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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.

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and that this time I'll introduce Mr. John Shacone to provide meeting logistic announcements.

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Thank you very much, Mr. Lensky. Good afternoon. My name is John Shacone.

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With a Health and Human Services Commission advisory committee coordination office.

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This meeting is being conducted and compliance with the Texas Open Meetings Act and is open to the public.

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Today's meeting is being webcast live and is being recorded as a matter of public record.

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Please do not use jargon and acronyms. Confidential information should not be discussed.

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For the sake of those viewing the webcasts and to comply with the text of Open Meetings app,

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

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

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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.

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Also, we recommend members and presenters to use headsets if possible to prevent feedback and minimize other noise.

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

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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.

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For members that are present as participating in person, we ask that you speak directly into

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the microphone so your voice and comment can be heard.

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

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So we ask that you make sure you speak right directly.

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This microphones are directional and you can also pick them up a little bit from the base

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from handling the movement for your comfort.

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Please put yourself on on me to vibrate.

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If you need to take a call.

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please step out of the room and away from the doors so the sound doesn't carry back into the

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meeting. For members and presenters who plan to utilize a PowerPoint or hand out during

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their presentation, one of our producers will pull out your PowerPoint or hand out and will

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advance the slides or pages by you indicating next slide next page.

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There is time on the agenda for

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public comment. Members of the public were able to submit written public comment prior to the

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In addition, members of the public were able to pre-resisture to provide oral public, virtual

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comments today during today's meeting.

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We do have one member who pre-resisture to provide virtual comments today.

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This member will be a place and listen only mode until it's time for them to provide

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their comments.

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We ask that members of the public who pre-resisture to provide public comments in person

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to please check in with the meeting facilitator.

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Members of the public who are attending in person may also register to provide public comments

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by completing the public registration form, located at the registration table at the door

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to the public hearing room. For everyone participating in person, the residents are located

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off the doors and down the hall to your left and on the left hand side. Note that emergency

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access are located at the back and at the side of the room where most of you came in from.

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If there is an alarm, we'll evacuate the building and return only at the direction of

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security personnel. If you have questions and comments regarding agenda topics presented today,

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please send any mail message to Ali Dukue at the email address provided in the chat section

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and at the bottom of the post of public agenda. At this time, I would like to call Role

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and members when I call your name, please turn on your camera and microphone and respond with

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here or present and provide a brief one sentence introduction of yourself on responding to

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the

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Anthony Bocaro,

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Ms. Esmeralda Costares-Baglia.

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Hi, I'm President.

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Would you care to introduce yourself, ma'am?

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Yes, I'm Esmeralda Costares-Baglia,

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I'm a Senior Vice President of Operations for Management,

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Care Organization Superior Health Fund.

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Thank you very much.

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Ms. Jane Kuncha,

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Dr. Christina Davidson,

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Ms. Michelle Lynn Evans.

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Hi, Michelle Evans, thank you.

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Thank you very much. This shana clover.

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Good afternoon, everybody. My name is Shana Glover. I am a class case manager at the

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Coastal Vincent Center for Independent Living. Thank you very much. Miss Yolanda Haines,

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Mims.

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Hi, good afternoon, everyone. I'm Yolanda Haines, Mims and the director of business operations

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Thank you very much, Mr. Erin Hiddard.

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Other, I'm Erin Hiddard, I'm the Executive Director for

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Star Kids Star Class Group and I am President.

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Thank you very much, sir.

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Ms. Tyra Hinton.

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Good afternoon, everyone. My name is Tyra Hinton.

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I am the Deputy Director of the Services Division here in

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Harris County, which encompasses the Harris County

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guardianship program in the Singar Justice Assessment Center.

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Thank you.

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Dr. David Lam,

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Mr. Ramsey Longbatham.

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I'm Ramsey Longbatham, the Vice Chair of this committee.

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I also am the Director of the IPA Independent Position Association of Victoria, Texas,

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with 86 doctors handling 19 contracts.

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Thank you,

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sir.

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Ms. Samantha Moreno.

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

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Thank you.

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Dr. Shahit Rahman.

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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.

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Thank you. Dr. Carl Serao.

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Mr. Jacob Yulinski.

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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,

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where we housing and serve the community as the local IDD authority as well as to area

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agencies on aging to aging and disability resource centers and a provider of medical

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non-emergency medical transportation.

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Thank you, sir.

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Dr. Lindsey Vasquez.

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Hi, good afternoon. I'm Dr. Lindsey Vasquez. I'm the director of maternal women's health

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And also a practicing OB-GYN in Harris County at a fairly cold Miami tonight.

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Thank you.

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Mr. Alfonso Velarde,

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Ms. Jennifer Vincent.

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I am a parent advocate, and I'm also the president of Galveston Houston's

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families exploring Galveston.

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Thank you very much.

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Let me go back to make sure anyone else join.

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Mr. Javier Bagnales,

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Mr. Anthony Brocado,

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Ms. Jane Concha.

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Welcome to

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you.

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Thank you very much, producers from uni.

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Dr. Christina Davidson.

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Dr. David Lam.

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Dr. Shahit Raghman.

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Dr. Carl Soaro.

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Mr. Alfonso Velarde.

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Mr. Linsky, you do have a forum of the committee.

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You have exactly 12 members.

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Excellent. Thank you, Mr. Shukham.

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I want to welcome our committee members and the public who are in attendance today.

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and also introduce our HHSC staff who are here to assist the committee. In particular, we

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have Ms. Eloici Indiquay, the committee liaison with Medicaid and CHIP services, Veronica

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Keram, the coordinator, Medicaid and CHIP services, and Basin Dora, Rishandori, for giving

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me advisory committee coordinator, Medicaid and CHIP services. So we will go ahead and

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on to our next agenda item, which is consideration of our February 8, 2023 minutes. Members,

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if you will please locate the minutes in your packet and take a moment to review those,

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are there any requests for edits or changes to the draft minutes?

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None, do I have the motion?

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Sean and Glover motions to approve the minute as written.

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I have a motion by Sean and Glover.

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Do I have a second?

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Just a ramsy long-batham you have a second for me.

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I have a second from ramsy.

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Members are there any discussion?

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All right.

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Hearing none.

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Mr. Shaqan, will you please conduct a roll call vote?

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Yes, sir.

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Committee members, when you hear your name,

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you could please indicate approve this approval or abstain

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to the motion of the floor to approve the February 8, 2023 meeting minutes as presented.

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So moved by Noshana Glover and seconded by Mr. Ramsey Longbottom.

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Mr. Javier Banyales.

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Mr. Anthony Brocado.

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Yes.

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Thank you, Mr. Brocado. Would you care to introduce yourself briefly?

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Yes. This is Anthony Brocado, CFO with Lincoln Healthcare System and Tolka Texas.

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Thank you very much, Mr. Brocado.

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Thank you Mrs. Madalda Kassat as baby.

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Approved.

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Thank you.

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Ms. Jane Concha.

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Dr. Christina Davidson.

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Michelle Lynn Evans.

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Approved.

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Thank you.

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Ms. Shana Glover.

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Ms. Shana Glover.

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I'll apologies.

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Approved.

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Thank you very much, man.

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Ms. Yolanda Haynes Mims.

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Approved.

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Thank you.

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Mr. Aaron Hidd.

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Approved.

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Thank you. Ms. Tyra Hinton.

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Approved. Thank you. Dr. David Lam.

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Mr. Ranzi Longbottom. Approved. Thank you.

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Ms. Samantha Moranel.

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Approved. Thank you. Dr. Shahit Rahman.

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Miss Beth Ryder.

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Approved. Thank you. Dr. Carl Saral.

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Mr. Jacob Yolinski.

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a proof. Thank you. Dr. Lindsey Boskis.

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Thank you. Mr. Alfonso Beladade

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and his Jennifer Vincent.

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Thank you very much. It being a unanimous vote of the committee, the motion carries

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I'll turn over to the meeting back to you, Mr. Yulinski.

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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.

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

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So first, we'll go with the Star Kids Management Care Advisory, is Catherine Carlton on.

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Much for accommodating.

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Go ahead, Miss Carlton.

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Okay, thank you so much.

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

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Since our last update, we've had two meetings in December and March.

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I'll focus on the most recent meeting as you have both in your packets.

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

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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.

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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.

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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.

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

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

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The committee that I chair is our assessment and service delivery.

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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.

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incredible resource to kiddos with mental health diagnoses as well as other diagnoses and

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star kids and that committee most recently met and focused on our annual report that we did

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and our recommendations and prioritizing those recommendations with HHSD staff looking at what

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would require legislative action, what could the state do with those recommendations and help prioritize

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What we can accomplish this year and moving into next year fiscal year that is we also have the health home subcommittee

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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

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That pilot program focused on

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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.

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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.

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And what are some best practices we can use with the MCOs and our HHSC partners to help our

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start kids in that age range.

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And they too are working on prioritization of the recommendations.

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A lot of the transition recommendations have been repeat recommendations that we are trying

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to tackle and so prioritizing those.

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We meet again in June on the 14th and welcome any questions or updates.

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We are finalizing that agenda and you should see it posted shortly.

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Great.

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Thank you, Ms. Carlton.

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Members, do you have any questions?

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Hearing none.

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Thank you very much for your time and we wish you safe travels.

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Next, we will move on to the,

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or I'm sorry, the hospital payment advisory committee did not meet and will be tabled.

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The meeting was canceled due to implement weather.

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Our next update will be from the Intellectual and Developmental Disability System Redesign Advisory Committee.

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Ms. Carroll Smith.

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Good afternoon. Can everyone hear?

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Yes, ma'am.

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I see that some people can't hear, so I'm just checking.

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Since the good afternoon, I am the current chair for the intellectual and developmental disability system

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redesigned advisory committee. Since the last update that we provided, I think I had reported in November

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that the committee had 11 seats on which appointments or reappointments were pending at our January

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26, 2023 meeting. Eight new members were appointed and one member was reappointed. Unfortunately,

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however, at that meeting also two members had resigned to two other commitments. So currently,

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There are seven members who, let's see,

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Charns have expired, and these members, as I'm assuming

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in the other committees on here today,

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will serve until the commission appoints

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the individuals to fill their seats.

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Concerning our activity since November,

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we had heard, and I think I had reported previously

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about the notice of intent to award-start-plus contracts and in February the Commission did

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issue a notice of intent and the doctor and I prepared for you I have listed those

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entities that receive this notice. We still at this point have not heard of any final notice

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of confirmation, and it's my understanding that the commission is waiting until after session

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to do so, because there are quite a few legislative bills out there that could impact some

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of this. If someone knows something differently, please, please advise. But that's what we've

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as I had previously reported.

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It also given the change in all the dates of when the notice and intent to award would be made.

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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.

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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.

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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.

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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.

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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.

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

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The committee has met twice since November and met in January and again in April and will meet again in July.

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We continue to receive updates on what our subcommittees are doing, as well as the Home and Community

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Base Services Weaver Renewal electronic visit verification and the new individualized

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skills and socialization service, as well as dental services, and of course, what's going

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on the session,

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and I'm going to let students and Ms. Perfrey get into what the start-plus

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pilot program what we're busy doing, but the subcommittees for the system redesign advisory

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committee have just continued to refine the pilot design recommendations and other things

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related to their responsibilities under Chapter 534 and the Texas Government Code.

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More recently, we are now immersed in preparing recommendations for the statutory required

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annual report that the commission must submit in September of this year to the legislature.

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As I said, that the committee continues to meet quarterly, and then we also meet jointly with the

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start-less pilot program work group. I have provided dates on when dates that our committees

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have met since November, and we don't have full, we haven't really scheduled beyond June yet,

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So I don't have any other dates to share with you.

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If anyone has any questions, I'll be glad to answer them.

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Thank you, Ms. Smith.

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Committee members, any questions?

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All right, hearing none, we will go ahead and move forward.

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Thank you, Ms. Smith, for your presentation.

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Our next committee is the Medical Care Advisory Committee.

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Mr. Doug Sven.

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Thank you, sir.

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This is my first time presenting here.

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So if I fumbled on a little bit, I'll apologize.

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We met on February the February, the February the night.

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We did not have a corn.

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We currently have three current appointed members that were absent.

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And we had three vacant positions

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and because it was no form of the item,

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that's not in the work discussed with the vote.

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Gradle input was given.

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I presented a summary of what happened during the meeting.

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It included a presentation by Emily Salkowski.

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and talk about autism services, new collaborative care, model of care,

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triage, triage and treatment, and they try to support model,

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carve in case man or for children and pregnant women.

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The implementation of federal regulations regarding the home care

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services.

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We focus on ensuring that people with disabilities

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receive the service integrated into community care as

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as a person's center.

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And then also, we discussed the ending of the continuous Medicaid eligibility.

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We had a little bit of discussion about what was coming to the Texas legislature, start

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was part of the 10th.

