November 19, 2020 State Medicaid Managed Care Advisory Committee (SMMCAC) Agenda
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1. Call to order, roll call, and opening remarks
1. Call to order, roll call, and opening remarks
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2. Adoption of August 26, 2020, minutes (vote required)
2. Adoption of August 26, 2020, minutes (vote required)
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7. Decline in care for children in Medicaid and Children’s Health Insurance Program due to the COVID-19 pandemic
7. Decline in care for children in Medicaid and Children’s Health Insurance Program due to the COVID-19 pandemic
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4. Advisory Committee chair updates » - a. Hospital Payment Advisory Committee b. Intellectual and Developmental Disability System Redesign Advisory Committee c. Medical Care Advisory Committee d. Perinatal Advisory Committee e. Policy Council for Children and Families f. STAR Kids Managed Care Advisory Committee g. STAR+PLUS Pilot Program Workgroup
4. Advisory Committee chair updates »
a. Hospital Payment Advisory Committee b. Intellectual and Developmental Disability System Redesign Advisory Committee
c. Medical Care Advisory Committee
d. Perinatal Advisory Committee
e. Policy Council for Children and Families
f. STAR Kids Managed Care Advisory Committee
g. STAR+PLUS Pilot Program Workgroup
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5. State Medicaid Managed Care Advisory Committee subcommittee updates » - a. Administrative simplification i. Durable medical equipment administrative simplification pilot project for individuals enrolled in STAR Kids and the Medically Dependent Children’s Program ii. Provider management and enrollment system iii. Other administrative simplification topics b. Clinical oversight and benefits i. Medical benefits process ii. Update on continuous glucose monitoring benefit iii. Update on RELiZORB topic nomination iv. Implementation of Texas Government Code § 533.005, as adopted by Senate Bill 1177, 86th Legislature, Regular Session (2019), concerning evidence-based behavioral health services in lieu of state plan services v. Other clinical oversight and benefits topics c. Complaints, appeals, and fair hearings i. External medical review implementation ii. Update on open enrollment for external medical review services iii. Other complaints, appeals, and fair hearings topics d. Network adequacy and access to care i. Network rosters ii. Update on options for remote delivery for federal qualified health centers and rural health clinics iii. Texas Government Code 541 and 2020-21 General Appropriations Act, 86th Legislature, Regular Session, article II, at II-74, Rider 94, at II-74 (Health and Human Services, Health and Human Services Commission) (2019), concerning pediatric tele-connectivity resource program for rural Texas iv. Delivery System Reform Incentive Program M-9 Milestone: Assessment of telemedicine and telehealth services v. Other network adequacy and access to care topics
5. State Medicaid Managed Care Advisory Committee subcommittee updates »
a. Administrative simplification i. Durable medical equipment administrative simplification pilot project for individuals enrolled in STAR Kids and the Medically Dependent Children’s Program
ii. Provider management and enrollment system
iii. Other administrative simplification topics
b. Clinical oversight and benefits
i. Medical benefits process
ii. Update on continuous glucose monitoring benefit
iii. Update on RELiZORB topic nomination
iv. Implementation of Texas Government Code § 533.005, as adopted by Senate Bill 1177, 86th Legislature, Regular Session (2019), concerning evidence-based behavioral health services in lieu of state plan services
v. Other clinical oversight and benefits topics
c. Complaints, appeals, and fair hearings
i. External medical review implementation
ii. Update on open enrollment for external medical review services
iii. Other complaints, appeals, and fair hearings topics
d. Network adequacy and access to care
i. Network rosters
ii. Update on options for remote delivery for federal qualified health centers and rural health clinics
iii. Texas Government Code 541 and 2020-21 General Appropriations Act, 86th Legislature, Regular Session, article II, at II-74, Rider 94, at II-74 (Health and Human Services, Health and Human Services Commission) (2019), concerning pediatric tele-connectivity resource program for rural Texas
iv. Delivery System Reform Incentive Program M-9 Milestone: Assessment of telemedicine and telehealth services
v. Other network adequacy and access to care topics
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6. Health and Human Services Commission (HHSC) updates (Part 1 of 2) » - a. Business plan b. Legislative implementation
6. Health and Human Services Commission (HHSC) updates (Part 1 of 2) »
a. Business plan b. Legislative implementation
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e. Service and care coordination » - i. Overview of managed care organization service coordination processes and roles ii. Coordination between managed care service coordinators and other case management entities iii. Service coordination during the COVID-19 emergency iv. Other service and care coordination topics
e. Service and care coordination »
i. Overview of managed care organization service coordination processes and roles ii. Coordination between managed care service coordinators and other case management entities
iii. Service coordination during the COVID-19 emergency
iv. Other service and care coordination topics
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6. Health and Human Services Commission (HHSC) updates (Part 2 of 2)
6. Health and Human Services Commission (HHSC) updates (Part 2 of 2)
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8. Committee discussion: Restructuring State Medicaid Managed Care Advisory Committee subcommittees
8. Committee discussion: Restructuring State Medicaid Managed Care Advisory Committee subcommittees
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9. State Medicaid Managed Care Advisory Committee reports to the Executive Commissioner and Legislature (vote required)
9. State Medicaid Managed Care Advisory Committee reports to the Executive Commissioner and Legislature (vote required)
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10. Draft amendments to the State Medicaid Managed Care Advisory Committee Texas Administrative Code rule (Title 1, Texas Administrative Code, §351.805)
10. Draft amendments to the State Medicaid Managed Care Advisory Committee Texas Administrative Code rule (Title 1, Texas Administrative Code, §351.805)
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13. Review of action items and agenda items for future meeting
13. Review of action items and agenda items for future meeting
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Items 12 & 14 » - 12. Public comment 14. Adjourn and thank you
Items 12 & 14 »
12. Public comment 14. Adjourn and thank you
