[46:38] advisory committee.

[46:40] As others have noted, it is quite a struggle to move forward

[46:45] unless we can get a quorum. And so, I should just see as doing quorum calls prior to

[46:54] meetings, and it's really important to respond to those, because if there is not a quorum

[47:01] known to happen prior to the meeting, it is my understanding based on the recent work by the

[47:15] operate effectively like that.

[47:18] There are always vacancies and we focus

[47:21] someone trying to get attention to those

[47:24] and get those feel sooner.

[47:26] It seems to always lag behind in that, that continues.

[47:30] We have very good news in that Kevin Borker

[47:34] is now our new vice chair.

[47:37] He agreed to serve in that position.

[47:40] And so we are in a bit of a holding pattern

[47:45] until we have more information about how to move forward or whether to move forward with the

[47:50] pilot. Be happy to answer any questions. Otherwise, thank you for allowing me to do this report today.

[47:59] Thank you, Ms. Murphy. Members, any questions?

[48:07] Hearing none, thank you again, Ms. Murphy,

[48:09] for your time and the update. We will move on to our next agenda item,

[48:15] which is the state Medicaid managed care advisory committee subcommittee updates.

[48:21] Our first subcommittee is an update from the complaints appeals and fair hearings subcommittee.

[48:28] Unfortunately, Dr. Carl Sareo was unable to be with us for the full committee meeting today,

[48:35] but I do have some written notes from the complaints appeals and fair hearings subcommittee

[48:41] that I will be reading out to give you all an update.

[48:47] So, the complaints appeals and fair hearing subcommittee was able to meet earlier today.

[48:54] They did not take any actionable items, but they did receive two different updates from HHS.

[49:02] The first was from the Health and Human Services Commission office of the Umbudsman managed care complaints.

[49:08] department on their first quarter 2023 report, and they received highlights from the

[49:17] Onbudsman managed care assistance team. They reviewed the quarterly Medicaid consumer

[49:23] complaints report that's currently publicly posted and identified that most consumer

[49:31] contacts are inquiries with about a third of those being complaints in the first quarter of 2023 on cap

[49:39] received 2339 complaints with 251 approximately 10.8% being sustained out of those first quarter

[49:52] complaints there was a decrease by 8% compared with the fourth quarter of 2022.

[50:02] and decreased 9% when compared with the first quarter of 2022.

[50:10] The top reasons for substantiated complaints,

[50:14] the first being difficulty accessing network specialties and facilities,

[50:18] the second being difficulty accessing home health providers,

[50:25] that fall into the access to care category,

[50:28] And the third being difficulty accessing prescription medications due to not the I guess the prescriber not showing active with Medicaid in the pharmacy systems.

[50:42] And then the top complaint categories were access to care prescription services and information are complaints related to managed care enrollment.

[50:53] They also received a update on the Independent Review Organization or IRO external medical review project.

[51:04] It's now been one year since the implementation of the IRO EMR project.

[51:09] There have been 430 external medical reviews received with 404 independent review organization decisions rendered since April 30, 2023.

[51:21] manage care organizations have been timely and submitting information for the independent

[51:28] reviews,

[51:31] the independent review organization decisions they've identified 72% have been

[51:37] upheld and 28% have been overturned or partially overturned. Most of the overturned

[51:45] IRO decisions related to therapy services.

[51:51] Among those decisions, the top-denial types,

[51:54] with no specific trend across any particular managed care

[51:59] organizations were dental, medication, pass,

[52:05] or personal assistant services, and speech therapy.

[52:10] And then the state fair hearings.

[52:12] There were state fair hearings, 293, sorry state fair hearings, that upheld IRO decisions.

[52:23] Most were sustained.

[52:30] Sorry, and having trouble understanding this last statement here, a little bit confusing, but we'll get clarification from Dr. Soraro.

[52:39] are only 9% or only 9% or 4% of the IRA decisions were reversed by the state fair hearings office.

[52:52] In the future, one of their future agenda items is a report from the state fair hearing office to discuss the state fair hearing process timelines and trends.

[53:05] members, any questions on that report from Dr. Saryo, do my best to answer as I can.

[53:20] All right, hearing none, we will then move on to the Service and Care Coordination subcommittee.

[53:25] Ms. Shana Glover.

[53:28] Good afternoon again, ladies and gentlemen.

[53:31] This is an update from our 17th meeting of the Service and Care Coordination subcommittee,

[53:37] which was held on March 17th.

[53:40] We received a heart of presentation

[53:43] from the director of program policy

[53:45] for Medicaid and CHIP, Ms. Jennifer Castelo,

[53:53] regarding House Bill 4 and telecommunications services

[53:57] and managed care.

[54:00] They will be discussing it further on item 5D,

[54:04] so I will let Ms. Brown and Ms. Castelo

[54:07] give the details on that. We also had an informal discussion roundtable with a quick guide,

[54:16] which was provided by the Texas Association of Health plans. It was very informative. It did

[54:23] flesh out and clarify terms such as what was considered telehealth, as well as the NCO's

[54:33] reassuring, et link and reminding about the steps to identify and report a

[54:42] basic neglect and exploitation. Now that tele-services are making their way

[54:50] into the final stages of regular use.

[54:59] We did not have any action items to vote on.

[55:05] We continue to encourage internal and external feedback from our stakeholders, especially since a part of a big part of service coordination includes making sure that individuals have enough adequacy to the services as well as consumer satisfaction and responsiveness from the entities who are tasked with providing the services.

[55:31] So this is also a call to all other members who are present on the line or listening.

[55:40] Please, our next service and care committee meeting will be on August 16th and we would like to have more feedback on how we can better come together.

[55:54] I do not have any other updates for my subcommittee, but I am open to any questions comments or concerns.

[56:00] you may have at this time. Thank you, Ms. Lover. Members any questions?

[56:13] We will go ahead and

[56:14] move on. Thank you. Our next agenda item is our Health and Human Services updates.

[56:24] So I'd like at this time to introduce Deputy Associate Commissioner Rachel Patton to discuss the

[56:31] ending of Continuous Medicaid coverage. Oh and good afternoon everyone. Thanks for

[56:38] allowing me to join you today to discuss the ending of continuous Medicaid coverage.

[56:45] We'll go ahead and start today with a brief background on the continued Medicaid coverage

[56:55] and sort of what the history is, where we are now, and how we're working through those cases.

[57:02] So all the way back to March 2020, Congress passed the family's first coronavirus response act.

[57:07] And this allowed states to receive that enhanced federal match given that they maintain most

[57:13] individuals who were receiving Medicaid eligibility as of March 18th, 2020.

[57:20] There were very few exceptions that an individual could be denied coverage.

[57:24] Those reasons include the individual passed away.