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We had an item which reference was referencing quality and improvement in programs.

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We see information from Ms. Jordan and the rules.

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We're glad the HFCC will bring to us earlier in the process.

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New regulations are rules that are being considered.

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We've had some discussion in the past and the committee that.

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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.

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So Mr. Dixon, notifies that we'll be getting information

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earlier in the process.

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Some of the rules that we discussed

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were the minimum standards for telecommunications

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and managed period systems.

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There was some feedback related to that.

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But one thing in particular we're going to have,

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they're going to create a managed period manual,

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not put all the changes in the standards themselves.

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And there is a process that'll go through for monitoring.

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their participation. We talk about telecommunications and the assessment process, except that

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these give me the service coordination process. And there was one of our members, who is Dr.

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00:29:09,290 --> 00:29:14,370
Sales Responding, he is a physician, he's also a medical director for one of the

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

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concern that we weren't going to be following, or we weren't allowing some flexibility

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and the service coordinating rule that was presented, and we're just going to continue

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by the legislature.

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

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the CFR is maintained, and particularly their assurances, there was not much discussion

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and they were really, really, just finally as the one you had to make most of this discussion.

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As far as the hospital payment and bathroom committee, there was a meeting schedule and on

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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,

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there was no public comment those taken, and we adjourned.

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As for me, if I can answer any questions,

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I'm taking that, I'm doing this in lieu of Ms. Mary Hill

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and Teacon who is our Acting Chair of our Committee.

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We would like to also piggyback on what Cheryl said in a go.

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We've had these three vacancies for quite a while

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and would encourage the commission to act swiftly

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on replacing those at all possible.

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Thank you, either any questions?

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Thank you, Mr. Sven.

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Committee members, any questions?

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Right, hearing none.

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We will move on.

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You guys are quiet today.

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Next, we have our Paranatled Advisory Committee.

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Dr. Patrick Ramsey.

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Thank you, Mr. Chairman.

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I'm Patrick Ramsey.

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I'm the current chair of the Paranatled Advisory Council.

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As you recall, the Paranatled Advisory Council was charged with crafting

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language for neonatal and maternal designation to levels of care and I was completed the most recent

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iteration of the maternal rules were just published in the Texas Register last fall and became active

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on January 8th and currently the neonatal rules are undergoing final revision of the

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and should be implemented published in Texas Registry later this year and implemented by really

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2024. So currently the pack is focusing on best practices and trends in maternal and new

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NATO designation, as well as exploring what data elements would be important for our programs

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

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some delays in having reappointments to our council. At our last meeting, we had, or in September

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

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So far, and there's another set being reviewed currently, so awaiting final decisions on that.

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But that has some significant vacancies in the council.

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Our council has met a twice since our last update to you all.

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December 7th and March 3rd.

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During our December meeting, we heard reports related to the designation program, including the rules revision update.

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00:32:42,520 --> 00:32:46,820
update from the Texas Collaborative for healthy mothers and babies or state per need of quality

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collaborative to give and update on the development of a per needal data system to inform care

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in the state.

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We also heard from the RACPCR Alliance to giving their perspective on a statewide database

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as well that's needed for per needal.

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At our March 23rd meeting, we received additional updates from the SAHS on the designation

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program.

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We had a long discussion about neonatal back transfers when a baby gets up,

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transfer to a higher level of care, and become stable at what point and how can we facilitate

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transfer back to the referring facility to bring the baby closer to mom and cause less expenses

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for the family.

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

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We had that last meeting, we also had a discussion about a legislative writer related to funding of a

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

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or consult going forward.

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

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neonatal and strategic review subject committee to give an update on recommendations of changes in the

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internal need and rules that may be beneficial to improve care in the state and

375
00:34:03,200 --> 00:34:09,100
to improve access. And based it interested our current strategic review documents are at

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00:34:09,100 --> 00:34:14,120
the links on our report and I encourage you to take a look at that if interested. And that concludes

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00:34:14,120 --> 00:34:14,880
my report today.

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00:34:17,060 --> 00:34:19,320
Thank you, Dr. Ramsey. Members and questions.

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All right, hearing none. Thank you

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00:34:25,320 --> 00:34:31,480
for your time, Dr. Ramsey. We'll see you next time. Next is our policy counsel for children and

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00:34:31,480 --> 00:34:33,220
families, miss Lisa Gordon.

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I am Lisa Gordon the chair of the policy council and I want to

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share information from our last meeting which was a while back because we have not been able

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

385
00:34:58,980 --> 00:35:04,480
information but I want to share what's in place. So our purpose is to improve the coordination

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00:35:04,480 --> 00:35:09,060
between the state's health, education and human services systems to ensure that children with

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and their families have access to high quality care.

388
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We also worked toward improving long-term services and supports,

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including community-based supports for children with special health

390
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and mental health care needs, as well as children with disabilities

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and their families receiving protective services from the state.

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We also work on addressing emergency issues affecting the quality

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and availability of services available to children with disabilities

394
00:35:33,440 --> 00:35:38,380
and their families, aligning resources with services for children

395
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and improving the star kids managed care program.

396
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So information that is maybe some information you've received before,

397
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but I wanted to go ahead and reiterate that we completed our legislative report for November

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00:35:54,360 --> 00:35:55,500
of 2022.

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And some of those recommendations that came out of that report were strengthening and expanding

400
00:35:59,680 --> 00:36:05,100
the community attendant workforce, addressing waiver, interest, list, access, eligibility

401
00:36:05,100 --> 00:36:09,900
funding to increase the number of children grow up in families and set of institutions, those

402
00:36:09,900 --> 00:36:15,760
white lists are extensive years and years and years. Increasing the threshold allowance for Medicaid

403
00:36:15,760 --> 00:36:22,920
buy-in for children adults to 300% of the federal poverty level, providing physician-assist education

404
00:36:22,920 --> 00:36:29,790
for a transition of care planning from the pediatric situation to adult, improving access to

405
00:36:29,790 --> 00:36:35,470
applied behavioral analysis services for children with autism disorder by increasing funding for

406
00:36:35,470 --> 00:36:38,750
IBA services and addressing challenges with access to care.

407
00:36:39,010 --> 00:36:44,330
Supporting children with disabilities and their families with child care needs by providing

408
00:36:44,330 --> 00:36:49,910
training for lessons, child care facilities to increase awareness of the requirements of

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00:36:49,910 --> 00:36:56,110
ADA in that many times our children are released from services based on their disabilities.

410
00:36:56,110 --> 00:37:01,570
And increasing funding for early childhood intervention programs to improve the amount of

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00:37:01,570 --> 00:37:07,430
provider support available to care for children's disabilities and improving data facilitation

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00:37:07,430 --> 00:37:11,810
between providers to allow for timely referral and a continuity of care.

413
00:37:12,610 --> 00:37:14,510
We are in kind of the same situation.

414
00:37:15,390 --> 00:37:23,630
The appointment of new members has been lengthy, so we have not made a forum for several meetings

415
00:37:23,630 --> 00:37:29,990
and due to that, our April meeting was cancelled, and we're now in the process of hoping to get some...

416
00:37:30,000 --> 00:37:44,600
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?

417
00:37:48,430 --> 00:37:50,410
Thank you, Ms. Gourmet, members and questions.

418
00:37:55,980 --> 00:37:57,900
Hearing none, thank you again for your time.

419
00:37:58,760 --> 00:37:59,560
All right, thank you.

420
00:37:59,720 --> 00:38:05,860
Our next presentation is from the start-plus pilot program work group, Mrs. Susan Murphy.

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00:38:17,230 --> 00:38:21,650
Producer, this is John Checkland, it's Ms. Murphy still in the platform, I know she had joined him.

422
00:38:31,930 --> 00:38:36,230
Ms. Murphy, this is John Checkland, can you please send me yourself and turn on your video camera?

423
00:38:36,510 --> 00:38:37,870
Will you see that you're in the platform?

424
00:38:45,870 --> 00:38:50,390
John, do you see that she is still there, but she's coming in as a guest.

425
00:38:53,460 --> 00:38:57,100
Producer, can you please go ahead and call her and just have a retone again?

426
00:38:58,680 --> 00:38:59,140
I will.

427
00:38:59,660 --> 00:39:00,700
Thank you.

428
00:39:02,400 --> 00:39:07,320
Mr. Linsky, if you could we can go to the next agenda item and when the smurf

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00:39:07,320 --> 00:39:11,240
comes back, we can go back to hearing her update.

430
00:39:12,800 --> 00:39:17,400
Absolutely. We'll go ahead then onto our next agenda item.

431
00:39:18,040 --> 00:39:24,900
We flip my pages here, which is our state Medicaid managed care advisory committee

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00:39:24,900 --> 00:39:25,540
up committee.

433
00:39:26,000 --> 00:39:29,600
I have to say that she's coming in as a guest.

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00:39:32,760 --> 00:39:36,200
So, please go ahead and call her and just have a retowing again.

435
00:39:38,800 --> 00:39:39,740
Thank you.

436
00:39:39,920 --> 00:39:41,560
Ms. Murphy is unmuted.

437
00:39:42,040 --> 00:39:43,260
She's alive now.

438
00:39:43,560 --> 00:39:47,420
Could we go up to the next agenda item when this Murphy comes back to call her?

439
00:39:47,420 --> 00:39:48,740
Can you hear me now?

440
00:39:49,080 --> 00:39:51,780
This is Susan Murphy.

441
00:39:51,920 --> 00:39:52,860
We'll go ahead.

442
00:39:53,540 --> 00:39:54,060
Yes, ma'am.

443
00:39:54,060 --> 00:39:54,680
Can you hear you?

444
00:39:54,880 --> 00:39:58,500
I can hear Ms. Murphy on the line letting us know she's here.

445
00:40:01,290 --> 00:40:05,850
Ms. Perfecto, this is John Checkwon. Can you turn on your camera?

446
00:40:07,270 --> 00:40:09,290
Yes, I think so.

447
00:40:10,390 --> 00:40:12,090
Hello, can you see me?

448
00:40:12,330 --> 00:40:14,590
Yes, Mr. Yelens, can we go back to?

449
00:40:15,150 --> 00:40:16,750
Yes, sir. We will go back.

450
00:40:17,170 --> 00:40:19,650
Thank you, Ms. Murphy, for joining us.

451
00:40:19,970 --> 00:40:24,730
Ms. Murphy, again, has the update from the Star Plus pilot program work group.

452
00:40:26,260 --> 00:40:33,980
Okay, thank you. Thank you for allowing me to provide an update today. The Star Plus

453
00:40:33,980 --> 00:40:41,400
pilot program work group is a work group specifically charged with the development operation

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00:40:41,400 --> 00:40:51,480
and evaluation of the new Star Plus pilot program. It was originally expected to be operational

455
00:40:51,480 --> 00:41:07,440
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.

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00:41:08,580 --> 00:41:19,220
And thank you to Miss Smith for mentioning, you know, all that is pending right now because the activities

457
00:41:19,220 --> 00:41:28,980
the eligibility, the benefits, the evaluation, all of the above are going to require resources.

458
00:41:30,940 --> 00:41:38,080
So it is a little disappointing to have worked on something for four years in good faith.

459
00:41:38,080 --> 00:41:41,960
And then by that, I mean, really the state agency

460
00:41:41,960 --> 00:41:45,640
all kinds of lay-asans and subject matter experts

461
00:41:45,640 --> 00:41:50,640
and all of the members which constitutes

462
00:41:51,160 --> 00:41:54,200
local intellectual and developmental authorities,

463
00:41:55,560 --> 00:41:59,080
providers, managed care companies, advocates,

464
00:41:59,780 --> 00:42:03,280
it's a good and diverse stakeholder group.

465
00:42:03,400 --> 00:42:06,860
And now we're at the point of still awaiting,

466
00:42:06,860 --> 00:42:18,640
And I would say having holding out for some hope that there might be some resources found to implement the pilot.

467
00:42:20,580 --> 00:42:32,080
So the updates here are that the quality subcommittee continues to focus on person centered practices, goals, and performance measures.

468
00:42:32,080 --> 00:42:58,960
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.

469
00:42:58,960 --> 00:43:19,780
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.

470
00:43:19,780 --> 00:43:23,900
So anyway, a lot of work has gone into that.

471
00:43:24,400 --> 00:43:28,060
The state has been working toward a decision

472
00:43:28,060 --> 00:43:31,600
around using different assessment tools

473
00:43:31,600 --> 00:43:34,640
for people who are not in the pilot,

474
00:43:35,000 --> 00:43:38,060
but who receive intellectual and developmental disabilities,

475
00:43:38,680 --> 00:43:42,880
a community and institution services.

