Medical Care Advisory Committee (MCAC) Agenda

June 10, 2021 - 9:00am

Meeting Site:
Microsoft Office Teams Live Event

Due to the COVID-19 pandemic, this meeting will be conducted virtually using Microsoft Teams only. There is not a physical location for this meeting.

Join the meeting here.

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Attendees who would like to provide public comment should see the Public Comment section below.

1. Welcome, introductions, and opening remarks
2. Consideration of February 11, 2021, meeting minutes (vote required)
3. Medicaid and Children’s Health Insurance Program (CHIP) activities
4. COVID-19 update
5. Extension for the 1115 Waiver: Texas Healthcare Transformation and Quality Improvement Program

Action Items:

6. Health and Human Services Commission (HHSC) Interest Lists waiver programs
   - Jennifer Chancellor-Hurd, Long Term Services and Supports Policy Unit Manager, HHSC
    
   The primary purpose of the proposed rule amendments is to implement Texas Government Code §531.0601, Long-term Care Services Waiver Program Interest Lists.  They provide that individuals who are enrolled in but become ineligible for the Medically Dependent Children Program may have their names returned to the interest list or placed on that of Home and Community-based Services, Texas Home Living, Deaf Blind with Multiple Disabilities, or Community Living Assistance and Support Services. The proposed amendments describe the circumstances under which these actions may be taken.
    
7. Drug Utilization Review Board (DURB) and conflict of interest
   - Stacey Johnston, Director of Pharmacy Operations, HHSC Vendor Drug Program
    
   The proposed amendments to Title 1, Texas Administrative Code (TAC), §354.1941 and §354.1942 strengthen current conflict-of-interest policies applicable to the DURB. These strengthened policies increase transparency by requiring DURB members to disclose financial relationships with drug manufacturers or labelers with products before the DURB; minimize the opportunity for pharmaceutical manufacturers or labelers to influence a member of the DURB when making recommendations about the Medicaid Preferred Drug List; and increase public confidence in DURB decisions.
    
8. State Medicaid Managed Care Advisory Committee (SMMCAC)
   - Michelle Erwin, Deputy Associate Commissioner, HHSC Medicaid/CHIP Services
    
   The primary purpose of amending TAC, Title 1, §351.805 is to implement changes recommended by SMMCAC in March 2020 and to make additional changes recommended by HHSC staff. These edits reorganize and format the rule so that the SMMCAC rule is consistent with other HHSC advisory committee rules established under Texas Government Code §531.012.
    
9. Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions Legislative Implementation and Updates
   - Diana Conces, Director of HHSC Long Term Care Policy & Rules
    
   The amendments and repeals to Title 26, TAC, Chapter 551 are intended to implement the changes made to Texas Health and Safety Code Chapters 81 and 252, by House Bills (HBs) 1848 and 3803, 86th Legislature, Regular Session, 2019. HB 1848 amends the requirements of a long-term care facility’s infection prevention and control program to include monitoring key infectious agents, including multidrug-resistant organisms and procedures for making rapid influenza diagnostic tests available to facility residents. HB 3803 sets the maximum amount of an administrative penalty assessed each day a violation occurs or continues to occur. Additionally, the amendments and repeals reflect the transition from paper applications to the use of the online licensure portal, called the Texas Unified Licensure Information Portal, and clarify other processes relating to licensure.

Informational Items:

10. Public Health Provider Charity Care Program (PHP-CCP)
    - Mohib Nawab, Senior Financial Analyst, HHSC Provider Finance
     
    This rule authorizes HHSC to implement the PHP-CCP under the 1115 waiver to reimburse certain costs for qualifying providers that provide care, including behavioral health, immunizations, chronic disease prevention and other preventative services for the uninsured. This program was created as part of the 1115 waiver extension and will provide an opportunity for reimbursement of charity care costs (or Medicaid shortfall in the first year of the program). The rule describes the requirements for participation in the PHP-CCP.
     
11. Payments to Public Health Providers for Charity Care Program – Year 2 and Beyond
    - Mohib Nawab, Senior Financial Analyst, HHSC Provider Finance Department
     
    This proposal establishes enhanced supplemental payments to publicly owned ground emergency ambulance service providers. These providers currently receive both fee-for-service and supplemental payments to cover uncompensated care costs. Subject to approval by the Centers for Medicare and Medicaid Services, the proposed amendment will make publicly owned ground emergency ambulance providers eligible for additional payments for services up to the average rate payable by commercial insurers for those services.
     
12. Disproportionate Share Hospital Reimbursement Methodology
    - Rene Cantu, Director of Hospital Finance, HHSC Provider Finance Department
     
    HHSC proposes to amend Title 1, §355.8065 of TAC, concerning Disproportionate Share Hospital Reimbursement Methodology. Historically, HHSC has allowed State Institutions for Mental Diseases (IMDs) to participate in the Disproportionate Share Hospital program, and they are treated in the same way as state hospitals. However, the rule does not explicitly reference State IMDs or state that State IMDs have been recognized as providers for years. The amendment broadens the definition of state-owned hospitals to include these hospitals.
     
13. Quality Incentive Payment Program (QIPP) Accelerated Payment and Metric Rule Change
    - Samuel West, Manager, HHSC Research, Development and Methodology
     
    HHSC is proposing to amend the QIPP quality year as well as certain component funding allocations beginning in program year five. Title 1, §353.1302 of TAC would adjust QIPP funding to increase the allocation from 30 percent to 40 percent in Component 2 and decrease the allocation from 70 percent to 60 percent in Component 3. The additional proposed amendments would discontinue an unnecessary requirement, provide increased clarity, and ensure that the language in this section corresponds to similar language in other sections. Title 1, TAC, §353.1304would be amended to remove set types of quality metrics and related performance requirements for each program year in favor of a public notice and hearing process.
     