[57:28] They moved out of state or they requested a voluntary withdrawal from the program.

[57:33] So with the exception of those three reasons, individuals who were receiving Medicaid as

[57:37] March 18, 2020 would continue to receive Medicaid coverage in the state of Texas and we would

[57:44] receive that enhanced federal match. At that time, the continuous Medicaid coverage requirement

[57:50] was directly tied to the public health emergency declaration. So fast forward to December 2022,

[57:57] almost three years later, Congress passed the 2023 consolidated appropriations act. And this effectively

[58:04] separated the continuous Medicaid coverage requirement from the declaration of public health

[58:10] emergency. And that also set a clearly defined date for the end of continuous Medicaid coverage.

[58:17] That date was March 31, 2023. So we have now ended our continuous Medicaid coverage requirement

[58:23] here in Texas. So starting April 1st, that was the first date that states could begin disenrolling

[58:30] members who are no longer eligible for Medicaid.

[58:34] We'll talk a little bit about what are our approaches and how we're conducting renewals

[58:39] as that phased approach is implemented, but one other key item to note is that enhanced federal

[58:45] match will be phased out through the rest of this calendar year, so that phased is out in steps

[58:51] starting April 1st of this year and is completely phased out on December 31st, 2023 for that enhanced

[58:59] federal match. If we go to the next slide, what I talk about, some of the major points of the federal

[59:06] guidance that we received, the first of which is that states will have 12 months to initiate

[59:11] re-determinations for everyone that is enrolled in Medicaid ship. So what that means is that we'll

[59:18] be reviewing and re-determining eligibility for our entire Medicaid and CHIP case load over

[59:24] the next 12 months.

[59:25] States must also conduct a full redetermination, following all federal regulations and must

[59:32] allow members a minimum of 30 days to respond to their renewal packets or request for

[59:38] information.

[59:39] So we will be returning to regular eligibility processes throughout this unwine period.

[59:45] But we must before we take any adverse action for it in a individual, meaning their benefits

[59:51] or reduced or denied, we would need to conduct that full renewal.

[59:57] And lastly, but very importantly, states must...

[1:00:00] To get updated contact information and may not disenroll members based on return mail, unless we attempt to contact the individual through multiple modalities.

[1:00:11] So those modalities could be phone calls, emails, and text.

[1:00:15] We'll talk a little bit about some of the ways we've been reaching out to our members to contact them about the ends of continuous coverage.

[1:00:23] If we go ahead and go to the next slide.

[1:00:25] And I want to talk a little bit about what our plan is here in Texas to end continuous coverage

[1:00:32] here in Texas.

[1:00:34] So as you can all imagine, this is an immense undertaking for states, especially in the

[1:00:39] state, the size of Texas.

[1:00:41] As of September 2022, we had 2.7 million members that were receiving extended Medicaid coverage

[1:00:49] due to the continuous Medicaid coverage requirement.

[1:00:52] So these may be folks who hadn't renewed, you know, between March 2020 and September 2022 or they may have otherwise been found in eligible.

[1:01:03] We also must renew the entire case load as, you know, federally were required to re-determine eligibility for individuals every 12 months.

[1:01:11] So not only will we re-determine this continuous coverage population, we will also re-determine everyone who is on their regular 12 month renewal cycle.

[1:01:20] And so what that really means is that HHSC must complete the re-determination process for more than 5.9 million members by May 2024.

[1:01:33] If we move to the next slide, this is a continuation of our plan to unwind continuous Medicaid coverage.

[1:01:41] So, our guiding principles really included maintaining coverage for those who remain eligible.

[1:01:48] We want to ensure continuity of those coverage for those individuals who remain eligible for Medicaid.

[1:01:54] We've also prioritized redeterminations for those who are most likely to no longer qualify for continued Medicaid coverage.

[1:02:03] And we also wanted to ensure a sustainable workload for our eligibility systems for these future renewal schedules.

[1:02:10] We go to the next slide when I talk a little bit about how we will stagger Medicaid terminations over multiple months.

[1:02:21] So this continuous coverage population has been distributed over three primary cohorts.

[1:02:29] These rate of terminations will be initiated for each cohort over a period of six months.

[1:02:34] And that's six-month period started in April 2023.

[1:02:39] So our first cohort was initiated on April the 8th, 2023.

[1:02:44] So just roughly about a month and a half.

[1:02:46] I'm not that a week ago.

[1:02:49] People enrolled in Medicaid and SHIP who are not included in those coverage cohort.

[1:02:54] So if they're not receiving continuous coverage,

[1:02:57] they will just be renewed within their normal renewal dates.

[1:03:00] So let's say someone is newly certified as of January 2023.

[1:03:05] They wouldn't have a renewal date and they would receive their 12-month certification through January 2024.

[1:03:12] They'll continue to remain on their 12-month cycle.

[1:03:17] If we go to our cohort timeline on the next slide, you'll see here that this timeline begins in March.

[1:03:25] We actually started our unwinds activities much sooner than that.

[1:03:29] We actually kicked off our communication with our members who would need to have their eligibility

[1:03:34] to turn it redetermined, back in January, on January 25th, 2023.

[1:03:40] We sent a notice out to many individuals to the individuals who would need to have their eligibility

[1:03:46] retested and let them know to be on the lookout for going to be reaching out to you.

[1:03:51] You will need to take action and respond to have your eligibility redetermined.

[1:03:57] We also, in March, sent out notices to individuals who were receiving Medicaid related to

[1:04:06] supplemental security income or department of family and protective services through some

[1:04:12] of their adoption assistance programs who were identified as no longer eligible throughout

[1:04:17] the continuous coverage period.

[1:04:19] We also sent them a notice letting them know that we would reach out to them at a later date

[1:04:24] and they would need to take action to renew their Medicaid coverage.

[1:04:30] So after we reached out and let everyone know we would be

[1:04:33] re-determined coverage for these continuous Medicaid coverage populations.

[1:04:38] As I stated earlier, our very first cohort kicked off on April 8th,

[1:04:44] and that is where we initiated really our first batch of Medicaid

[1:04:48] re-determinations for individuals who received continuous coverage.

[1:04:52] We're in the process, so they received individuals received 30 days to return that information that 30 days has passed.

[1:05:00] And now our access and eligibility service staff are working through that case load to ensure that those cases are re-determined.

[1:05:10] I did want to make one note that is if an individual does a response and let's say the work is in queue and let's say the agency is unable to work that case

[1:05:20] by the end of their certification period in this case would be July 31st, they will continue

[1:05:26] to receive one month extensions until their eligibility has been processed. So that is tied

[1:05:33] back to be will not take any adverse action, either benefits in Iowa reduction until that

[1:05:39] redetermination is completed if they've returned their forms timely. Our next cohort, which will

[1:05:45] cohort number two. Those packets will be sent out to members on July 15th. Then in September

[1:05:52] on the third we will initiate our packets for the subliminal security income into apartment

[1:06:00] a family and protective services, types of assistance on December 3rd and then followed by our

[1:06:06] very last cohort, which is cohort number three, which will be initiated on July the 9th.