476
00:43:43,920 --> 00:43:49,160
And also the assessment that the pilot would use

477
00:43:49,160 --> 00:43:56,220
which we worked a lot on that being the same assessment, the thing that has been more recent

478
00:43:56,220 --> 00:44:04,380
on the assessment piece is trying to having some work done to figure out so you have

479
00:44:04,380 --> 00:44:11,000
assessed a person's need. What does that mean in terms of the scope of services or resources,

480
00:44:11,000 --> 00:44:21,040
resource, lemon, et cetera, that people would get. So now we were preparing, you know, education

481
00:44:21,040 --> 00:44:33,580
and outreach to all stakeholders to really explain what the pilot is eligible, who gets to opt

482
00:44:33,580 --> 00:44:43,600
to the pilot and who is in or needs to opt-out. So all that work is going to be on pause until

483
00:44:43,600 --> 00:44:54,080
there are some final legislative and HHSC decisions on that. I know that HHSC is Ms. Smith has already mentioned.

484
00:44:54,080 --> 00:44:59,260
a dead ask for what was needed in the legislative appropriation request.

485
00:45:00,000 --> 00:45:12,140
And so some of that was step-to-tory required. Some of that were more optional. Things in terms of services in particular.

486
00:45:13,080 --> 00:45:27,480
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.

487
00:45:27,480 --> 00:45:35,800
I will say that right now, all the committees are starting to work on the annual report.

488
00:45:35,800 --> 00:45:38,000
I know that Ms. Smith mentioned that.

489
00:45:38,520 --> 00:45:46,000
And some of the Star Plus pilot program work, great members are active on that too.

490
00:45:46,440 --> 00:45:47,260
We're just starting.

491
00:45:47,520 --> 00:45:49,300
We have a pretty short timeline.

492
00:45:50,140 --> 00:45:56,220
We will be talking about that again and the kind of getting into how to participate

493
00:45:56,220 --> 00:46:02,460
that people want to, there are members that participate in little subgroups that help develop

494
00:46:02,460 --> 00:46:09,500
recommendations. There are also subject matter experts. So, if anybody listening today has

495
00:46:09,500 --> 00:46:18,640
an interest in anything about that work, working toward a new annual report, please let me or Ms. Smith

496
00:46:18,640 --> 00:46:22,420
know, we always welcome additional stakeholders.

497
00:46:23,540 --> 00:46:28,240
So our next meeting is coming up on June 1st,

498
00:46:28,240 --> 00:46:34,560
and it will be a joint meeting with the Star-Plus

499
00:46:34,560 --> 00:46:38,460
pilot program work group and the system redesign

500
00:46:38,460 --> 00:46:39,580
advisory committee.

501
00:46:40,080 --> 00:46:45,620
As others have noted, it is quite a struggle to move forward

502
00:46:45,620 --> 00:46:52,480
unless we can get a quorum. And so, I should just see as doing quorum calls prior to

503
00:46:54,060 --> 00:47:01,420
meetings, and it's really important to respond to those, because if there is not a quorum

504
00:47:01,420 --> 00:47:15,600
known to happen prior to the meeting, it is my understanding based on the recent work by the

505
00:47:15,600 --> 00:47:17,800
operate effectively like that.

506
00:47:18,260 --> 00:47:21,420
There are always vacancies and we focus

507
00:47:21,420 --> 00:47:24,020
someone trying to get attention to those

508
00:47:24,020 --> 00:47:25,560
and get those feel sooner.

509
00:47:26,160 --> 00:47:29,500
It seems to always lag behind in that, that continues.

510
00:47:30,460 --> 00:47:34,140
We have very good news in that Kevin Borker

511
00:47:34,140 --> 00:47:37,220
is now our new vice chair.

512
00:47:37,220 --> 00:47:39,620
He agreed to serve in that position.

513
00:47:40,760 --> 00:47:45,260
And so we are in a bit of a holding pattern

514
00:47:45,260 --> 00:47:50,860
until we have more information about how to move forward or whether to move forward with the

515
00:47:50,860 --> 00:47:57,900
pilot. Be happy to answer any questions. Otherwise, thank you for allowing me to do this report today.

516
00:47:59,560 --> 00:48:02,300
Thank you, Ms. Murphy. Members, any questions?

517
00:48:07,380 --> 00:48:09,040
Hearing none, thank you again, Ms. Murphy,

518
00:48:09,320 --> 00:48:15,000
for your time and the update. We will move on to our next agenda item,

519
00:48:15,000 --> 00:48:19,920
which is the state Medicaid managed care advisory committee subcommittee updates.

520
00:48:21,400 --> 00:48:26,900
Our first subcommittee is an update from the complaints appeals and fair hearings subcommittee.

521
00:48:28,260 --> 00:48:34,460
Unfortunately, Dr. Carl Sareo was unable to be with us for the full committee meeting today,

522
00:48:35,040 --> 00:48:41,240
but I do have some written notes from the complaints appeals and fair hearings subcommittee

523
00:48:41,240 --> 00:48:46,380
that I will be reading out to give you all an update.

524
00:48:47,560 --> 00:48:52,740
So, the complaints appeals and fair hearing subcommittee was able to meet earlier today.

525
00:48:54,100 --> 00:49:01,860
They did not take any actionable items, but they did receive two different updates from HHS.

526
00:49:02,220 --> 00:49:08,220
The first was from the Health and Human Services Commission office of the Umbudsman managed care complaints.

527
00:49:08,220 --> 00:49:17,800
department on their first quarter 2023 report, and they received highlights from the

528
00:49:17,800 --> 00:49:23,920
Onbudsman managed care assistance team. They reviewed the quarterly Medicaid consumer

529
00:49:23,920 --> 00:49:31,240
complaints report that's currently publicly posted and identified that most consumer

530
00:49:31,240 --> 00:49:39,020
contacts are inquiries with about a third of those being complaints in the first quarter of 2023 on cap

531
00:49:39,020 --> 00:49:52,940
received 2339 complaints with 251 approximately 10.8% being sustained out of those first quarter

532
00:49:52,940 --> 00:50:00,340
complaints there was a decrease by 8% compared with the fourth quarter of 2022.

533
00:50:02,620 --> 00:50:08,720
and decreased 9% when compared with the first quarter of 2022.

534
00:50:10,100 --> 00:50:12,600
The top reasons for substantiated complaints,

535
00:50:14,000 --> 00:50:17,760
the first being difficulty accessing network specialties and facilities,

536
00:50:18,880 --> 00:50:22,620
the second being difficulty accessing home health providers,

537
00:50:25,340 --> 00:50:28,500
that fall into the access to care category,

538
00:50:28,500 --> 00:50:40,780
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.

539
00:50:42,160 --> 00:50:53,180
And then the top complaint categories were access to care prescription services and information are complaints related to managed care enrollment.

540
00:50:53,180 --> 00:51:03,040
They also received a update on the Independent Review Organization or IRO external medical review project.

541
00:51:04,080 --> 00:51:08,520
It's now been one year since the implementation of the IRO EMR project.

542
00:51:09,440 --> 00:51:21,400
There have been 430 external medical reviews received with 404 independent review organization decisions rendered since April 30, 2023.

543
00:51:21,400 --> 00:51:28,200
manage care organizations have been timely and submitting information for the independent

544
00:51:28,200 --> 00:51:29,220
reviews,

545
00:51:31,280 --> 00:51:37,540
the independent review organization decisions they've identified 72% have been

546
00:51:37,540 --> 00:51:45,040
upheld and 28% have been overturned or partially overturned. Most of the overturned

547
00:51:45,040 --> 00:51:48,800
IRO decisions related to therapy services.

548
00:51:51,340 --> 00:51:53,940
Among those decisions, the top-denial types,

549
00:51:54,860 --> 00:51:59,180
with no specific trend across any particular managed care

550
00:51:59,180 --> 00:52:05,020
organizations were dental, medication, pass,

551
00:52:05,440 --> 00:52:09,000
or personal assistant services, and speech therapy.

552
00:52:10,260 --> 00:52:12,780
And then the state fair hearings.

553
00:52:12,780 --> 00:52:22,460
There were state fair hearings, 293, sorry state fair hearings, that upheld IRO decisions.

554
00:52:23,700 --> 00:52:24,820
Most were sustained.

555
00:52:30,110 --> 00:52:39,650
Sorry, and having trouble understanding this last statement here, a little bit confusing, but we'll get clarification from Dr. Soraro.

556
00:52:39,650 --> 00:52:49,410
are only 9% or only 9% or 4% of the IRA decisions were reversed by the state fair hearings office.

557
00:52:52,110 --> 00:53:01,870
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.

558
00:53:05,040 --> 00:53:13,220
members, any questions on that report from Dr. Saryo, do my best to answer as I can.

559
00:53:20,080 --> 00:53:24,920
All right, hearing none, we will then move on to the Service and Care Coordination subcommittee.

560
00:53:25,540 --> 00:53:26,380
Ms. Shana Glover.

561
00:53:28,520 --> 00:53:31,040
Good afternoon again, ladies and gentlemen.

562
00:53:31,680 --> 00:53:37,660
This is an update from our 17th meeting of the Service and Care Coordination subcommittee,

563
00:53:37,660 --> 00:53:40,060
which was held on March 17th.

564
00:53:40,480 --> 00:53:43,320
We received a heart of presentation

565
00:53:43,320 --> 00:53:45,440
from the director of program policy

566
00:53:45,440 --> 00:53:50,940
for Medicaid and CHIP, Ms. Jennifer Castelo,

567
00:53:53,360 --> 00:53:57,320
regarding House Bill 4 and telecommunications services

568
00:53:57,320 --> 00:53:58,620
and managed care.

569
00:54:00,220 --> 00:54:03,740
They will be discussing it further on item 5D,

570
00:54:04,040 --> 00:54:07,860
so I will let Ms. Brown and Ms. Castelo

571
00:54:07,860 --> 00:54:15,860
give the details on that. We also had an informal discussion roundtable with a quick guide,

572
00:54:16,040 --> 00:54:21,820
which was provided by the Texas Association of Health plans. It was very informative. It did

573
00:54:23,020 --> 00:54:33,620
flesh out and clarify terms such as what was considered telehealth, as well as the NCO's

574
00:54:33,620 --> 00:54:42,480
reassuring, et link and reminding about the steps to identify and report a

575
00:54:42,480 --> 00:54:50,280
basic neglect and exploitation. Now that tele-services are making their way

576
00:54:50,760 --> 00:54:56,360
into the final stages of regular use.

577
00:54:59,160 --> 00:55:03,960
We did not have any action items to vote on.

578
00:55:05,160 --> 00:55:31,980
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.

579
00:55:31,980 --> 00:55:39,920
So this is also a call to all other members who are present on the line or listening.

580
00:55:40,940 --> 00:55:51,780
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.

581
00:55:54,260 --> 00:56:00,860
I do not have any other updates for my subcommittee, but I am open to any questions comments or concerns.

582
00:56:00,860 --> 00:56:06,420
you may have at this time. Thank you, Ms. Lover. Members any questions?

583
00:56:13,720 --> 00:56:14,500
We will go ahead and

584
00:56:14,500 --> 00:56:22,840
move on. Thank you. Our next agenda item is our Health and Human Services updates.

585
00:56:24,080 --> 00:56:31,940
So I'd like at this time to introduce Deputy Associate Commissioner Rachel Patton to discuss the

586
00:56:31,940 --> 00:56:38,520
ending of Continuous Medicaid coverage. Oh and good afternoon everyone. Thanks for

587
00:56:38,520 --> 00:56:42,760
allowing me to join you today to discuss the ending of continuous Medicaid coverage.

588
00:56:45,620 --> 00:56:55,940
We'll go ahead and start today with a brief background on the continued Medicaid coverage

589
00:56:55,940 --> 00:57:01,900
and sort of what the history is, where we are now, and how we're working through those cases.

590
00:57:02,820 --> 00:57:07,940
So all the way back to March 2020, Congress passed the family's first coronavirus response act.

591
00:57:07,940 --> 00:57:13,600
And this allowed states to receive that enhanced federal match given that they maintain most

592
00:57:13,600 --> 00:57:20,080
individuals who were receiving Medicaid eligibility as of March 18th, 2020.

593
00:57:20,500 --> 00:57:24,100
There were very few exceptions that an individual could be denied coverage.

594
00:57:24,640 --> 00:57:28,020
Those reasons include the individual passed away.

595
00:57:28,100 --> 00:57:32,600
They moved out of state or they requested a voluntary withdrawal from the program.

596
00:57:33,040 --> 00:57:37,920
So with the exception of those three reasons, individuals who were receiving Medicaid as

597
00:57:37,920 --> 00:57:44,140
March 18, 2020 would continue to receive Medicaid coverage in the state of Texas and we would

598
00:57:44,140 --> 00:57:50,660
receive that enhanced federal match. At that time, the continuous Medicaid coverage requirement

599
00:57:50,660 --> 00:57:57,380
was directly tied to the public health emergency declaration. So fast forward to December 2022,

600
00:57:57,380 --> 00:58:04,560
almost three years later, Congress passed the 2023 consolidated appropriations act. And this effectively

601
00:58:04,560 --> 00:58:10,580
separated the continuous Medicaid coverage requirement from the declaration of public health

602
00:58:10,580 --> 00:58:16,520
emergency. And that also set a clearly defined date for the end of continuous Medicaid coverage.

