Item 1

Opening comments: Gilbert Handal, M.D., Medical Care Advisory Committee Chair

Item 2

Comments from the Associate Commissioner for Medicaid and CHIP Services Department, Jami Snyder, Health and Human Services Commission
(HHSC)

Item 3

Approval of Nov. 10, 2016, meeting minutes (/sites/hhs/files//basic_page/20161110_MCAC_Meeting_Minutes.pdf) (Vote required)

Item 4 (Part 1 of 2)

General Provisions (/sites/hhs/files/basic_page/4.pdf)*
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 (CMS) allowed states that operate MMC to direct managed care
organizations' (MCOs') 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 5

Regional Uniform Rate Increases for Hospital Services* (/sites/hhs/files//basic_page/5.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) for the 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 6

Quality Incentive Payment Program (QIPP) for Nursing Facilities (NF)* (/sites/hhs/files//basic_page/6.pdf)
HHSC proposes new §353.1303, relating to Quality Incentive Payment Program (QIPP) for NFs, in TAC Title 1, Part 15, Chapter 353, new Subchapter O.
This proposed new rule describes the QIPP. QIPP is designed to incentivize NFs to improve quality and innovation in the provision of NF services,
using the CMS Five-Star Quality Rating System as its measure of success.
During the 83rd Session, the Legislature outlined its goals for the Medicaid managed care carve-in of NFs. In implementing the NF carve-in, HHSC
was directed to encourage transformative efforts in the delivery of NF services, including "efforts to promote a resident-centered care culture
through facility design and services provided" (Senate Bill 7, 83rd Legislature, Regular Session, 2013).
In 2014, HHSC established the Minimum Payment Amount Program (MPAP). The MPAP, which became effective March 1, 2015, established minimum
payment amounts for qualified NFs participating in STAR+PLUS. The STAR+PLUS MCOs paid the minimum payment amounts to qualified NFs based
on state direction. The MPAP was always intended to be a short-term program that would ultimately transition to a performance-based initiative.
The goal of transition was reinforced during the 84th Legislative Session. The General Appropriations Act for the 2016-2017 biennium contains HHSC
Budget Rider 97, which directs HHSC to transition the MPAP to QIPP.
- Pam McDonald, HHSC Director of Rate Analysis

Item 7

NOTICE OF PROPOSED RULES AND ACTION ITEMS:

Substitute Dentists* (PDF) (https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communications-events/meetings-events/agenda-item-7-
Medical-Care-Advisory-Committee.pdf)
HHSC proposes amendments to TAC Title 1, Part 15, Chapter 354, §354.1121, relating to Definitions; and §354.1221, relating to Authorized Dentists'
Services. Current federal Medicaid rules allow Medicaid-enrolled dentists to arrange for a substitute Medicaid-enrolled dentist to serve in the billing
physician's practice on a short or long-term basis. However, current Texas Medicaid rules do not include this option for dentists. The proposed rule
amendments would extend this billing arrangement option to Medicaid dentists. The substitute dentists would be required to be enrolled in
Medicaid, and time limits apply unless the reason for the billing agent dentist's absence is active duty as a member of a reserve component in the
United States Armed Forces.

- Mary Haifley, Director, HHSC Medicaid and CHIP Services Department, Medical Benefits

Item 8

Life Safety Code for an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)* (PDF)
(https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communications-events/meetings-events/agenda-item-8-Medical-Care-Advisory-
Committee.pdf)
HHSC, on behalf of Department of Aging and Disability Services, proposes to amend TAC Title 40, Part 1, Chapter 90, Intermediate Care Facilities for
Individuals with an Intellectual Disability (ICF/IID) or Related Conditions: §90.3, relating to Definitions; §90.50, relating to Emergency Preparedness
and Response; §90.61, relating to Introduction, Application, and General Requirements; and §90.74, relating to Safety Operations; and 40 TAC,
Chapter 9, Intellectual Disability Services – Medicaid State Operating Agency Responsibilities.
The CMS adopted a rule that made the 2012 edition of two publications of the National Fire Protection Association (NFPA)—the Life Safety Code
(NFPA 101) and the Health Care Facilities Code (NFPA 99)—apply to an ICF/IID. Therefore, the proposed amendments refer to the 2012 edition of
those publications and make references to the publications consistent throughout the amended sections. Consistent with the CMS rule, the
proposed amendments allow an existing small facility until July 5, 2019, to be in compliance with the NFPA provisions in Chapter 33 regarding
sprinklers and heat detection systems in attics.

The proposed amendments also delete definitions in §90.61 because they duplicate definitions in §90.3. The proposed amendments change dates in
the descriptions of "new construction" and "existing facility" in §90.61. The characterization as "new construction" or an "existing facility" affects
which chapter of NFPA 101 applies to a facility. The amendments also correct references to statutes.
- Barbara Blankenship, Policy Specialist, Department of Aging and Disability Services

Item 4 (Part 2 of 2)

General Provisions (/sites/hhs/files/basic_page/4.pdf)*
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 (CMS) allowed states that operate MMC to direct managed care
organizations' (MCOs') 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

Items 9 & 12

9. Transition to Managed Care for Medicaid Breast and Cervical Cancer, Adoption Assistance, and Permanency Care Assistance Populations; Managed
Care for Former Foster Care Children* (PDF) (https://hhs.texas.gov/sites/hhs/files//documents/about-hhs/communications-events/meetingsevents/
agenda-item-9-Medical-Care-Advisory-Committee.pdf)
HHSC proposes amendments to TAC Title 1, Part 15, Chapter 353, Subchapter A General Provisions: §353.2, relating to Definitions; Subchapter G,
STAR+PLUS; §353.603, relating to Member Participation; Subchapter I, STAR; §353.802, relating to Member Participation; and Subchapter N, STAR
Kids; §353.1203, relating to Member Participation. HHSC also proposes new §353.609, relating to Service Coordination.
Under the 2014-2015 General Appropriations Act (Senate Bill 1, 83rd Legislature, Regular Session, 2013, Article II, HHSC, Rider 51(b)(15)), HHSC was
directed to improve care coordination through a capitated managed care program for remaining Medicaid fee-for-service populations. As a result,
HHSC will transfer the Adoption Assistance (AA), Permanency Care Assistance (PCA), and Medicaid Breast and Cervical Cancer (MBCC) populations
from traditional fee-for-service Medicaid to Medicaid managed care on September 1, 2017. The proposed amendments to §353.603, §353.802, and
§353.1203 add the AA, PCA, and MBCC populations as mandatory groups for the appropriate managed care programs.
In addition to amending rules for the transition to managed care, HHSC is proposing new §353.609 regarding service coordination for the
STAR+PLUS program. The amendments to §353.602 add definitions to implement this new benefit for the STAR+PLUS program.
While not currently reflected in the current draft rules, HHSC also proposes amendments relating to Former Foster Care Children (FFCC) to TAC, Title
1, Part 15, Chapter 353, Subchapter G, §353.603; Subchapter H, §353.702, relating to Member Participation; Subchapter I, §353.802; and Subchapter
N, §353.1203, relating to FFCC. These amendments will allow FFCC individuals under the age of 20 who meet the STAR Kids criteria to choose
between STAR Health and STAR Kids. The amendments will also require FFCC individuals ages 21 through 26 who meet STAR+PLUS criteria to enroll
in STAR+PLUS.
- Michelle Erwin, Director, HHSC Medicaid and Children's Health Insurance Program (CHIP) Policy and Program Development

12. Adjourn