[1:06:15] You will see that our very first cohort is really individuals that we don't believe

[1:06:20] will remain eligible for Medicaid.

[1:06:23] That second cohort is individuals who may transfer to another benefit type or who need additional

[1:06:29] information, and then that last, that very last cohort number three, consists of individuals

[1:06:36] who will likely remain eligible for Medicaid. And that is, of course, based on the information

[1:06:45] that we have available to us within the system. One other item I do want to note is that as

[1:06:50] we're re-determining these individuals and we're generating these renewal packets, we are also

[1:06:57] utilizing electronic data sources, and if we can verify an individual's eligibility, there may

[1:07:05] be members who may not have to respond. They will receive a packet letting them know. This

[1:07:10] is the information and we have on file and if it's correct, they don't need to respond. But

[1:07:14] we want to just make sure that members are aware to look out for those envelopes. They're going

[1:07:20] to be yellow envelopes. I think I have a copy of that envelope later in this presentation. We

[1:07:24] folks to really know that if they receive that yellow envelope with the red text, to take action.

[1:07:30] And to pay attention to those envelopes that will be in their mailbox.

[1:07:36] I want to talk a little bit about the communications plan.

[1:07:39] So the agency has developed a robust communications plan.

[1:07:43] So as you can imagine, almost 6 million people, that's a lot of folks to communicate with.

[1:07:48] And we want to make sure that we continue coverage for as many folks as possible,

[1:07:54] and ensuring those folks that remain eligible stay eligible for Medicaid.

[1:07:58] So, I'm sure you've probably maybe heard some ads on TV radio if you follow us on Twitter or Facebook.

[1:08:06] You've probably seen some of this communication.

[1:08:09] But we really have, and if we go to the next slide here,

[1:08:13] we've had three phases to our communications plan.

[1:08:16] And these communications plan is really a multi-pronged communications campaign that helps

[1:08:22] members, providers, health plans, and advocates prepare for the end of continuous coverage.

[1:08:28] We realize this is an immense undertaking in anyone that our members may encounter.

[1:08:33] We want to make sure that they have the information to help folks that they serve too.

[1:08:38] So this could be advocacy groups, providers, doctors, offices, they're seeing these individuals

[1:08:44] as well.

[1:08:45] So we wanted to spread this message far and wide to make sure everyone is informed.

[1:08:50] Our third phase includes texts and notices, social media.

[1:08:56] We also have some earned media and paid outreach from HHSC to our members.

[1:09:02] So when our first rounds of renewal packets was mailed, members who we had information on

[1:09:07] file descended text to, we send them a text, letting them know, check your mail, it's time

[1:09:12] to renew.

[1:09:14] There were some robocalls that went out for individuals who hadn't returned their packets.

[1:09:18] So, really trying to reach members to let them know it is time to take action for their Medicaid case.

[1:09:27] On the next slide, talk a little bit about some of these key messages.

[1:09:31] Our key message right now is really that continuous Medicaid coverage has ended and renewals have started.

[1:09:38] Again, we are emphasizing that Medicaid members should look out for those notices that are meld in those yellow envelopes that say action required in red.

[1:09:46] Also members who have opted into electronic communication, we want to make sure that those folks pay attention to any alerts or emails or systems generated messages, they may get from HHSC.

[1:09:59] We also want to emphasize that members must complete and return renewal packets and request information on time.

[1:10:07] We want to make sure that we give them their information timely and again, they until their renewal is complete and we have completed a complete redetermination

[1:10:16] Their benefits will not be reduced or denied.

[1:10:20] We also want to emphasize the importance of contacting HHSC to report any changes.

[1:10:28] All changes are important but certainly contacting information.

[1:10:31] And household changes, addresses, or so very important into being able to reach our members.

[1:10:39] These key messages really do aim to increase the likelihood of maintaining eligibility

[1:10:44] for these eligible folks and reducing turn in the case load.

[1:10:50] That's beneficial for both our members and the agency as we work through this amount of work.

[1:10:56] And we'll also minimize call center volume as well.

[1:11:02] I can tell you there have been some other improvements such as the password reset.

[1:11:06] We realized that the process before we have to call 211 now, they can see something that's

[1:11:12] more along the lines of the interest to be standard by clicking a link in resetting their

[1:11:16] password.

[1:11:17] So that was just another win for individuals to be able to log into their case because in some

[1:11:22] cases they may not have logged in for several years.

[1:11:25] and may not remember their password, and so that's just one more way we've aimed to simplify

[1:11:31] the re-determination process. On the next slide, we have our communications timeline here.

[1:11:40] So, as I mentioned before, we did resume the eligibility re-determinations with our first cohort

[1:11:47] starting in April. We went live with updates on your Texas Benefits.com, we're utilizing the

[1:11:55] messages on our websites also on our HHSC website. So there's going to be a couple of links that

[1:12:02] I share that shared with this presentation. I encourage you if you haven't already to go out and

[1:12:07] click those links. We have some very robust tools. We have frequently asked questions which cover

[1:12:14] many many topics related to the end of continuous coverage. Again, just to recap cohort one,

[1:12:22] started on April the 8th. And we started those monthly text and email messages on April 17th.

[1:12:30] So there were communicating just in time. So it's top of mind as folks are receiving those

[1:12:35] packets and they know they need to take action. Of course, then our phase 3 social media

[1:12:41] went live on April the 18th. And then, most recently, the Robo calls began as a reminder

[1:12:47] to individuals who needed to respond on April the 24th.

[1:12:52] On the next slide, I have a couple of graphics to share with you.

[1:12:55] So these are Ambassadors or Program graphics.

[1:12:58] HHSE established the end of continuous coverage

[1:13:01] ambassador program to enlist the help of many other groups

[1:13:05] to get the word out to folks that they may serve as well.

[1:13:08] So these, again, may be providers or advocates

[1:13:12] who want to help us get the word out.

[1:13:13] And so with that, we've provided some graphics,

[1:13:16] which can be shared on social media, they can be printed.

[1:13:19] We have all of these on our website.

[1:13:21] If you're just a couple of them noting, you've got mail and it's time to renew and of course

[1:13:26] you see our yellow envelopes there to call attention.

[1:13:31] If you go to the next slide, we have a copy of the yellow envelope here with the red text.

[1:13:37] This is something that folks have just placed out in their lobby and to be on the lookout

[1:13:41] if you receive mail and this envelope makes you take action because that will

[1:13:46] be your renewal and you'll need to respond.