603
00:58:17,080 --> 00:58:23,940
That date was March 31, 2023. So we have now ended our continuous Medicaid coverage requirement

604
00:58:23,940 --> 00:58:30,420
here in Texas. So starting April 1st, that was the first date that states could begin disenrolling

605
00:58:30,420 --> 00:58:33,440
members who are no longer eligible for Medicaid.

606
00:58:34,020 --> 00:58:39,540
We'll talk a little bit about what are our approaches and how we're conducting renewals

607
00:58:39,540 --> 00:58:45,900
as that phased approach is implemented, but one other key item to note is that enhanced federal

608
00:58:45,900 --> 00:58:51,580
match will be phased out through the rest of this calendar year, so that phased is out in steps

609
00:58:51,580 --> 00:58:59,100
starting April 1st of this year and is completely phased out on December 31st, 2023 for that enhanced

610
00:58:59,100 --> 00:59:06,280
federal match. If we go to the next slide, what I talk about, some of the major points of the federal

611
00:59:06,280 --> 00:59:11,560
guidance that we received, the first of which is that states will have 12 months to initiate

612
00:59:11,560 --> 00:59:18,040
re-determinations for everyone that is enrolled in Medicaid ship. So what that means is that we'll

613
00:59:18,040 --> 00:59:24,020
be reviewing and re-determining eligibility for our entire Medicaid and CHIP case load over

614
00:59:24,020 --> 00:59:25,220
the next 12 months.

615
00:59:25,980 --> 00:59:32,520
States must also conduct a full redetermination, following all federal regulations and must

616
00:59:32,520 --> 00:59:38,400
allow members a minimum of 30 days to respond to their renewal packets or request for

617
00:59:38,400 --> 00:59:38,860
information.

618
00:59:39,240 --> 00:59:44,720
So we will be returning to regular eligibility processes throughout this unwine period.

619
00:59:45,280 --> 00:59:51,620
But we must before we take any adverse action for it in a individual, meaning their benefits

620
00:59:51,620 --> 00:59:55,740
or reduced or denied, we would need to conduct that full renewal.

621
00:59:57,240 --> 00:59:59,980
And lastly, but very importantly, states must...

622
01:00:00,000 --> 01:00:10,680
To get updated contact information and may not disenroll members based on return mail, unless we attempt to contact the individual through multiple modalities.

623
01:00:11,160 --> 01:00:15,000
So those modalities could be phone calls, emails, and text.

624
01:00:15,300 --> 01:00:22,780
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.

625
01:00:23,740 --> 01:00:25,540
If we go ahead and go to the next slide.

626
01:00:25,540 --> 01:00:32,940
And I want to talk a little bit about what our plan is here in Texas to end continuous coverage

627
01:00:32,940 --> 01:00:33,740
here in Texas.

628
01:00:34,320 --> 01:00:39,740
So as you can all imagine, this is an immense undertaking for states, especially in the

629
01:00:39,740 --> 01:00:41,040
state, the size of Texas.

630
01:00:41,560 --> 01:00:49,280
As of September 2022, we had 2.7 million members that were receiving extended Medicaid coverage

631
01:00:49,280 --> 01:00:52,180
due to the continuous Medicaid coverage requirement.

632
01:00:52,180 --> 01:01:01,680
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.

633
01:01:03,040 --> 01:01:11,040
We also must renew the entire case load as, you know, federally were required to re-determine eligibility for individuals every 12 months.

634
01:01:11,580 --> 01:01:20,680
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.

635
01:01:20,680 --> 01:01:30,320
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.

636
01:01:33,740 --> 01:01:41,660
If we move to the next slide, this is a continuation of our plan to unwind continuous Medicaid coverage.

637
01:01:41,660 --> 01:01:47,720
So, our guiding principles really included maintaining coverage for those who remain eligible.

638
01:01:48,000 --> 01:01:53,480
We want to ensure continuity of those coverage for those individuals who remain eligible for Medicaid.

639
01:01:54,220 --> 01:02:02,620
We've also prioritized redeterminations for those who are most likely to no longer qualify for continued Medicaid coverage.

640
01:02:03,160 --> 01:02:10,220
And we also wanted to ensure a sustainable workload for our eligibility systems for these future renewal schedules.

641
01:02:10,220 --> 01:02:21,100
We go to the next slide when I talk a little bit about how we will stagger Medicaid terminations over multiple months.

642
01:02:21,720 --> 01:02:28,740
So this continuous coverage population has been distributed over three primary cohorts.

643
01:02:29,440 --> 01:02:34,960
These rate of terminations will be initiated for each cohort over a period of six months.

644
01:02:34,960 --> 01:02:38,320
And that's six-month period started in April 2023.

645
01:02:39,260 --> 01:02:43,760
So our first cohort was initiated on April the 8th, 2023.

646
01:02:44,260 --> 01:02:46,360
So just roughly about a month and a half.

647
01:02:46,460 --> 01:02:47,920
I'm not that a week ago.

648
01:02:49,600 --> 01:02:54,170
People enrolled in Medicaid and SHIP who are not included in those coverage cohort.

649
01:02:54,480 --> 01:02:56,600
So if they're not receiving continuous coverage,

650
01:02:57,120 --> 01:03:00,300
they will just be renewed within their normal renewal dates.

651
01:03:00,300 --> 01:03:05,220
So let's say someone is newly certified as of January 2023.

652
01:03:05,740 --> 01:03:11,540
They wouldn't have a renewal date and they would receive their 12-month certification through January 2024.

653
01:03:12,140 --> 01:03:14,840
They'll continue to remain on their 12-month cycle.

654
01:03:17,200 --> 01:03:25,180
If we go to our cohort timeline on the next slide, you'll see here that this timeline begins in March.

655
01:03:25,380 --> 01:03:29,500
We actually started our unwinds activities much sooner than that.

656
01:03:29,500 --> 01:03:34,640
We actually kicked off our communication with our members who would need to have their eligibility

657
01:03:34,640 --> 01:03:39,960
to turn it redetermined, back in January, on January 25th, 2023.

658
01:03:40,800 --> 01:03:46,340
We sent a notice out to many individuals to the individuals who would need to have their eligibility

659
01:03:46,340 --> 01:03:51,780
retested and let them know to be on the lookout for going to be reaching out to you.

660
01:03:51,800 --> 01:03:56,700
You will need to take action and respond to have your eligibility redetermined.

661
01:03:57,660 --> 01:04:06,060
We also, in March, sent out notices to individuals who were receiving Medicaid related to

662
01:04:06,060 --> 01:04:12,680
supplemental security income or department of family and protective services through some

663
01:04:12,680 --> 01:04:17,300
of their adoption assistance programs who were identified as no longer eligible throughout

664
01:04:17,300 --> 01:04:18,880
the continuous coverage period.

665
01:04:19,000 --> 01:04:24,600
We also sent them a notice letting them know that we would reach out to them at a later date

666
01:04:24,600 --> 01:04:28,360
and they would need to take action to renew their Medicaid coverage.

667
01:04:30,120 --> 01:04:33,300
So after we reached out and let everyone know we would be

668
01:04:33,300 --> 01:04:37,440
re-determined coverage for these continuous Medicaid coverage populations.

669
01:04:38,360 --> 01:04:44,060
As I stated earlier, our very first cohort kicked off on April 8th,

670
01:04:44,180 --> 01:04:48,880
and that is where we initiated really our first batch of Medicaid

671
01:04:48,880 --> 01:04:52,680
re-determinations for individuals who received continuous coverage.

672
01:04:52,680 --> 01:05:00,720
We're in the process, so they received individuals received 30 days to return that information that 30 days has passed.

673
01:05:00,780 --> 01:05:09,440
And now our access and eligibility service staff are working through that case load to ensure that those cases are re-determined.

674
01:05:10,180 --> 01:05:20,700
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

675
01:05:20,700 --> 01:05:26,760
by the end of their certification period in this case would be July 31st, they will continue

676
01:05:26,760 --> 01:05:33,660
to receive one month extensions until their eligibility has been processed. So that is tied

677
01:05:33,660 --> 01:05:39,220
back to be will not take any adverse action, either benefits in Iowa reduction until that

678
01:05:39,220 --> 01:05:45,420
redetermination is completed if they've returned their forms timely. Our next cohort, which will

679
01:05:45,420 --> 01:05:52,920
cohort number two. Those packets will be sent out to members on July 15th. Then in September

680
01:05:52,920 --> 01:06:00,200
on the third we will initiate our packets for the subliminal security income into apartment

681
01:06:00,200 --> 01:06:06,220
a family and protective services, types of assistance on December 3rd and then followed by our

682
01:06:06,220 --> 01:06:15,680
very last cohort, which is cohort number three, which will be initiated on July the 9th.

683
01:06:15,900 --> 01:06:20,860
You will see that our very first cohort is really individuals that we don't believe

684
01:06:20,860 --> 01:06:22,720
will remain eligible for Medicaid.

685
01:06:23,260 --> 01:06:29,660
That second cohort is individuals who may transfer to another benefit type or who need additional

686
01:06:29,660 --> 01:06:36,280
information, and then that last, that very last cohort number three, consists of individuals

687
01:06:36,280 --> 01:06:45,280
who will likely remain eligible for Medicaid. And that is, of course, based on the information

688
01:06:45,280 --> 01:06:50,820
that we have available to us within the system. One other item I do want to note is that as

689
01:06:50,820 --> 01:06:57,180
we're re-determining these individuals and we're generating these renewal packets, we are also

690
01:06:57,180 --> 01:07:05,000
utilizing electronic data sources, and if we can verify an individual's eligibility, there may

691
01:07:05,000 --> 01:07:10,020
be members who may not have to respond. They will receive a packet letting them know. This

692
01:07:10,020 --> 01:07:14,780
is the information and we have on file and if it's correct, they don't need to respond. But

693
01:07:14,780 --> 01:07:20,100
we want to just make sure that members are aware to look out for those envelopes. They're going

694
01:07:20,100 --> 01:07:24,840
to be yellow envelopes. I think I have a copy of that envelope later in this presentation. We

695
01:07:24,840 --> 01:07:29,980
folks to really know that if they receive that yellow envelope with the red text, to take action.

696
01:07:30,000 --> 01:07:35,140
And to pay attention to those envelopes that will be in their mailbox.

697
01:07:36,360 --> 01:07:39,240
I want to talk a little bit about the communications plan.

698
01:07:39,760 --> 01:07:43,140
So the agency has developed a robust communications plan.

699
01:07:43,840 --> 01:07:48,360
So as you can imagine, almost 6 million people, that's a lot of folks to communicate with.

700
01:07:48,840 --> 01:07:54,060
And we want to make sure that we continue coverage for as many folks as possible,

701
01:07:54,600 --> 01:07:58,160
and ensuring those folks that remain eligible stay eligible for Medicaid.

702
01:07:58,160 --> 01:08:06,160
So, I'm sure you've probably maybe heard some ads on TV radio if you follow us on Twitter or Facebook.

703
01:08:06,400 --> 01:08:08,440
You've probably seen some of this communication.

704
01:08:09,180 --> 01:08:12,700
But we really have, and if we go to the next slide here,

705
01:08:13,100 --> 01:08:16,100
we've had three phases to our communications plan.

706
01:08:16,720 --> 01:08:22,800
And these communications plan is really a multi-pronged communications campaign that helps

707
01:08:22,800 --> 01:08:28,460
members, providers, health plans, and advocates prepare for the end of continuous coverage.

708
01:08:28,880 --> 01:08:33,300
We realize this is an immense undertaking in anyone that our members may encounter.

709
01:08:33,500 --> 01:08:38,280
We want to make sure that they have the information to help folks that they serve too.

710
01:08:38,380 --> 01:08:44,580
So this could be advocacy groups, providers, doctors, offices, they're seeing these individuals

711
01:08:44,580 --> 01:08:45,320
as well.

712
01:08:45,800 --> 01:08:50,280
So we wanted to spread this message far and wide to make sure everyone is informed.

713
01:08:50,280 --> 01:08:55,780
Our third phase includes texts and notices, social media.

714
01:08:56,220 --> 01:09:01,800
We also have some earned media and paid outreach from HHSC to our members.

715
01:09:02,340 --> 01:09:07,840
So when our first rounds of renewal packets was mailed, members who we had information on

716
01:09:07,840 --> 01:09:12,980
file descended text to, we send them a text, letting them know, check your mail, it's time

717
01:09:12,980 --> 01:09:13,640
to renew.

718
01:09:14,540 --> 01:09:18,240
There were some robocalls that went out for individuals who hadn't returned their packets.