14. Inpatient Hospital Reimbursement
    - Megan Wolfe, Deputy Director, HHSC Provider Finance
     
    The aim of this amendment to Title 1, TAC, § 355.8052 is to comply with Texas Government Code §531.02194, as adopted Senate Bill (SB) 170, 86th Legislature, Regular Session (2019), and Texas Health and Safety Code Chapter 241, Subchapter K, as adopted by SB 1621, 86th Legislature, Regular Session (2019), and to make other amendments to enhance clarity, consistency, and specificity. In accordance with Texas Government Code §531.02194, HHSC is required, to the extent allowed by law, to calculate Medicaid rural hospital inpatient rates using a cost-based prospective reimbursement methodology. Additionally, HHSC must calculate rates for rural hospitals once every two years, using the most recent cost information available. The current rule does not require a biennial review of the rural hospital rates. Rates have not been realigned or rebased since state fiscal year 2014. The proposed amendment adds a Medicaid minimum fee schedule for all rural hospitals to conform the rule to the contracts; arranges the rule by hospital type; adds and modifies definitions, including “rebasing” and “realignment”; and specifies a policy for updating Diagnosis Related Group statistical calculations.
     
15. Disaster Rule Flexibilities for Community Behavioral Health Providers
    - Corliss Powell, Director, HHSC Behavioral Health Services Operations
     
    The purpose of this proposal is to allow HHSC flexibility to waive certain requirements for the delivery of services in response to a declared disaster. The proposed new rule is based on the existing emergency rule created in 26 TAC §306.1351, relating to COVID-19 Flexibilities. This proposal creates a standing rule, allowing providers subject to the rule to operate with the same flexibilities afforded by the emergency rule and ensuring continuity of services for individuals receiving community-based behavioral health services.
     
16. Medicaid Bed Reallocation
    - Diana Conces, Director of HHSC Long Term Care Policy & Rules
     
    This proposed new rule is to implement Texas Health and Safety Code §533A.062, as amended by HB 3117, 86th Legislature, Regular Session, 2019, requiring HHSC to develop a process to redistribute Medicaid beds in existing intermediate care facilities for individuals with an intellectual disability or related conditions as per the authority of the State Plan for Individuals in Intermediate Care Facilities Intellectual and Developmental Disorders (ICF/IDD). Adding a new rule to 26 TAC Chapter 261 will enable HHSC to reallocate available beds reverted to HHSC due to provider closure or expiration of beds in suspension. With the addition of new §261.220, ICF/IID providers can apply to HHSC to request up to a maximum of six additional beds if they choose. This new rule formalizes the current process for Medicaid bed reallocation authorized by the Long-Term Care Plan for Individuals with Intellectual Disabilities and Related Conditions, based on Texas Health and Safety Code §533A.062(b-1), relating to Plan on Long-Term Care for Persons with an Intellectual Disability.
     
17. Public comment
18. Proposed next meeting: August 12, 2021, at 9:00 a.m.
19. Adjourn

Public Comment:

HHSC welcomes public comments pertaining to topics related to eligibility, health and medical care services, and policies that govern the administration of the Texas Medicaid program. Members of the public who would like to provide public comment are asked to complete a Public Comment form at http://texashhsmeetings.org/MCAC_PCReg_June2021. 

Members of the public who would like to provide written public comment to HHSC may email Caroline Sunshine no later than 5:00 p.m. Tuesday, June 8, 2021. Please include your name and the organization you are representing, or that you are speaking as a private citizen. Staff will not read written comments aloud during the meeting, but comments will be forwarded to State staff and committee members for their consideration. Comments should not include confidential information or protected health information.

If you would like to register to provide oral comments, please mark the correct box on the Public Comment form. Instructions for providing oral comment will be emailed to you. Registration should be completed no later than 5:00 p.m., Tuesday, June 8, 2021. Members of the public may also use the Microsoft Teams Live Event Q&A section during the meeting to submit a request to provide public comment.  The request must contain your name and either the organization you are representing or that you are speaking as a private citizen, and your direct phone number. Do not include confidential information or protected health information in comments.

Public comment is limited to three minutes. Each speaker must state their name and either the organization they are representing or that they are speaking as a private citizen. Public members who are using handouts are asked to provide an electronic copy in accessible PDF format. Handouts are limited to two pages (paper size: 8.5” by 11”, one side only). Handouts must be emailed to HHSC immediately after registering and include the name of the person who will be commenting. Do not include confidential information or protected health information in handouts. Staff will not read handouts aloud during the meeting, but handouts will be provided to Committee members and State staff. It is not permissible for public speakers to interject or ask questions to Committee members during the rest of the meeting.

Contact: Questions regarding agenda items, content, or meeting arrangements should be directed to Caroline Sunshine, Advisory Committee Coordinator, Medicaid and CHIP Services Department, 512-428-1948, caroline.sunshine@hhs.texas.gov.

This meeting is open to the public. No reservations are required, and there is no cost to attend this meeting.

People with disabilities who wish to attend the meeting and require auxiliary aids or services should contact Sunshine at 512-428-1948 or caroline.sunshine@hhs.texas.gov at least 72 hours before the meeting so appropriate arrangements can be made.