[1:13:50] We also on our website have a sample of forms.

[1:13:54] If you go to the next slide here, you'll see that this is a template form.

[1:13:58] Of course, the forms that members will receive will have personalized information regarding

[1:14:03] their particular case situation.

[1:14:05] We do have some samples so that they recognize the form when they receive it.

[1:14:10] And again, these are the same forms that they received pre-continuous coverage period as well.

[1:14:17] And the last tool that I just want to share with you, an end plug here, is the frequently

[1:14:22] asked questions on the next slide.

[1:14:25] So there is a frequently asked questions document, again, that is very robust that folks

[1:14:29] will be able to view and read through.

[1:14:34] And we'll certainly accept any questions that folks have outside of this.

[1:14:38] you have a particular scenario, we're always happy to talk through it and discuss and we appreciate

[1:14:44] any feedback that you have for us. I think one of our slides here is our resources slide.

[1:14:52] So if you're not already signed up for the Ambassador Program or you've not downloaded

[1:14:59] the Ambassador Program.

[1:15:00] So we'll get on this next slide that we'll bring up here. It has the link to our ambassador program, which, again, just has a wealth of materials. This presentation, there's actually a presentation that's recorded. We recorded several weeks ago, so you can actually see a presentation very similar to what I'm doing today online that was targeted toward our long-term care providers.

[1:15:24] So there's great information out there.

[1:15:27] We also on this slide have a stakeholder engagement email.

[1:15:31] This is for stakeholders to may have questions about eligibility and about the process.

[1:15:38] The email box wasn't really intended for client specific requesting concerns but certainly

[1:15:43] any stakeholder feedback we appreciate it there.

[1:15:46] And if you're interested in one like to join us, I believe it's every two weeks on this

[1:15:51] culture calls, you can register for the Ambassador Program

[1:15:54] Context List and join us. I believe it's every two weeks on Monday

[1:15:58] afternoons and we'll talk about all things and of continuous coverage.

[1:16:03] We'll provide the latest updates and that's that presentation is presented in

[1:16:09] partnership with our partners over in access to knowledge ability services.

[1:16:14] If we go to the next slide, I just wanted to share some information that I think

[1:16:18] is helpful for provider communities and then also for individuals who are receiving Medicaid

[1:16:25] benefits and may have questions about, you know, do I have Medicaid?

[1:16:29] What do I do now?

[1:16:30] So what a patient can do is to verify their coverage, is certainly to go to your Texas

[1:16:37] benefits app on your phone or go online to your Texas benefits or call to one one.

[1:16:43] We also have a local offices available to assist individuals with questions.

[1:16:47] For providers, they can always, could form coverage through the Texas Medicaid and health care

[1:16:54] partnership, text med connect portal, or they can call 211 and select option 2, and then

[1:17:01] they will need to provide their national provider identifier.

[1:17:05] One of the things that we've been to a size with our provider populations is that getting back

[1:17:09] into the habit of verifying that coverage now, because it's been so long since we've not

[1:17:14] had folks denied for Medicaid, so we're really getting back into that the habit of verifying

[1:17:22] coverage. So with that, that's the presentation that I have for you this afternoon. I

[1:17:27] certainly appreciate you having me and allowing me time to share information on endive

[1:17:32] continuous coverage, and if the committee has any questions, I can take this now.

[1:17:37] Thank you so much for the presentation, and certainly all the work that has gone into

[1:17:43] starting to unwind from the continuous coverage. I am curious now that cohort one has had their

[1:17:54] opportunity to submit in information for the re-determinations. I can only imagine processing

[1:18:01] these cohorts is a bit like swallowing a Mac hole, right? Because of the volume, just the sheer volume

[1:18:10] of re-determination at a time.

[1:18:12] So I'm curious how that's impacting the process workflow

[1:18:17] where you're seeing delays for people that may be

[1:18:20] or applying for Medicaid for the first time,

[1:18:23] or what does that kind of look like right now?

[1:18:27] So I can give you a very, I'm not with access and eligibility

[1:18:30] services, so I need them to give you some more specifics.

[1:18:33] But what I can tell you is that there

[1:18:35] were a lot of efforts to prepare the system

[1:18:38] and the workforce for this work, so they increased staff and the call centers to make sure

[1:18:44] we could handle call volumes, they increased eligibility staff, they've been conducting

[1:18:49] hiring events on the spot hiring events, I know I saw some of that on Facebook, so really

[1:18:54] stabilizing and making sure that our workforce was available so that we don't see delays

[1:19:00] with our applications and such, but yes, there have been, that has been really an immense

[1:19:06] they're taking is just making sure that that workforce is ready and available.

[1:19:10] And in fact, I just talked with staff there today and they were talking about some of the

[1:19:15] efforts that they had taken to make sure that they've had increased their workforce.

[1:19:20] So I can tell you just at a high level that, yes, they have prepared their workforce,

[1:19:25] they increased their workforce to address this workload.

[1:19:30] Thank you.

[1:19:31] Members, do you have other questions?

[1:19:36] I'm Beth Wright, or thank you so much, this very informative.

[1:19:40] I'm a little curious about the SSI population.

[1:19:45] I guess I was under the impression that they were sort of waved,

[1:19:49] because it is a federal program.

[1:19:52] So can you go into a little bit more about that eligibility

[1:19:56] and what you're looking for those who are on SSI?

[1:20:00] That is a great question, so the only individuals who will need to take action are those who've been identified as denied.

[1:20:08] So if they are currently denied, we will outreach them to apply.

[1:20:12] So, you know, normal process would be when they stopped receiving SSI, their coverage would have ended,

[1:20:17] but because their eligibility was continued, we will reach out to them, send them a packet so that they can apply for benefits.

[1:20:24] But if an individual is on SSI and they continue to receive SSI, no action will be required

[1:20:30] you're right.

[1:20:31] They are eligible, but just by virtue of their SSI eligibility, but that's a great question.

[1:20:37] You bet.

[1:20:39] Hi.

[1:20:40] I have a question actually, if I may.

[1:20:44] Go ahead, Ms. Glover.

[1:20:45] Yes.

[1:20:47] Thank you.

[1:20:48] To be back off the Mrs. Brighter, I appreciate that question that was a good one.

[1:20:54] So for individuals, since there are three, is it possible for individuals to be in different cohorts within the timeline?

[1:21:06] The reason why I ask is because a lot of the individuals, well, we serve individuals who are in waiver programs and a lot of them, like you said,

[1:21:17] writer they do are on SSI or things like that and that's how they receive Medicaid. However,

[1:21:25] some of them have transitioned during that time from Medicaid to Medicare but we've noticed I don't

[1:21:30] really know the rhyme in the reason I guess is why some of our consumers keep getting renewals

[1:21:37] for Medicaid applications during this unwinding period and I'm getting again I don't really know what's

[1:21:46] to tell the families when we do receive calls like that, however we are, you know, we go through the process and submit the applications so that way there are no delays.