719
01:09:18,240 --> 01:09:25,120
So, really trying to reach members to let them know it is time to take action for their Medicaid case.

720
01:09:27,140 --> 01:09:30,620
On the next slide, talk a little bit about some of these key messages.

721
01:09:31,320 --> 01:09:37,500
Our key message right now is really that continuous Medicaid coverage has ended and renewals have started.

722
01:09:38,100 --> 01:09:46,380
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.

723
01:09:46,380 --> 01:09:59,120
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.

724
01:09:59,860 --> 01:10:07,040
We also want to emphasize that members must complete and return renewal packets and request information on time.

725
01:10:07,040 --> 01:10:16,680
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

726
01:10:16,680 --> 01:10:19,980
Their benefits will not be reduced or denied.

727
01:10:20,580 --> 01:10:27,300
We also want to emphasize the importance of contacting HHSC to report any changes.

728
01:10:28,700 --> 01:10:31,980
All changes are important but certainly contacting information.

729
01:10:31,980 --> 01:10:38,340
And household changes, addresses, or so very important into being able to reach our members.

730
01:10:39,220 --> 01:10:44,900
These key messages really do aim to increase the likelihood of maintaining eligibility

731
01:10:44,900 --> 01:10:49,020
for these eligible folks and reducing turn in the case load.

732
01:10:50,500 --> 01:10:56,440
That's beneficial for both our members and the agency as we work through this amount of work.

733
01:10:56,440 --> 01:11:00,960
And we'll also minimize call center volume as well.

734
01:11:02,120 --> 01:11:06,520
I can tell you there have been some other improvements such as the password reset.

735
01:11:06,700 --> 01:11:12,840
We realized that the process before we have to call 211 now, they can see something that's

736
01:11:12,840 --> 01:11:16,420
more along the lines of the interest to be standard by clicking a link in resetting their

737
01:11:16,420 --> 01:11:16,760
password.

738
01:11:17,340 --> 01:11:22,900
So that was just another win for individuals to be able to log into their case because in some

739
01:11:22,900 --> 01:11:25,420
cases they may not have logged in for several years.

740
01:11:25,420 --> 01:11:31,740
and may not remember their password, and so that's just one more way we've aimed to simplify

741
01:11:31,740 --> 01:11:39,100
the re-determination process. On the next slide, we have our communications timeline here.

742
01:11:40,380 --> 01:11:47,500
So, as I mentioned before, we did resume the eligibility re-determinations with our first cohort

743
01:11:47,500 --> 01:11:55,100
starting in April. We went live with updates on your Texas Benefits.com, we're utilizing the

744
01:11:55,100 --> 01:12:02,500
messages on our websites also on our HHSC website. So there's going to be a couple of links that

745
01:12:02,500 --> 01:12:07,980
I share that shared with this presentation. I encourage you if you haven't already to go out and

746
01:12:07,980 --> 01:12:14,460
click those links. We have some very robust tools. We have frequently asked questions which cover

747
01:12:14,460 --> 01:12:21,820
many many topics related to the end of continuous coverage. Again, just to recap cohort one,

748
01:12:22,840 --> 01:12:30,480
started on April the 8th. And we started those monthly text and email messages on April 17th.

749
01:12:30,600 --> 01:12:35,580
So there were communicating just in time. So it's top of mind as folks are receiving those

750
01:12:35,580 --> 01:12:41,020
packets and they know they need to take action. Of course, then our phase 3 social media

751
01:12:41,020 --> 01:12:47,020
went live on April the 18th. And then, most recently, the Robo calls began as a reminder

752
01:12:47,020 --> 01:12:51,380
to individuals who needed to respond on April the 24th.

753
01:12:52,100 --> 01:12:55,500
On the next slide, I have a couple of graphics to share with you.

754
01:12:55,620 --> 01:12:57,900
So these are Ambassadors or Program graphics.

755
01:12:58,800 --> 01:13:01,220
HHSE established the end of continuous coverage

756
01:13:01,220 --> 01:13:05,500
ambassador program to enlist the help of many other groups

757
01:13:05,500 --> 01:13:08,440
to get the word out to folks that they may serve as well.

758
01:13:08,760 --> 01:13:11,300
So these, again, may be providers or advocates

759
01:13:12,050 --> 01:13:13,700
who want to help us get the word out.

760
01:13:13,820 --> 01:13:16,180
And so with that, we've provided some graphics,

761
01:13:16,180 --> 01:13:19,500
which can be shared on social media, they can be printed.

762
01:13:19,760 --> 01:13:21,180
We have all of these on our website.

763
01:13:21,720 --> 01:13:26,960
If you're just a couple of them noting, you've got mail and it's time to renew and of course

764
01:13:26,960 --> 01:13:30,320
you see our yellow envelopes there to call attention.

765
01:13:31,020 --> 01:13:36,780
If you go to the next slide, we have a copy of the yellow envelope here with the red text.

766
01:13:37,100 --> 01:13:41,260
This is something that folks have just placed out in their lobby and to be on the lookout

767
01:13:41,260 --> 01:13:46,160
if you receive mail and this envelope makes you take action because that will

768
01:13:46,160 --> 01:13:49,920
be your renewal and you'll need to respond.

769
01:13:50,960 --> 01:13:53,880
We also on our website have a sample of forms.

770
01:13:54,000 --> 01:13:58,620
If you go to the next slide here, you'll see that this is a template form.

771
01:13:58,620 --> 01:14:03,320
Of course, the forms that members will receive will have personalized information regarding

772
01:14:03,320 --> 01:14:04,960
their particular case situation.

773
01:14:05,400 --> 01:14:10,120
We do have some samples so that they recognize the form when they receive it.

774
01:14:10,120 --> 01:14:15,860
And again, these are the same forms that they received pre-continuous coverage period as well.

775
01:14:17,140 --> 01:14:22,800
And the last tool that I just want to share with you, an end plug here, is the frequently

776
01:14:22,800 --> 01:14:24,560
asked questions on the next slide.

777
01:14:25,080 --> 01:14:29,800
So there is a frequently asked questions document, again, that is very robust that folks

778
01:14:29,800 --> 01:14:34,080
will be able to view and read through.

779
01:14:34,200 --> 01:14:38,320
And we'll certainly accept any questions that folks have outside of this.

780
01:14:38,320 --> 01:14:44,660
you have a particular scenario, we're always happy to talk through it and discuss and we appreciate

781
01:14:44,660 --> 01:14:51,460
any feedback that you have for us. I think one of our slides here is our resources slide.

782
01:14:52,020 --> 01:14:59,220
So if you're not already signed up for the Ambassador Program or you've not downloaded

783
01:14:59,220 --> 01:14:59,980
the Ambassador Program.

784
01:15:00,000 --> 01:15:23,640
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.

785
01:15:24,840 --> 01:15:27,060
So there's great information out there.

786
01:15:27,500 --> 01:15:31,300
We also on this slide have a stakeholder engagement email.

787
01:15:31,680 --> 01:15:37,180
This is for stakeholders to may have questions about eligibility and about the process.

788
01:15:38,040 --> 01:15:43,340
The email box wasn't really intended for client specific requesting concerns but certainly

789
01:15:43,340 --> 01:15:46,400
any stakeholder feedback we appreciate it there.

790
01:15:46,840 --> 01:15:51,040
And if you're interested in one like to join us, I believe it's every two weeks on this

791
01:15:51,040 --> 01:15:54,120
culture calls, you can register for the Ambassador Program

792
01:15:54,120 --> 01:15:58,120
Context List and join us. I believe it's every two weeks on Monday

793
01:15:58,120 --> 01:16:03,020
afternoons and we'll talk about all things and of continuous coverage.

794
01:16:03,520 --> 01:16:09,600
We'll provide the latest updates and that's that presentation is presented in

795
01:16:09,600 --> 01:16:13,060
partnership with our partners over in access to knowledge ability services.

796
01:16:14,480 --> 01:16:18,720
If we go to the next slide, I just wanted to share some information that I think

797
01:16:18,720 --> 01:16:25,400
is helpful for provider communities and then also for individuals who are receiving Medicaid

798
01:16:25,400 --> 01:16:28,940
benefits and may have questions about, you know, do I have Medicaid?

799
01:16:29,120 --> 01:16:30,060
What do I do now?

800
01:16:30,960 --> 01:16:37,480
So what a patient can do is to verify their coverage, is certainly to go to your Texas

801
01:16:37,480 --> 01:16:43,200
benefits app on your phone or go online to your Texas benefits or call to one one.

802
01:16:43,480 --> 01:16:47,860
We also have a local offices available to assist individuals with questions.

803
01:16:47,860 --> 01:16:54,440
For providers, they can always, could form coverage through the Texas Medicaid and health care

804
01:16:54,440 --> 01:17:01,680
partnership, text med connect portal, or they can call 211 and select option 2, and then

805
01:17:01,680 --> 01:17:04,520
they will need to provide their national provider identifier.

806
01:17:05,440 --> 01:17:09,960
One of the things that we've been to a size with our provider populations is that getting back

807
01:17:09,960 --> 01:17:14,920
into the habit of verifying that coverage now, because it's been so long since we've not

808
01:17:14,920 --> 01:17:22,300
had folks denied for Medicaid, so we're really getting back into that the habit of verifying

809
01:17:22,300 --> 01:17:27,420
coverage. So with that, that's the presentation that I have for you this afternoon. I

810
01:17:27,420 --> 01:17:32,680
certainly appreciate you having me and allowing me time to share information on endive

811
01:17:32,680 --> 01:17:36,140
continuous coverage, and if the committee has any questions, I can take this now.

812
01:17:37,820 --> 01:17:42,200
Thank you so much for the presentation, and certainly all the work that has gone into

813
01:17:43,080 --> 01:17:54,340
starting to unwind from the continuous coverage. I am curious now that cohort one has had their

814
01:17:54,340 --> 01:18:01,500
opportunity to submit in information for the re-determinations. I can only imagine processing

815
01:18:01,500 --> 01:18:10,420
these cohorts is a bit like swallowing a Mac hole, right? Because of the volume, just the sheer volume

816
01:18:10,420 --> 01:18:12,320
of re-determination at a time.

817
01:18:12,440 --> 01:18:17,860
So I'm curious how that's impacting the process workflow

818
01:18:17,860 --> 01:18:20,620
where you're seeing delays for people that may be

819
01:18:20,620 --> 01:18:23,620
or applying for Medicaid for the first time,

820
01:18:23,920 --> 01:18:26,580
or what does that kind of look like right now?

821
01:18:27,140 --> 01:18:30,200
So I can give you a very, I'm not with access and eligibility

822
01:18:30,200 --> 01:18:32,900
services, so I need them to give you some more specifics.

823
01:18:33,360 --> 01:18:35,080
But what I can tell you is that there

824
01:18:35,080 --> 01:18:38,580
were a lot of efforts to prepare the system

825
01:18:38,580 --> 01:18:44,260
and the workforce for this work, so they increased staff and the call centers to make sure

826
01:18:44,260 --> 01:18:49,500
we could handle call volumes, they increased eligibility staff, they've been conducting

827
01:18:49,500 --> 01:18:54,320
hiring events on the spot hiring events, I know I saw some of that on Facebook, so really

828
01:18:54,320 --> 01:19:00,700
stabilizing and making sure that our workforce was available so that we don't see delays

829
01:19:00,700 --> 01:19:06,600
with our applications and such, but yes, there have been, that has been really an immense

830
01:19:06,600 --> 01:19:10,300
they're taking is just making sure that that workforce is ready and available.

831
01:19:10,440 --> 01:19:15,940
And in fact, I just talked with staff there today and they were talking about some of the

832
01:19:15,940 --> 01:19:20,140
efforts that they had taken to make sure that they've had increased their workforce.

833
01:19:20,560 --> 01:19:25,580
So I can tell you just at a high level that, yes, they have prepared their workforce,

834
01:19:25,880 --> 01:19:28,680
they increased their workforce to address this workload.

835
01:19:30,100 --> 01:19:31,240
Thank you.

836
01:19:31,660 --> 01:19:33,280
Members, do you have other questions?

837
01:19:36,160 --> 01:19:39,720
I'm Beth Wright, or thank you so much, this very informative.

838
01:19:40,560 --> 01:19:44,520
I'm a little curious about the SSI population.

839
01:19:45,780 --> 01:19:49,280
I guess I was under the impression that they were sort of waved,

840
01:19:49,660 --> 01:19:52,400
because it is a federal program.

841
01:19:52,960 --> 01:19:56,860
So can you go into a little bit more about that eligibility

842
01:19:56,860 --> 01:20:00,360
and what you're looking for those who are on SSI?

843
01:20:00,360 --> 01:20:07,240
That is a great question, so the only individuals who will need to take action are those who've been identified as denied.

844
01:20:08,040 --> 01:20:11,220
So if they are currently denied, we will outreach them to apply.

