February 9, 2017 Hospital Payment Advisory Committee
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Item 1 - Opening comments: William Galinsky, Hospital Payment Advisory Committee Chair
Item 1
Opening comments: William Galinsky, Hospital Payment Advisory Committee Chair
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Item 2 - Approval of February 11, 2016 and May 5, 2016, meeting minutes (Vote required) INFORMATIONAL ITEMS:
Item 2
Approval of February 11, 2016 and May 5, 2016, meeting minutes (Vote required) INFORMATIONAL ITEMS:
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Item 3 - General Provisions* (PDF) (https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communications-events/meetings-events/agenda_item-3-hpac.pdf)
Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 353, new Subchapter O, relating to Delivery System and Provider Payment Initiatives, and new§ 353.1301, relating to General Provisions. This proposed new rule describes certain general provisions that apply to all Medicaid managed care delivery system and provider payment initiatives, or directed payments. As part of the recent overhaul of federal Medicaid Managed Care (MMC) rules, the Centers for Medicare and Medicaid Services allowed states that operate
MMC to direct Managed Care Organizations' (MCOs1) payments to providers. This rule describes provisions HHSC considers to be universal to all
such directed payment programs that are, or will be, implemented in Texas.
Pam McDonald, HHSC Director of Rate Analysis
Item 3
General Provisions* (PDF) (https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communications-events/meetings-events/agenda_item-3-hpac.pdf)Health and Human Services Commission (HHSC) proposes in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 353, new Subchapter O, relating to Delivery System and Provider Payment Initiatives, and new§ 353.1301, relating to General Provisions. This proposed new rule describes certain general provisions that apply to all Medicaid managed care delivery system and provider payment initiatives, or directed payments. As part of the recent overhaul of federal Medicaid Managed Care (MMC) rules, the Centers for Medicare and Medicaid Services allowed states that operate
MMC to direct Managed Care Organizations' (MCOs1) payments to providers. This rule describes provisions HHSC considers to be universal to all
such directed payment programs that are, or will be, implemented in Texas.
Pam McDonald, HHSC Director of Rate Analysis
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Item 4 - Regional Uniform Rate Increases for Hospital Services* (PDF) (https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communicationsevents/
meetings-events/agenda_item-4-hpac.pdf)
HHSC proposes new § 353.1305, relating to Regional Uniform Rate Increases for Hospital Services, in TAC Title 1, Part 15, Chapter 353, new
Subchapter O.The proposed new section describes the circumstances under which HHSC will direct a Medicaid MCO to provide a uniform
percentage rate increase to hospitals in the MCO's network in a participating Service Delivery Area (SDA)forthe provision of inpatient services,
outpatient services, or both. This section also describes the methodology used by HHSC to determine the percentage rate increase.
In light of recent federal regulation and with the goal of enhancing care coordination and achieving better health outcomes, this proposed rule
authorizes HHSC to use intergovernmental transfers from non-state governmental entities or from other state agencies to support capitation
payment increases in one or more SDAs. Each
MCO within the SDA would then be contractually required by the state to increase hospital payment rates by a uniform percentage for one or more
classes of hospital that provide services within the SDA.
Pam McDonald, HHSC Director of Rate Analysis
Item 4
Regional Uniform Rate Increases for Hospital Services* (PDF) (https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communicationsevents/meetings-events/agenda_item-4-hpac.pdf)
HHSC proposes new § 353.1305, relating to Regional Uniform Rate Increases for Hospital Services, in TAC Title 1, Part 15, Chapter 353, new
Subchapter O.The proposed new section describes the circumstances under which HHSC will direct a Medicaid MCO to provide a uniform
percentage rate increase to hospitals in the MCO's network in a participating Service Delivery Area (SDA)forthe provision of inpatient services,
outpatient services, or both. This section also describes the methodology used by HHSC to determine the percentage rate increase.
In light of recent federal regulation and with the goal of enhancing care coordination and achieving better health outcomes, this proposed rule
authorizes HHSC to use intergovernmental transfers from non-state governmental entities or from other state agencies to support capitation
payment increases in one or more SDAs. Each
MCO within the SDA would then be contractually required by the state to increase hospital payment rates by a uniform percentage for one or more
classes of hospital that provide services within the SDA.
Pam McDonald, HHSC Director of Rate Analysis
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Items 6 & 7 - 6. Proposed next meeting: June 8,2017, at 1:30 p.m.
7. Adjourn
Items 6 & 7
6. Proposed next meeting: June 8,2017, at 1:30 p.m.7. Adjourn