[1:21:57] That's my question. If you can answer that great, if not, I will.

[1:22:04] That is another great question, Shawnee. So yes, so we've continued to renew eligibility. So even though coverage was continued, we've continued to renew folks,

[1:22:14] which is why you see not everyone being in continuous coverage and so for those folks that have renewed let's say

[1:22:21] Shawnee you

[1:22:22] Help to family renew and they were renewed in February of 2023. They're going to receive a full year of coverage if they

[1:22:30] May be successfully renewed. Now, there may be individuals. Let's say they were over the resource limit for some reason, right? They would they may fall into one of the cohorts, but in general, the agency continued to process renewals. So, you would have seen them renewals continue to the families.

[1:22:48] So, in essence, if they were in the last 12 months, if they were re-determined into terminology, they will receive the 12 months of coverage and they'll fall in their regular renewal cycle.

[1:22:58] However, if they were trying to determine ineligible in that period, they would be assigned

[1:23:02] to one of these cohorts.

[1:23:04] You bring up a very good point about the cohorts and one of the things that I want to mention

[1:23:09] about the cohort, especially for folks who serve folks that are in the community and a waiver

[1:23:14] program.

[1:23:15] They're more likely to have other individuals in their household.

[1:23:19] So while we could have an individual in a household that is likely to be ineligible, which

[1:23:24] will be assigned to cohort one, and then someone who's likely to remain eligible, who may

[1:23:29] be a cohort three.

[1:23:30] We will assign all of those family members to that very first cohort, and the reason

[1:23:35] being is because we want to reach out and read a term in a family at a time.

[1:23:39] We don't want to read a term in one member of the family, and then several months later,

[1:23:43] we would like to sync them all together and renew the family to lessen that sort of burden

[1:23:49] of having to reply multiple times for folks in the same household.

[1:23:54] That was excellent information. Thank you for that clarification. Also I do want to give

[1:23:59] you all big kudos because this is a major major major task and thank you very much for adding

[1:24:06] into the application options for email telephone and text because that's getting positive feedback

[1:24:12] from our consumers. So thanks. Awesome. That's great to hear. Thank you so much.

[1:24:17] members.

[1:24:22] Other questions?

[1:24:27] Hearing none. Thank you again. Deputy Associate Commissioner. Thank you for your presentation and your time today.

[1:24:33] Thank you for your time.

[1:24:38] All right. We will move on to our next our next presentation. The Texas dual eligible in a red integrated care demonstration project update.

[1:24:48] Ms. Vangie Serrano, senior policy advisor with program policy and Medicaid and chip services.

[1:24:57] Good afternoon. This is Van G. I work with the MCS Office of Policy as the senior policy advisor as mentioned here on the slide.

[1:25:11] Next slide please.

[1:25:14] We'll be providing you all an update on the dual demonstration.

[1:25:20] HHSE submitted its preliminary dual demonstration transition plan to the Center for Medicare and Medicaid Services.

[1:25:27] Last September, on September 30, 2022, this was a requirement from CMS contract year 2023

[1:25:37] Medicare Advantage and Part D final rule. At the time the HHSE submitted its transition

[1:25:44] plan to CMS HHSE was considering three potential end dates for the dual demonstration,

[1:25:50] which were December 31st, 2023, 2024 or 2025.

[1:25:58] Since then, or actually let me back up a little bit,

[1:26:03] the transition plan outlined agencies plans to transition

[1:26:06] the demonstration, Medicare, Medicaid plans

[1:26:09] to integrate dual eligible special needs plans,

[1:26:13] or these steps in the most seamless way possible.

[1:26:16] But since the meeting are transition plan to CMS, we have decided to extend the demonstration

[1:26:23] through December 2023 and or beyond December 2023 and now we are only considering two potential

[1:26:33] and dates which are the other two December 31st, 2024 or 2025.

[1:26:38] Next slide please.

[1:26:46] In November 2022, HHSC began participating in the Center for Healthcare

[1:26:51] Strategies Medicare Academy. This is a training program designed to help states build our

[1:26:58] Medicare knowledge that we would need to develop and oversee Medicare and Medicaid integration

[1:27:05] and to engage in longer term policy and program refinement.

[1:27:10] Some of the knowledge that we've gained through this participation will help inform the agency's transition plan from the demonstration to integrated decimbs.

[1:27:21] And to provide a few examples of the topics that H2C has learned about through this training

[1:27:27] program so far, is they are different enrollment options that the states have available

[1:27:34] to them to support integrated care between Medicare and Medicaid for our dualieligible

[1:27:39] individuals, key areas of intersection between Medicare and Medicaid to improve care coordination

[1:27:46] efforts and partnerships that Medicaid agencies can establish with other state agencies that will

[1:27:53] further support dual eligible care and I will pause there in case there are any questions.

[1:28:05] Members any questions?

[1:28:12] I do not hear any. Thank you so much.

[1:28:16] Thank you, if anyone thinks of any please feel free to contact me. My email is on the next slide.

[1:28:23] there we go. Thank you. Thank you. Our next presentation is the Healthy Texas Women

[1:28:31] Transition to Managed Care Status Update. The presentation will be given by Ms.

[1:28:36] Susana Binyathe, Manager with Program Policy and Medicaid and Ship Services.

[1:28:45] Okay, good afternoon all. Today we'll be presenting an update on the Healthy Texas Women

[1:28:50] Transition to Managed Care project as directed by House Bill 133 from the 87th Legislature

[1:28:58] My name is Susanna Binyathe.

[1:29:01] I work at HHSC and the Medicaid and CHIP services division.

[1:29:05] I am a manager in the Office of Policy area.

[1:29:09] And I help oversee the HW program, okay, and next slide.

[1:29:19] So today, I will be presenting a bit of background on this project.

[1:29:24] Some updates on the star and chipper quest for proposal.

[1:29:27] and then outlines some next steps for this project.

[1:29:33] Next slide.

[1:29:39] Okay, some background on this project.

[1:29:42] This project was directed by House Bill 133,

[1:29:46] which directs HHSC to contract with Medicaid,

[1:29:50] managed care organizations to provide HHSW program services.

[1:29:55] House Bill 133 also requires HHSC.

[1:30:00] And so for the

[1:30:13] next two slides, I will provide an update on the start chip request for proposal.

[1:30:19] So on this slide, you see the timeline for the RFP as it is now.