845
01:20:12,800 --> 01:20:17,580
So, you know, normal process would be when they stopped receiving SSI, their coverage would have ended,

846
01:20:17,980 --> 01:20:24,080
but because their eligibility was continued, we will reach out to them, send them a packet so that they can apply for benefits.

847
01:20:24,080 --> 01:20:30,120
But if an individual is on SSI and they continue to receive SSI, no action will be required

848
01:20:30,120 --> 01:20:30,660
you're right.

849
01:20:31,560 --> 01:20:36,920
They are eligible, but just by virtue of their SSI eligibility, but that's a great question.

850
01:20:37,280 --> 01:20:37,620
You bet.

851
01:20:39,860 --> 01:20:40,420
Hi.

852
01:20:40,980 --> 01:20:43,560
I have a question actually, if I may.

853
01:20:44,200 --> 01:20:45,080
Go ahead, Ms. Glover.

854
01:20:45,480 --> 01:20:45,640
Yes.

855
01:20:47,240 --> 01:20:47,960
Thank you.

856
01:20:48,620 --> 01:20:54,060
To be back off the Mrs. Brighter, I appreciate that question that was a good one.

857
01:20:54,640 --> 01:21:06,200
So for individuals, since there are three, is it possible for individuals to be in different cohorts within the timeline?

858
01:21:06,340 --> 01:21:17,200
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,

859
01:21:17,200 --> 01:21:23,820
writer they do are on SSI or things like that and that's how they receive Medicaid. However,

860
01:21:25,080 --> 01:21:30,360
some of them have transitioned during that time from Medicaid to Medicare but we've noticed I don't

861
01:21:30,360 --> 01:21:37,840
really know the rhyme in the reason I guess is why some of our consumers keep getting renewals

862
01:21:37,840 --> 01:21:46,840
for Medicaid applications during this unwinding period and I'm getting again I don't really know what's

863
01:21:46,840 --> 01:21:55,600
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.

864
01:21:57,140 --> 01:22:03,020
That's my question. If you can answer that great, if not, I will.

865
01:22:04,520 --> 01:22:14,420
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,

866
01:22:14,420 --> 01:22:21,240
which is why you see not everyone being in continuous coverage and so for those folks that have renewed let's say

867
01:22:21,240 --> 01:22:22,300
Shawnee you

868
01:22:22,780 --> 01:22:29,980
Help to family renew and they were renewed in February of 2023. They're going to receive a full year of coverage if they

869
01:22:30,000 --> 01:22:45,920
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.

870
01:22:48,560 --> 01:22:57,880
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.

871
01:22:58,480 --> 01:23:02,940
However, if they were trying to determine ineligible in that period, they would be assigned

872
01:23:02,940 --> 01:23:04,080
to one of these cohorts.

873
01:23:04,740 --> 01:23:09,660
You bring up a very good point about the cohorts and one of the things that I want to mention

874
01:23:09,660 --> 01:23:14,760
about the cohort, especially for folks who serve folks that are in the community and a waiver

875
01:23:14,760 --> 01:23:15,260
program.

876
01:23:15,740 --> 01:23:18,520
They're more likely to have other individuals in their household.

877
01:23:19,180 --> 01:23:24,780
So while we could have an individual in a household that is likely to be ineligible, which

878
01:23:24,780 --> 01:23:29,260
will be assigned to cohort one, and then someone who's likely to remain eligible, who may

879
01:23:29,260 --> 01:23:30,200
be a cohort three.

880
01:23:30,740 --> 01:23:35,280
We will assign all of those family members to that very first cohort, and the reason

881
01:23:35,280 --> 01:23:39,380
being is because we want to reach out and read a term in a family at a time.

882
01:23:39,660 --> 01:23:43,160
We don't want to read a term in one member of the family, and then several months later,

883
01:23:43,640 --> 01:23:49,720
we would like to sync them all together and renew the family to lessen that sort of burden

884
01:23:49,720 --> 01:23:53,280
of having to reply multiple times for folks in the same household.

885
01:23:54,880 --> 01:23:59,600
That was excellent information. Thank you for that clarification. Also I do want to give

886
01:23:59,600 --> 01:24:06,360
you all big kudos because this is a major major major task and thank you very much for adding

887
01:24:06,360 --> 01:24:12,660
into the application options for email telephone and text because that's getting positive feedback

888
01:24:12,660 --> 01:24:17,940
from our consumers. So thanks. Awesome. That's great to hear. Thank you so much.

889
01:24:17,940 --> 01:24:18,940
members.

890
01:24:22,400 --> 01:24:23,200
Other questions?

891
01:24:27,500 --> 01:24:33,680
Hearing none. Thank you again. Deputy Associate Commissioner. Thank you for your presentation and your time today.

892
01:24:33,740 --> 01:24:34,940
Thank you for your time.

893
01:24:38,230 --> 01:24:47,790
All right. We will move on to our next our next presentation. The Texas dual eligible in a red integrated care demonstration project update.

894
01:24:48,950 --> 01:24:54,830
Ms. Vangie Serrano, senior policy advisor with program policy and Medicaid and chip services.

895
01:24:57,520 --> 01:25:07,180
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.

896
01:25:11,650 --> 01:25:13,370
Next slide please.

897
01:25:14,770 --> 01:25:17,990
We'll be providing you all an update on the dual demonstration.

898
01:25:20,330 --> 01:25:27,550
HHSE submitted its preliminary dual demonstration transition plan to the Center for Medicare and Medicaid Services.

899
01:25:27,550 --> 01:25:37,030
Last September, on September 30, 2022, this was a requirement from CMS contract year 2023

900
01:25:37,030 --> 01:25:44,450
Medicare Advantage and Part D final rule. At the time the HHSE submitted its transition

901
01:25:44,450 --> 01:25:50,830
plan to CMS HHSE was considering three potential end dates for the dual demonstration,

902
01:25:50,830 --> 01:25:56,830
which were December 31st, 2023, 2024 or 2025.

903
01:25:58,650 --> 01:26:03,370
Since then, or actually let me back up a little bit,

904
01:26:03,850 --> 01:26:06,770
the transition plan outlined agencies plans to transition

905
01:26:06,770 --> 01:26:09,910
the demonstration, Medicare, Medicaid plans

906
01:26:09,910 --> 01:26:13,130
to integrate dual eligible special needs plans,

907
01:26:13,570 --> 01:26:16,850
or these steps in the most seamless way possible.

908
01:26:16,850 --> 01:26:23,410
But since the meeting are transition plan to CMS, we have decided to extend the demonstration

909
01:26:23,410 --> 01:26:33,730
through December 2023 and or beyond December 2023 and now we are only considering two potential

910
01:26:33,730 --> 01:26:38,710
and dates which are the other two December 31st, 2024 or 2025.

911
01:26:38,710 --> 01:26:43,130
Next slide please.

912
01:26:46,700 --> 01:26:51,480
In November 2022, HHSC began participating in the Center for Healthcare

913
01:26:51,480 --> 01:26:58,460
Strategies Medicare Academy. This is a training program designed to help states build our

914
01:26:58,460 --> 01:27:05,120
Medicare knowledge that we would need to develop and oversee Medicare and Medicaid integration

915
01:27:05,120 --> 01:27:09,520
and to engage in longer term policy and program refinement.

916
01:27:10,420 --> 01:27:21,780
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.

917
01:27:21,780 --> 01:27:27,540
And to provide a few examples of the topics that H2C has learned about through this training

918
01:27:27,540 --> 01:27:34,200
program so far, is they are different enrollment options that the states have available

919
01:27:34,200 --> 01:27:39,800
to them to support integrated care between Medicare and Medicaid for our dualieligible

920
01:27:39,800 --> 01:27:46,560
individuals, key areas of intersection between Medicare and Medicaid to improve care coordination

921
01:27:46,560 --> 01:27:53,380
efforts and partnerships that Medicaid agencies can establish with other state agencies that will

922
01:27:53,380 --> 01:28:01,240
further support dual eligible care and I will pause there in case there are any questions.

923
01:28:05,890 --> 01:28:07,070
Members any questions?

924
01:28:12,880 --> 01:28:16,580
I do not hear any. Thank you so much.

925
01:28:16,940 --> 01:28:23,300
Thank you, if anyone thinks of any please feel free to contact me. My email is on the next slide.

926
01:28:23,300 --> 01:28:31,290
there we go. Thank you. Thank you. Our next presentation is the Healthy Texas Women

927
01:28:31,290 --> 01:28:36,830
Transition to Managed Care Status Update. The presentation will be given by Ms.

928
01:28:36,830 --> 01:28:40,870
Susana Binyathe, Manager with Program Policy and Medicaid and Ship Services.

929
01:28:45,050 --> 01:28:50,530
Okay, good afternoon all. Today we'll be presenting an update on the Healthy Texas Women

930
01:28:50,530 --> 01:28:58,210
Transition to Managed Care project as directed by House Bill 133 from the 87th Legislature

931
01:28:58,290 --> 01:29:00,710
My name is Susanna Binyathe.

932
01:29:01,210 --> 01:29:04,990
I work at HHSC and the Medicaid and CHIP services division.

933
01:29:05,570 --> 01:29:08,550
I am a manager in the Office of Policy area.

934
01:29:09,530 --> 01:29:15,550
And I help oversee the HW program, okay, and next slide.

935
01:29:19,030 --> 01:29:24,250
So today, I will be presenting a bit of background on this project.

936
01:29:24,530 --> 01:29:27,750
Some updates on the star and chipper quest for proposal.

937
01:29:27,750 --> 01:29:32,850
and then outlines some next steps for this project.

938
01:29:33,690 --> 01:29:34,630
Next slide.

939
01:29:39,280 --> 01:29:41,680
Okay, some background on this project.

940
01:29:42,440 --> 01:29:46,360
This project was directed by House Bill 133,

941
01:29:46,940 --> 01:29:49,820
which directs HHSC to contract with Medicaid,

942
01:29:50,140 --> 01:29:54,480
managed care organizations to provide HHSW program services.

943
01:29:55,880 --> 01:29:59,980
House Bill 133 also requires HHSC.

944
01:30:00,000 --> 01:30:10,220
And so for the

945
01:30:13,230 --> 01:30:19,870
next two slides, I will provide an update on the start chip request for proposal.

946
01:30:19,870 --> 01:30:27,390
So on this slide, you see the timeline for the RFP as it is now.

947
01:30:28,670 --> 01:30:35,870
So the RFP posted in December 2022, the anticipated notice of award is

948
01:30:35,870 --> 01:30:42,470
state-of-school year 2024, quarter-two, and the anticipated sort of operations

949
01:30:42,470 --> 01:30:46,430
is state-of-school year 2025, Q2 as well.

950
01:30:46,430 --> 01:30:56,230
So I will point out that any changes to the RFP timeline will be posted on the agency procurement website.

951
01:30:57,410 --> 01:31:06,550
On that website you can also access the exhibits, the scope of works for the new contract that is publicly available.

952
01:31:06,550 --> 01:31:13,570
So if the committee would want more information on which specific documents to look at or

953
01:31:13,570 --> 01:31:16,570
or links, I can definitely provide that as a follow-up.

954
01:31:18,690 --> 01:31:19,330
Next slide.

955
01:31:23,650 --> 01:31:29,270
And then the last update on the RFP is the first just confirmation that

956
01:31:29,270 --> 01:31:32,970
HEW is included in the Starship RFP.

957
01:31:33,450 --> 01:31:39,650
We do plan to incorporate HEW plus services into managed care as well.

958
01:31:39,650 --> 01:31:46,670
And then an update on where we are in the RFP process is we are in the evaluation period.

959
01:31:47,510 --> 01:31:53,430
So this means HHSC is evaluating proposals received by MCOs.

960
01:31:56,280 --> 01:32:00,780
And I will add that many of the contract requirements,

961
01:32:00,780 --> 01:32:08,540
So we have for star and chip, are very similar or the same for HTW, so that includes MCO

962
01:32:08,540 --> 01:32:16,660
member materials, ID card, online provider directories, et cetera, et cetera, et cetera, but

963
01:32:16,660 --> 01:32:22,620
it's definitely what point you need to the A to just the procurement website for additional

964
01:32:22,620 --> 01:32:24,780
details on what the RFP includes.

965
01:32:26,100 --> 01:32:27,260
Next slide.

966
01:32:32,900 --> 01:32:39,280
Okay, and so for next step, we usually we have several here. These include some

967
01:32:39,280 --> 01:32:47,280
knitting the H-C-W-U-1115 waiver amendment, developing a definition for the H-C-W

968
01:32:47,280 --> 01:32:56,940
Significant Provider, Provider Education and Outreach, a paying feedback from and providing

969
01:32:56,940 --> 01:33:02,300
of dates to the smacac network adequacy and access to ticker subcommittee.

970
01:33:03,660 --> 01:33:10,660
Client education and outreach, updating systems, of course updating HW client-basing materials.

971
01:33:12,300 --> 01:33:20,480
And then working with our new HWMCOs by hosting transition calls and CO readiness activities

972
01:33:20,480 --> 01:33:23,280
and any education and outreach.

973
01:33:24,360 --> 01:33:30,740
And so you'll see that there's asterisks to some of these next steps, and that means that

974
01:33:30,740 --> 01:33:38,780
these really won't begin until we know who the H.E.W.M.C.O.s are, and we will know that until

975
01:33:38,780 --> 01:33:44,960
the estimated notice of intent of award in Q2's tape this clear 2024.

976
01:33:46,660 --> 01:33:55,680
And while I'm here, I will just share some information that on June 8, we will be hosting

977
01:33:55,680 --> 01:33:59,860
the HW poster award public forum.

978
01:34:00,440 --> 01:34:08,100
That's a public forum where you can hear updates from HHSC about how the HWLM15

979
01:34:08,100 --> 01:34:11,240
through demonstration program is going.

980
01:34:12,520 --> 01:34:15,660
So we can definitely provide more information to the committee.

981
01:34:15,660 --> 01:34:20,540
on how to attend that public forum. Next slide

982
01:34:23,830 --> 01:34:26,630
and that is the end of my presentation.

983
01:34:26,930 --> 01:34:29,310
Thank you so much and I'm happy to take any questions.

984
01:34:33,010 --> 01:34:35,130
Thank you so much. Definitely please

985
01:34:35,130 --> 01:34:40,090
do share with the committee the information regarding the public forum. I feel sure the

986
01:34:40,090 --> 01:34:44,890
members would appreciate receiving that. Members any questions?

987
01:34:50,440 --> 01:34:56,520
All right hearing none. Thank you

988
01:34:56,520 --> 01:35:03,720
is on new legislation from the 88th legislative session pertaining to Medicaid managed care.

989
01:35:03,960 --> 01:35:11,680
And we have Ms. Erica Brown, deputy director in program policy, and Jenny Costillot,

990
01:35:11,880 --> 01:35:14,520
director of program policy, Medicaid and ship services.

991
01:35:15,880 --> 01:35:20,460
Good afternoon. This is Erica Brown. I serve as the deputy director of program policy

992
01:35:20,460 --> 01:35:25,860
and Medicaid and ship services. It will actually just be me today. I think Jenny may be

993
01:35:25,860 --> 01:35:33,320
listening in but I'll give the presentation. Okay, next slide, please. All right, so I wanted

994
01:35:33,320 --> 01:35:39,980
to start out with a high level summary of the 88th legislative session so far and talk a little

995
01:35:39,980 --> 01:35:49,360
bit about the numbers. So this session there have been 10,742 bills filed and of those our

996
01:35:49,360 --> 01:35:56,020
Medicaid and CHIP services division has analyzed more than 800 Medicaid-related bills.

997
01:35:56,960 --> 01:36:02,960
We're now nearing the end of the legislative session as many of you know it's just one week to go.

998
01:36:03,820 --> 01:36:10,940
I'm going to note that the information that I'm going to cover in the presentation today was prepared earlier this week

999
01:36:10,940 --> 01:36:17,320
because we wanted to be as up-to-date as possible, but as many members of the committee know, things are moving quickly.

1000
01:36:17,320 --> 01:36:23,320
day to day with the legislative session so please keep that in mind and we will provide another

1001
01:36:23,320 --> 01:36:29,060
presentation at the next committee meeting that will cover everything that is in fact passed during

1002
01:36:29,060 --> 01:36:38,380
the 88th legislative session. Next slide please. Okay so there are a few key topics that we have

1003
01:36:38,380 --> 01:36:46,680
seen across the Medicaid related bills that HHSC has analyzed the session. So starting out we've analyzed

1004
01:36:46,680 --> 01:36:56,360
Several bills related to provider requirements, so this includes new provider types for already covered Medicaid and chip services.

1005
01:36:57,120 --> 01:37:06,680
It also includes specific requirements and restrictions, for example prohibiting discrimination based on immunization status for Medicaid and chip providers.

1006
01:37:08,180 --> 01:37:13,660
We've also analyzed several bills related to long-term services and supports.

1007
01:37:13,660 --> 01:37:19,520
These bills have addressed requirements for nursing facilities, participating in star

1008
01:37:19,520 --> 01:37:20,140
plus.

1009
01:37:21,020 --> 01:37:25,880
They've also addressed the personal needs allowance for residents of long-term care facilities.

1010
01:37:25,880 --> 01:37:29,500
and we've seen several bills related to abuse.

1011
01:37:31,720 --> 01:37:57,220
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.

1012
01:37:58,820 --> 01:38:05,780
Moving on, we've also analyzed several bills that impact HHSC's operations, so this

1013
01:38:05,780 --> 01:38:11,280
is included bills focused on things like data sharing, legislative reports, and the creation

1014
01:38:11,280 --> 01:38:12,800
of new advisory committees.

1015
01:38:14,360 --> 01:38:20,480
Women's health has also been a key topic this session, and we've analyzed several bills

1016
01:38:20,480 --> 01:38:24,620
that would provide 12 months of postpartum coverage for pregnant women.

1017
01:38:24,620 --> 01:38:30,860
We also analyzed bills related to non-medical screenings for pregnant women and new provider

1018
01:38:30,860 --> 01:38:36,340
types for the case management for children and pregnant women or CPW program.

1019
01:38:38,040 --> 01:38:44,120
Regarding eligibility, we have analyzed bills related to Medicaid and CHIP eligibility determinations,

1020
01:38:44,820 --> 01:38:48,920
particularly around automatic enrollment of children in CHIP.

1021
01:38:50,560 --> 01:38:58,300
Another key topic this session as in prior sessions is new or amended Medicaid or chip services.

1022
01:38:59,160 --> 01:39:06,520
So we have analyzed bills that would add new Medicaid benefits, including cranial remolding orthosis,

1023
01:39:07,700 --> 01:39:13,900
hair prosthesis, or wig coverage for cancer patients, several mental health services,

1024
01:39:13,900 --> 01:39:18,980
new telemonodering services and a few pilot programs.

1025
01:39:20,600 --> 01:39:26,500
And then finally there have been a lot of those focused on pharmacy and prescription drugs that we've analyzed.

1026
01:39:27,400 --> 01:39:32,260
One of the major topics has been the drug formulary in the preferred drug list.

1027
01:39:33,560 --> 01:39:42,440
So I'm now going to highlight several specific bills within these categories that are active legislation that Medicaid and chip services is tracking.

1028
01:39:42,440 --> 01:39:44,520
Next slide please.

1029
01:39:47,020 --> 01:39:51,440
Okay, so we'll start with our active legislation related to provider

1030
01:39:51,440 --> 01:39:57,960
requirements. The first Baltha Highlight is host Bill 98 and this bill requires the Health

1031
01:39:57,960 --> 01:40:03,760
and Human Services Commission to allow a school district to enroll as a provider under Medicaid

1032
01:40:03,760 --> 01:40:10,760
to provide and receive reimbursement for mental health services to students who are Medicaid recipients.

1033
01:40:10,760 --> 01:40:13,460
There is also a Senate Companion Bill to that.

1034
01:40:13,660 --> 01:40:14,940
It's Senate Bill 113.

1035
01:40:16,800 --> 01:40:20,360
The next bill to highlight is House Bill 1008.

1036
01:40:20,820 --> 01:40:24,340
That bill is related to abuse neglect and exploitation.

1037
01:40:25,020 --> 01:40:29,460
And it requires providers to immediately suspend the employment

1038
01:40:29,460 --> 01:40:33,400
or contract of an employee immediately upon notice

1039
01:40:33,400 --> 01:40:35,620
of a reportable conduct finding.

1040
01:40:36,540 --> 01:40:39,860
And the bill describes disciplinary action

1041
01:40:39,860 --> 01:40:45,440
for not terminating employees and states that the commission should consider the nature and

1042
01:40:45,440 --> 01:40:52,460
seriousness of the violation any history of previous violations in any other matters if that

1043
01:40:52,460 --> 01:41:01,500
circumstance comes up. Another provider related bill is House Bill 1879. This bill allows

1044
01:41:01,500 --> 01:41:08,880
licensed master social workers, licensed professional counselor associates, and licensed

1045
01:41:08,880 --> 01:41:15,760
marriage and family therapist associates for underclinical supervision to be reimbursed

1046
01:41:15,760 --> 01:41:20,340
through Medicaid while completing their clinical requirements to become clinicians.

1047
01:41:21,440 --> 01:41:28,140
And the bill specifies that the rate for these provider types will be at 50% of the reimbursement

1048
01:41:28,140 --> 01:41:32,880
for licensed psychologists and psychiatrists providing similar services.

1049
01:41:35,920 --> 01:41:36,700
Next slide please.

1050
01:41:39,770 --> 01:41:43,950
Okay, getting into the bills related to long-term services and supports.

1051
01:41:44,670 --> 01:41:47,950
The first bill to highlight is Senate Bill 1629,

1052
01:41:48,690 --> 01:41:52,590
which requires nursing facilities who participate in star-plus

1053
01:41:52,590 --> 01:41:55,670
to comply with the direct care expense ratio.

1054
01:41:55,830 --> 01:42:01,710
That's adopted in the Human Resources Code at Section 32.0286.

1055
01:42:02,810 --> 01:42:18,710
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.

1056
01:42:18,710 --> 01:42:23,450
And then the third built to highlight is House Bill 3550.

1057
01:42:24,170 --> 01:42:35,090
This bill directs HHSC to establish minimum standards regarding transportation services for pediatric extended care centers or PPEX.

1058
01:42:35,790 --> 01:42:44,190
And the bill also directs HHSC to establish a reimbursement rate by rule for PPEX services, including transportation.

1059
01:42:47,070 --> 01:42:48,330
Go to the next slide please.

1060
01:42:48,330 --> 01:42:56,050
Okay, one bill to highlight related to HHSC operations is House Bill 1238.

1061
01:42:56,930 --> 01:43:03,110
So this bill prohibits a school district or charter school, the Texas Education Agency,

1062
01:43:03,510 --> 01:43:12,350
or HHSC from requiring additional parental consent under the School Health and Related Services Program,

1063
01:43:12,350 --> 01:43:19,150
known as Shars for a program-related purpose that does not involve sharing of a student's

1064
01:43:19,890 --> 01:43:21,290
personally identifiable information.

1065
01:43:24,610 --> 01:43:28,470
Next slide, please. Okay, a few bills to highlight

1066
01:43:28,470 --> 01:43:36,090
related to women's health. First, House Bill 12 would extend Medicaid postpartum eligibility for

1067
01:43:36,090 --> 01:43:42,490
12 months. That 12 months begins on the last day of the women's pregnancy and ends on the last

1068
01:43:42,490 --> 01:43:45,490
of the month in which the 12 month period ends.

1069
01:43:47,350 --> 01:43:49,710
The second Delta Highlight is Senate Bill 1989.

1070
01:43:50,830 --> 01:43:59,550
That bill would expand the existing IOMARC or testing benefit in Medicaid and CHIP by adding new covered biomarker tests.

1071
01:44:01,010 --> 01:44:04,570
And then the third Delta Highlight is House Bill 1575.

1072
01:44:04,570 --> 01:44:07,130
And this still does several things.

1073
01:44:07,850 --> 01:44:11,830
First, it requires the use of a standardized screening tool

1074
01:44:12,210 --> 01:44:15,750
to assess non-medical health-related needs

1075
01:44:15,750 --> 01:44:17,610
of certain pregnant women,

1076
01:44:17,910 --> 01:44:20,590
and it requires star-manage care organizations

1077
01:44:20,590 --> 01:44:23,910
to conduct the new non-medical health-related screening.

1078
01:44:25,470 --> 01:44:27,890
Second, it allows new provider types,

1079
01:44:28,590 --> 01:44:31,450
including community health workers and dual laws

1080
01:44:31,450 --> 01:44:35,050
as part of the Medicaid case management for children

1081
01:44:35,050 --> 01:44:37,890
in pregnant women program known as CPW.

1082
01:44:38,970 --> 01:44:41,030
And then third, it adds some new topics

1083
01:44:41,030 --> 01:44:44,990
to the required provider training for that CPW program.

1084
01:44:48,640 --> 01:44:49,560
Next slide, please.

1085
01:44:51,560 --> 01:44:55,180
Wanted to highlight one bill that we're tracking related to eligible.

1086
01:45:00,940 --> 01:45:25,560
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.

1087
01:45:30,290 --> 01:45:37,470
All right, the next several bills are focused on new or amended Medicaid or chip services.

1088
01:45:38,430 --> 01:45:40,550
So starting with House Bill 134.

1089
01:45:41,210 --> 01:45:46,770
This bill would require coverage for cranial remolding orthosis, also known as baby helmets.

1090
01:45:47,250 --> 01:45:53,110
In both Medicaid and chip, and it would provide coverage for more conditions than are currently covered.