[1:30:28] So the RFP posted in December 2022, the anticipated notice of award is

[1:30:35] state-of-school year 2024, quarter-two, and the anticipated sort of operations

[1:30:42] is state-of-school year 2025, Q2 as well.

[1:30:46] So I will point out that any changes to the RFP timeline will be posted on the agency procurement website.

[1:30:57] On that website you can also access the exhibits, the scope of works for the new contract that is publicly available.

[1:31:06] So if the committee would want more information on which specific documents to look at or

[1:31:13] or links, I can definitely provide that as a follow-up.

[1:31:18] Next slide.

[1:31:23] And then the last update on the RFP is the first just confirmation that

[1:31:29] HEW is included in the Starship RFP.

[1:31:33] We do plan to incorporate HEW plus services into managed care as well.

[1:31:39] And then an update on where we are in the RFP process is we are in the evaluation period.

[1:31:47] So this means HHSC is evaluating proposals received by MCOs.

[1:31:56] And I will add that many of the contract requirements,

[1:32:00] So we have for star and chip, are very similar or the same for HTW, so that includes MCO

[1:32:08] member materials, ID card, online provider directories, et cetera, et cetera, et cetera, but

[1:32:16] it's definitely what point you need to the A to just the procurement website for additional

[1:32:22] details on what the RFP includes.

[1:32:26] Next slide.

[1:32:32] Okay, and so for next step, we usually we have several here. These include some

[1:32:39] knitting the H-C-W-U-1115 waiver amendment, developing a definition for the H-C-W

[1:32:47] Significant Provider, Provider Education and Outreach, a paying feedback from and providing

[1:32:56] of dates to the smacac network adequacy and access to ticker subcommittee.

[1:33:03] Client education and outreach, updating systems, of course updating HW client-basing materials.

[1:33:12] And then working with our new HWMCOs by hosting transition calls and CO readiness activities

[1:33:20] and any education and outreach.

[1:33:24] And so you'll see that there's asterisks to some of these next steps, and that means that

[1:33:30] these really won't begin until we know who the H.E.W.M.C.O.s are, and we will know that until

[1:33:38] the estimated notice of intent of award in Q2's tape this clear 2024.

[1:33:46] And while I'm here, I will just share some information that on June 8, we will be hosting

[1:33:55] the HW poster award public forum.

[1:34:00] That's a public forum where you can hear updates from HHSC about how the HWLM15

[1:34:08] through demonstration program is going.

[1:34:12] So we can definitely provide more information to the committee.

[1:34:15] on how to attend that public forum. Next slide

[1:34:23] and that is the end of my presentation.

[1:34:26] Thank you so much and I'm happy to take any questions.

[1:34:33] Thank you so much. Definitely please

[1:34:35] do share with the committee the information regarding the public forum. I feel sure the

[1:34:40] members would appreciate receiving that. Members any questions?

[1:34:50] All right hearing none. Thank you

[1:34:56] is on new legislation from the 88th legislative session pertaining to Medicaid managed care.

[1:35:03] And we have Ms. Erica Brown, deputy director in program policy, and Jenny Costillot,

[1:35:11] director of program policy, Medicaid and ship services.

[1:35:15] Good afternoon. This is Erica Brown. I serve as the deputy director of program policy

[1:35:20] and Medicaid and ship services. It will actually just be me today. I think Jenny may be

[1:35:25] listening in but I'll give the presentation. Okay, next slide, please. All right, so I wanted

[1:35:33] to start out with a high level summary of the 88th legislative session so far and talk a little

[1:35:39] bit about the numbers. So this session there have been 10,742 bills filed and of those our

[1:35:49] Medicaid and CHIP services division has analyzed more than 800 Medicaid-related bills.

[1:35:56] We're now nearing the end of the legislative session as many of you know it's just one week to go.

[1:36:03] I'm going to note that the information that I'm going to cover in the presentation today was prepared earlier this week

[1:36:10] because we wanted to be as up-to-date as possible, but as many members of the committee know, things are moving quickly.

[1:36:17] day to day with the legislative session so please keep that in mind and we will provide another

[1:36:23] presentation at the next committee meeting that will cover everything that is in fact passed during

[1:36:29] the 88th legislative session. Next slide please. Okay so there are a few key topics that we have

[1:36:38] seen across the Medicaid related bills that HHSC has analyzed the session. So starting out we've analyzed

[1:36:46] Several bills related to provider requirements, so this includes new provider types for already covered Medicaid and chip services.

[1:36:57] It also includes specific requirements and restrictions, for example prohibiting discrimination based on immunization status for Medicaid and chip providers.

[1:37:08] We've also analyzed several bills related to long-term services and supports.

[1:37:13] These bills have addressed requirements for nursing facilities, participating in star

[1:37:19] plus.

[1:37:21] They've also addressed the personal needs allowance for residents of long-term care facilities.

[1:37:25] and we've seen several bills related to abuse.

[1:37:31] There have also been several bills focused on our fee-for-service Medicaid IDD waiver programs. I'm not going to go over these today because they don't impact managed care. But if any members of the committee are interested in learning about those specific bills, I'd encourage you to review a similar presentation that we made for the IDD SRAC, and we can share the materials with the committee members if you'd like.

[1:37:58] Moving on, we've also analyzed several bills that impact HHSC's operations, so this

[1:38:05] is included bills focused on things like data sharing, legislative reports, and the creation

[1:38:11] of new advisory committees.

[1:38:14] Women's health has also been a key topic this session, and we've analyzed several bills

[1:38:20] that would provide 12 months of postpartum coverage for pregnant women.

[1:38:24] We also analyzed bills related to non-medical screenings for pregnant women and new provider

[1:38:30] types for the case management for children and pregnant women or CPW program.

[1:38:38] Regarding eligibility, we have analyzed bills related to Medicaid and CHIP eligibility determinations,

[1:38:44] particularly around automatic enrollment of children in CHIP.

[1:38:50] Another key topic this session as in prior sessions is new or amended Medicaid or chip services.

[1:38:59] So we have analyzed bills that would add new Medicaid benefits, including cranial remolding orthosis,

[1:39:07] hair prosthesis, or wig coverage for cancer patients, several mental health services,

[1:39:13] new telemonodering services and a few pilot programs.

[1:39:20] And then finally there have been a lot of those focused on pharmacy and prescription drugs that we've analyzed.

[1:39:27] One of the major topics has been the drug formulary in the preferred drug list.

[1:39:33] So I'm now going to highlight several specific bills within these categories that are active legislation that Medicaid and chip services is tracking.

[1:39:42] Next slide please.

[1:39:47] Okay, so we'll start with our active legislation related to provider

[1:39:51] requirements. The first Baltha Highlight is host Bill 98 and this bill requires the Health

[1:39:57] and Human Services Commission to allow a school district to enroll as a provider under Medicaid

[1:40:03] to provide and receive reimbursement for mental health services to students who are Medicaid recipients.