1091
01:45:53,970 --> 01:46:03,170
The second bill, host bill 1164, requires health plans to provide coverage for wigs for Medicaid and

1092
01:46:03,170 --> 01:46:08,870
chip members who are undergoing or have undergone medical treatment for breast cancer.

1093
01:46:11,300 --> 01:46:14,920
The next two bills are related to coverage of mental health services.

1094
01:46:15,640 --> 01:46:23,300
So first, host bill 2337 would provide Medicaid coverage for intensive outpatient services

1095
01:46:23,300 --> 01:46:26,500
and partial hospitalization services.

1096
01:46:27,740 --> 01:46:30,900
I'll note that in HHSC's analysis of this bill,

1097
01:46:31,440 --> 01:46:33,660
it's assumed that these services would be covered

1098
01:46:33,660 --> 01:46:36,440
in both fee-for-service and managed care

1099
01:46:36,440 --> 01:46:38,060
as state-plan services.

1100
01:46:38,720 --> 01:46:40,860
As many members of this committee know,

1101
01:46:41,420 --> 01:46:44,680
these services can be covered by MCOs already

1102
01:46:44,680 --> 01:46:48,740
as in lieu of services if an MCO chooses to do so.

1103
01:46:48,920 --> 01:46:52,320
And if their operational plan is approved by HHSC.

1104
01:46:53,500 --> 01:47:01,920
And then the second bill related to mental health house bill 2638, this would require that

1105
01:47:01,920 --> 01:47:08,000
multi-systemic therapy would be a Medicaid covered service and the bill requires the executive

1106
01:47:08,000 --> 01:47:14,880
commissioner of HHSC to establish a separate provider type for multi-systemic therapy providers

1107
01:47:14,880 --> 01:47:18,460
for purposes of enrollment and reimbursement.

1108
01:47:19,660 --> 01:47:29,740
And then House Bill 2727 is related to Medicaid reimbursement for home telemonitoring services for people with certain medical conditions.

1109
01:47:30,660 --> 01:47:40,120
It would require HHSC to cover home telemonitoring for additional conditions if it's clinically effective and cost effective to do so.

1110
01:47:40,560 --> 01:47:47,040
And the bill also adds FQHCs and RHCs as home telemonitoring providers.

1111
01:47:47,040 --> 01:47:48,020
Next

1112
01:47:50,040 --> 01:47:50,780
slide, please.

1113
01:47:51,460 --> 01:47:54,100
Okay, continuing with newer amended services.

1114
01:47:55,000 --> 01:48:02,640
House Bill 40702, this bill would require the commission to establish peer support specialists

1115
01:48:03,120 --> 01:48:08,860
as a Medicaid benefit for certain individuals with intellectual or developmental disabilities.

1116
01:48:09,740 --> 01:48:16,220
The bill requires HHSC to obtain input from a work group and to develop rules that establish

1117
01:48:16,220 --> 01:48:23,740
training requirements, certification, and supervision requirements for these IDD peer support specialists.

1118
01:48:26,000 --> 01:48:33,300
House Bill 4713 is another behavioral health related bill and it would require coverage of a

1119
01:48:33,300 --> 01:48:41,540
sort of community treatment, coordinated specialty care, and peer services for first episode psychosis.

1120
01:48:41,540 --> 01:48:56,020
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.

1121
01:48:57,340 --> 01:49:08,640
And then finally, House Bill 2983 would create a new pilot program that would provide medically tailored meals for pregnant and postpartum Medicaid recipients.

1122
01:49:08,640 --> 01:49:19,330
Next slide please. Okay, and last but not least, we wanted to highlight a few bills focused on pharmacy and prescription drugs.

1123
01:49:20,070 --> 01:49:29,370
So the first to highlight is host bill 3286, which requires that the commission ensure all drugs and national drug codes.

1124
01:49:29,370 --> 01:49:36,030
be made available on the federal Medicaid drug rebate program, regardless of the status of certification

1125
01:49:36,570 --> 01:49:43,630
of information for the drug. The bill also makes other changes related to generic equivalents,

1126
01:49:43,970 --> 01:49:50,310
creating an expedited review process and adding another member from an MCO to the drug utilization

1127
01:49:50,310 --> 01:50:00,110
review board. And then House Bill 4888 requires Texas Medicaid to cover and reimburse for FDA

1128
01:50:00,110 --> 01:50:07,910
approved drugs, biologicals, and implantable, reusable, or disposable medical devices for pain

1129
01:50:07,910 --> 01:50:14,550
management that have demonstrated the ability to replace, reduce, or avoid opioid use.

1130
01:50:17,430 --> 01:50:18,050
Okay, I know

1131
01:50:18,050 --> 01:50:24,550
was a lot of bills so I'll pause there. See if anybody has questions and again we will provide another

1132
01:50:24,550 --> 01:50:30,330
presentation at the next committee meeting with information about bills that actually passed during

1133
01:50:30,330 --> 01:50:31,390
the 88 session.

1134
01:50:33,700 --> 01:50:40,080
Thank you so much. Curious jumping back to eligibility in the House Bill 1599.

1135
01:50:40,600 --> 01:50:47,860
Could you expand a little bit on what an eligibility express lane is as conceptualized in the bill?

1136
01:50:49,620 --> 01:50:56,160
I will, this is one bill that I actually can't explain well because it's mostly having

1137
01:50:56,160 --> 01:51:01,620
to do with eligibility, which is led by our access and eligibility system, but we can definitely

1138
01:51:01,620 --> 01:51:04,340
get some more information and share that with the committee.

1139
01:51:05,040 --> 01:51:07,280
I am just not the expert on eligibility.

1140
01:51:09,610 --> 01:51:10,290
Fair enough.

1141
01:51:11,310 --> 01:51:12,450
Members, any questions?

1142
01:51:20,360 --> 01:51:21,120
I hear none.

1143
01:51:22,740 --> 01:51:23,480
Thank you.

1144
01:51:25,470 --> 01:51:34,230
All right, and then our final update from Health and Human Services is an update regarding pharmacies as vaccine providers.

1145
01:51:35,010 --> 01:51:42,930
And that presentation will be provided by Ms. Sarah Gonzaga, manager with the medical and dental benefits policy.

1146
01:51:43,950 --> 01:51:51,090
And Rachel Koseum, hope I got the name right, nurse with medical and dental benefits policy.

1147
01:51:52,690 --> 01:51:59,150
Hi, good afternoon. I'm Sarah Gonzaga, manager with a medical dental benefits policy unit at

1148
01:51:59,150 --> 01:52:06,090
Medicaid services with HHSC and I have the vaccine services nurse policy analyst on my

1149
01:52:06,090 --> 01:52:11,130
team. So Rachel, I'm going to let you go ahead and introduce yourself and share some information

1150
01:52:11,130 --> 01:52:17,010
on this topic and then I believe we also have some folks from our vendor drug program as well

1151
01:52:17,010 --> 01:52:21,430
are Medicaid chief medical director online to help us answer any questions.

1152
01:52:22,730 --> 01:52:22,870
Thanks.

1153
01:52:25,240 --> 01:52:27,740
Thanks, Sarah. I am Rick.

1154
01:52:30,000 --> 01:52:35,760
I'm going to talk a bit of its policy and Medicaid chip services. I just have one slide for you all this afternoon.

1155
01:52:37,480 --> 01:52:50,180
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.

1156
01:52:50,180 --> 01:52:57,000
So to do that, Pharmacy is must enroll with TMHP as a medical provider to be reimbursed

1157
01:52:57,000 --> 01:53:03,880
to be a medical claim and there is the URL for more information for provider enrollment

1158
01:53:03,880 --> 01:53:11,040
on TMHP's website. Pharmacy can also enroll in the Texas Vaccines for Children Program.

1159
01:53:11,860 --> 01:53:19,060
That is a federal program and this is the Texas branch of it. That is administered through

1160
01:53:19,060 --> 01:53:28,560
is HHS and that allows pharmacies and other providers to obtain vaccines through the state.

1161
01:53:30,060 --> 01:53:35,040
And like Sarah said, I'm happy to answer any questions and we also have representatives from

1162
01:53:35,040 --> 01:53:38,900
the Office of Medical Director and the vendor drug program on the call.

1163
01:53:44,240 --> 01:53:46,280
Thank you, members. Do you have questions?

1164
01:53:47,600 --> 01:53:54,960
Hi there. This is Aaron head. My understanding that the limitation that pharmacies

1165
01:53:54,960 --> 01:54:00,900
experiences that not all the vaccines are on the formulary. For instance, I believe

1166
01:54:00,900 --> 01:54:06,620
one of the issues that we had run into was shingles. Can you speak to that and why

1167
01:54:06,620 --> 01:54:09,500
we wouldn't open up the formulary for all those vaccines?

1168
01:54:13,400 --> 01:54:16,660
for O.C.C. to see you.

1169
01:54:18,360 --> 01:54:19,140
Hi, good afternoon.

1170
01:54:19,520 --> 01:54:20,780
This is Stacey Pietro Palo.

1171
01:54:21,060 --> 01:54:22,680
I'm the inventor of drug program,

1172
01:54:23,260 --> 01:54:26,260
and I can speak to the formulary development.

1173
01:54:29,200 --> 01:54:31,280
We, I believe sheingles,

1174
01:54:32,380 --> 01:54:34,020
is correct to me if I'm wrong,

1175
01:54:34,120 --> 01:54:36,580
but is offered by the Medicare

1176
01:54:37,100 --> 01:54:40,500
and is generally provided to folks who are enrolled

1177
01:54:40,500 --> 01:54:41,600
in the Medicare program,

1178
01:54:41,600 --> 01:54:45,000
so it may be offered through that benefit.

1179
01:54:46,440 --> 01:54:54,100
And then we do consider adding other products to the formulae, but it does go through the

1180
01:54:54,100 --> 01:55:03,700
reboot process. So I'm not sure if any kind of research we've done on adding sheagles

1181
01:55:03,700 --> 01:55:12,040
to the formulae or that would be something that would be considered a medical benefit that the

1182
01:55:12,040 --> 01:55:19,740
is this would be able to enroll through team HP as a medical provider and be able to build that way.

1183
01:55:20,800 --> 01:55:26,840
So that's the information I have right now on the shingles. I can take that back and

1184
01:55:26,840 --> 01:55:34,280
try to get some more information. But I haven't heard of any specific projects

1185
01:55:35,440 --> 01:55:38,960
and recently on that particular vaccine.

1186
01:55:40,120 --> 01:55:40,220
Sure.

1187
01:55:40,340 --> 01:55:41,500
And that was just an example.

1188
01:55:41,720 --> 01:55:48,400
I know that there are some others and I can certainly provide some follow-up to that as well to address that for you.

1189
01:55:56,220 --> 01:55:56,420
Right.

1190
01:55:56,420 --> 01:55:57,820
Any other member questions?

1191
01:56:02,060 --> 01:56:02,540
Hearing none.

1192
01:56:02,620 --> 01:56:05,820
Thank you everybody for the presentation and for the questions.

1193
01:56:06,380 --> 01:56:12,500
We'll move on to our next item, which is to take public comment.

1194
01:56:13,220 --> 01:56:16,460
Is there anyone that has signed up for public comment?

1195
01:56:19,230 --> 01:56:22,190
Ms. Yuliska, this is John Chakong with Advisory Committee, Coronation Office.

1196
01:56:23,230 --> 01:56:27,570
And we have no one in the gallery to provide public comment on site.

1197
01:56:28,170 --> 01:56:35,630
And the member that had pre-resistant indicated that she no longer wants to provide oral testimony for today.

1198
01:56:35,850 --> 01:56:38,770
So we have no one to provide public testimony.

1199
01:56:39,730 --> 01:56:41,330
Thank you, Mr. Chakong.

1200
01:56:41,330 --> 01:56:48,470
Then our next agenda item is a review of action items and agenda items for future meetings.

1201
01:56:48,690 --> 01:56:53,630
Members, do you have any agenda items to request for future meetings?

1202
01:57:02,060 --> 01:57:14,940
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

1203
01:57:14,940 --> 01:57:19,320
in order to get those items on our list for our future meetings.

1204
01:57:20,480 --> 01:57:29,680
Our next State Medicaid managed care advisory committee meeting is scheduled for Thursday, August 17th, 2023 at 1 p.m.

1205
01:57:30,840 --> 01:57:41,280
And with that, we will go ahead and move to a adjourn here at 258 p.m.

1206
01:57:41,280 --> 01:57:49,430
I want to thank everybody for joining us today and thank you again for all our presenters and HHSC support staff.

1207
01:57:52,800 --> 01:57:58,060
Thank you very much, Mr. Yolensky. At this time, I want to stop the recording and transcription and leave the site.

1208
01:57:58,140 --> 01:57:59,900
Thank you all very much. Have a great rest of your day.