[1:40:10] There is also a Senate Companion Bill to that.

[1:40:13] It's Senate Bill 113.

[1:40:16] The next bill to highlight is House Bill 1008.

[1:40:20] That bill is related to abuse neglect and exploitation.

[1:40:25] And it requires providers to immediately suspend the employment

[1:40:29] or contract of an employee immediately upon notice

[1:40:33] of a reportable conduct finding.

[1:40:36] And the bill describes disciplinary action

[1:40:39] for not terminating employees and states that the commission should consider the nature and

[1:40:45] seriousness of the violation any history of previous violations in any other matters if that

[1:40:52] circumstance comes up. Another provider related bill is House Bill 1879. This bill allows

[1:41:01] licensed master social workers, licensed professional counselor associates, and licensed

[1:41:08] marriage and family therapist associates for underclinical supervision to be reimbursed

[1:41:15] through Medicaid while completing their clinical requirements to become clinicians.

[1:41:21] And the bill specifies that the rate for these provider types will be at 50% of the reimbursement

[1:41:28] for licensed psychologists and psychiatrists providing similar services.

[1:41:35] Next slide please.

[1:41:39] Okay, getting into the bills related to long-term services and supports.

[1:41:44] The first bill to highlight is Senate Bill 1629,

[1:41:48] which requires nursing facilities who participate in star-plus

[1:41:52] to comply with the direct care expense ratio.

[1:41:55] That's adopted in the Human Resources Code at Section 32.0286.

[1:42:02] The next bill to highlight is House Bill 54, that bill increases the personal needs allowance for certain Medicaid recipients, who are residents of long-term care facilities, from $60 per month to $75 per month.

[1:42:18] And then the third built to highlight is House Bill 3550.

[1:42:24] This bill directs HHSC to establish minimum standards regarding transportation services for pediatric extended care centers or PPEX.

[1:42:35] And the bill also directs HHSC to establish a reimbursement rate by rule for PPEX services, including transportation.

[1:42:47] Go to the next slide please.

[1:42:48] Okay, one bill to highlight related to HHSC operations is House Bill 1238.

[1:42:56] So this bill prohibits a school district or charter school, the Texas Education Agency,

[1:43:03] or HHSC from requiring additional parental consent under the School Health and Related Services Program,

[1:43:12] known as Shars for a program-related purpose that does not involve sharing of a student's

[1:43:19] personally identifiable information.

[1:43:24] Next slide, please. Okay, a few bills to highlight

[1:43:28] related to women's health. First, House Bill 12 would extend Medicaid postpartum eligibility for

[1:43:36] 12 months. That 12 months begins on the last day of the women's pregnancy and ends on the last

[1:43:42] of the month in which the 12 month period ends.

[1:43:47] The second Delta Highlight is Senate Bill 1989.

[1:43:50] That bill would expand the existing IOMARC or testing benefit in Medicaid and CHIP by adding new covered biomarker tests.

[1:44:01] And then the third Delta Highlight is House Bill 1575.

[1:44:04] And this still does several things.

[1:44:07] First, it requires the use of a standardized screening tool

[1:44:12] to assess non-medical health-related needs

[1:44:15] of certain pregnant women,

[1:44:17] and it requires star-manage care organizations

[1:44:20] to conduct the new non-medical health-related screening.

[1:44:25] Second, it allows new provider types,

[1:44:28] including community health workers and dual laws

[1:44:31] as part of the Medicaid case management for children

[1:44:35] in pregnant women program known as CPW.

[1:44:38] And then third, it adds some new topics

[1:44:41] to the required provider training for that CPW program.

[1:44:48] Next slide, please.

[1:44:51] Wanted to highlight one bill that we're tracking related to eligible.

[1:45:00] So, this is an eligibility-related bill that instructs the commission to implement an express-lane option under which the commission can use information obtained by an express-lane agency to determine a child's eligibility for coverage under chip and the bill specifies that the commission shall automatically enroll a child in chip who is determined to be eligible.

[1:45:30] All right, the next several bills are focused on new or amended Medicaid or chip services.

[1:45:38] So starting with House Bill 134.

[1:45:41] This bill would require coverage for cranial remolding orthosis, also known as baby helmets.

[1:45:47] In both Medicaid and chip, and it would provide coverage for more conditions than are currently covered.

[1:45:53] The second bill, host bill 1164, requires health plans to provide coverage for wigs for Medicaid and

[1:46:03] chip members who are undergoing or have undergone medical treatment for breast cancer.

[1:46:11] The next two bills are related to coverage of mental health services.

[1:46:15] So first, host bill 2337 would provide Medicaid coverage for intensive outpatient services

[1:46:23] and partial hospitalization services.

[1:46:27] I'll note that in HHSC's analysis of this bill,

[1:46:31] it's assumed that these services would be covered

[1:46:33] in both fee-for-service and managed care

[1:46:36] as state-plan services.

[1:46:38] As many members of this committee know,

[1:46:41] these services can be covered by MCOs already

[1:46:44] as in lieu of services if an MCO chooses to do so.

[1:46:48] And if their operational plan is approved by HHSC.

[1:46:53] And then the second bill related to mental health house bill 2638, this would require that

[1:47:01] multi-systemic therapy would be a Medicaid covered service and the bill requires the executive

[1:47:08] commissioner of HHSC to establish a separate provider type for multi-systemic therapy providers

[1:47:14] for purposes of enrollment and reimbursement.

[1:47:19] And then House Bill 2727 is related to Medicaid reimbursement for home telemonitoring services for people with certain medical conditions.

[1:47:30] It would require HHSC to cover home telemonitoring for additional conditions if it's clinically effective and cost effective to do so.

[1:47:40] And the bill also adds FQHCs and RHCs as home telemonitoring providers.

[1:47:47] Next

[1:47:50] slide, please.

[1:47:51] Okay, continuing with newer amended services.

[1:47:55] House Bill 40702, this bill would require the commission to establish peer support specialists

[1:48:03] as a Medicaid benefit for certain individuals with intellectual or developmental disabilities.

[1:48:09] The bill requires HHSC to obtain input from a work group and to develop rules that establish

[1:48:16] training requirements, certification, and supervision requirements for these IDD peer support specialists.

[1:48:26] House Bill 4713 is another behavioral health related bill and it would require coverage of a

[1:48:33] sort of community treatment, coordinated specialty care, and peer services for first episode psychosis.

[1:48:41] So the bill would add new services to be covered by Medicaid that aren't already covered so that the entire comprehensive service models are covered in both fee for service and managed care.

[1:48:57] And then finally, House Bill 2983 would create a new pilot program that would provide medically tailored meals for pregnant and postpartum Medicaid recipients.

[1:49:08] Next slide please. Okay, and last but not least, we wanted to highlight a few bills focused on pharmacy and prescription drugs.

[1:49:20] So the first to highlight is host bill 3286, which requires that the commission ensure all drugs and national drug codes.

[1:49:29] be made available on the federal Medicaid drug rebate program, regardless of the status of certification

[1:49:36] of information for the drug. The bill also makes other changes related to generic equivalents,

[1:49:43] creating an expedited review process and adding another member from an MCO to the drug utilization

[1:49:50] review board. And then House Bill 4888 requires Texas Medicaid to cover and reimburse for FDA

[1:50:00] approved drugs, biologicals, and implantable, reusable, or disposable medical devices for pain

[1:50:07] management that have demonstrated the ability to replace, reduce, or avoid opioid use.

[1:50:17] Okay, I know

[1:50:18] was a lot of bills so I'll pause there. See if anybody has questions and again we will provide another

[1:50:24] presentation at the next committee meeting with information about bills that actually passed during

[1:50:30] the 88 session.

[1:50:33] Thank you so much. Curious jumping back to eligibility in the House Bill 1599.

[1:50:40] Could you expand a little bit on what an eligibility express lane is as conceptualized in the bill?

[1:50:49] I will, this is one bill that I actually can't explain well because it's mostly having

[1:50:56] to do with eligibility, which is led by our access and eligibility system, but we can definitely

[1:51:01] get some more information and share that with the committee.

[1:51:05] I am just not the expert on eligibility.

[1:51:09] Fair enough.

[1:51:11] Members, any questions?

[1:51:20] I hear none.

[1:51:22] Thank you.

[1:51:25] All right, and then our final update from Health and Human Services is an update regarding pharmacies as vaccine providers.

[1:51:35] And that presentation will be provided by Ms. Sarah Gonzaga, manager with the medical and dental benefits policy.

[1:51:43] And Rachel Koseum, hope I got the name right, nurse with medical and dental benefits policy.

[1:51:52] Hi, good afternoon. I'm Sarah Gonzaga, manager with a medical dental benefits policy unit at

[1:51:59] Medicaid services with HHSC and I have the vaccine services nurse policy analyst on my

[1:52:06] team. So Rachel, I'm going to let you go ahead and introduce yourself and share some information

[1:52:11] on this topic and then I believe we also have some folks from our vendor drug program as well

[1:52:17] are Medicaid chief medical director online to help us answer any questions.

[1:52:22] Thanks.

[1:52:25] Thanks, Sarah. I am Rick.

[1:52:30] I'm going to talk a bit of its policy and Medicaid chip services. I just have one slide for you all this afternoon.

[1:52:37] And letting you all know that currently pharmacies and pharmacies can be reimbursed for some vaccines and vaccine administration in Texas Medicaid through the medical benefit.

[1:52:50] So to do that, Pharmacy is must enroll with TMHP as a medical provider to be reimbursed

[1:52:57] to be a medical claim and there is the URL for more information for provider enrollment

[1:53:03] on TMHP's website. Pharmacy can also enroll in the Texas Vaccines for Children Program.

[1:53:11] That is a federal program and this is the Texas branch of it. That is administered through

[1:53:19] is HHS and that allows pharmacies and other providers to obtain vaccines through the state.

[1:53:30] And like Sarah said, I'm happy to answer any questions and we also have representatives from

[1:53:35] the Office of Medical Director and the vendor drug program on the call.

[1:53:44] Thank you, members. Do you have questions?

[1:53:47] Hi there. This is Aaron head. My understanding that the limitation that pharmacies

[1:53:54] experiences that not all the vaccines are on the formulary. For instance, I believe

[1:54:00] one of the issues that we had run into was shingles. Can you speak to that and why

[1:54:06] we wouldn't open up the formulary for all those vaccines?

[1:54:13] for O.C.C. to see you.

[1:54:18] Hi, good afternoon.

[1:54:19] This is Stacey Pietro Palo.

[1:54:21] I'm the inventor of drug program,

[1:54:23] and I can speak to the formulary development.

[1:54:29] We, I believe sheingles,

[1:54:32] is correct to me if I'm wrong,

[1:54:34] but is offered by the Medicare

[1:54:37] and is generally provided to folks who are enrolled

[1:54:40] in the Medicare program,

[1:54:41] so it may be offered through that benefit.

[1:54:46] And then we do consider adding other products to the formulae, but it does go through the

[1:54:54] reboot process. So I'm not sure if any kind of research we've done on adding sheagles

[1:55:03] to the formulae or that would be something that would be considered a medical benefit that the

[1:55:12] is this would be able to enroll through team HP as a medical provider and be able to build that way.

[1:55:20] So that's the information I have right now on the shingles. I can take that back and

[1:55:26] try to get some more information. But I haven't heard of any specific projects

[1:55:35] and recently on that particular vaccine.

[1:55:40] Sure.

[1:55:40] And that was just an example.

[1:55:41] I know that there are some others and I can certainly provide some follow-up to that as well to address that for you.

[1:55:56] Right.

[1:55:56] Any other member questions?

[1:56:02] Hearing none.

[1:56:02] Thank you everybody for the presentation and for the questions.

[1:56:06] We'll move on to our next item, which is to take public comment.

[1:56:13] Is there anyone that has signed up for public comment?

[1:56:19] Ms. Yuliska, this is John Chakong with Advisory Committee, Coronation Office.

[1:56:23] And we have no one in the gallery to provide public comment on site.

[1:56:28] And the member that had pre-resistant indicated that she no longer wants to provide oral testimony for today.

[1:56:35] So we have no one to provide public testimony.

[1:56:39] Thank you, Mr. Chakong.

[1:56:41] Then our next agenda item is a review of action items and agenda items for future meetings.

[1:56:48] Members, do you have any agenda items to request for future meetings?

[1:57:02] I'm hearing nothing, so if you have an idea between now and our next meeting, please feel free to email me or email our support team here at HHSC

[1:57:14] in order to get those items on our list for our future meetings.

[1:57:20] Our next State Medicaid managed care advisory committee meeting is scheduled for Thursday, August 17th, 2023 at 1 p.m.

[1:57:30] And with that, we will go ahead and move to a adjourn here at 258 p.m.

[1:57:41] I want to thank everybody for joining us today and thank you again for all our presenters and HHSC support staff.

[1:57:52] Thank you very much, Mr. Yolensky. At this time, I want to stop the recording and transcription and leave the site.

[1:57:58] Thank you all very much. Have a great rest of your day.

May 18, 2023 State Medicaid Managed Care Advisory Committee - Texas Health and Human Services Commission

Agenda

Transcript