March 12, 2020 State Medicaid Managed Care Advisory Committee
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1. Call to order
1. Call to order
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2. Roll call
2. Roll call
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3. Adoption of November 21, 2019, and December 12, 2019, minutes (vote required)
3. Adoption of November 21, 2019, and December 12, 2019, minutes (vote required)
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a. Behavioral Health Advisory Committee
a. Behavioral Health Advisory Committee
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b. Drug Utilization Review Board (Part 1 of 2)
b. Drug Utilization Review Board (Part 1 of 2)
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c. eHealth Advisory Committee
c. eHealth Advisory Committee
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g. Palliative Care Interdisciplinary Advisory Committee
g. Palliative Care Interdisciplinary Advisory Committee
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k. Texas Council on Consumer Direction
k. Texas Council on Consumer Direction
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l. Value Based Payment and Quality Improvement Advisory Committee
l. Value Based Payment and Quality Improvement Advisory Committee
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b. Drug Utilization Review Board (Part 2 of 2)
b. Drug Utilization Review Board (Part 2 of 2)
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a. Administrative Simplification » - i. Claims processing guidelines for managed care organizations ii. Interaction between Texas Medicaid Healthcare Partnership provider enrollment and managed care organizations iii. Provider abrasion and administrative burden involved in the prior authorization process iv. Other administrative simplification topics
a. Administrative Simplification »
i. Claims processing guidelines for managed care organizations ii. Interaction between Texas Medicaid Healthcare Partnership provider enrollment and managed care organizations
iii. Provider abrasion and administrative burden involved in the prior authorization process
iv. Other administrative simplification topics
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b. Clinical Oversight and Benefits » - i. Texas Government Code §533.005, as adopted by Senate Bill 1177, 86th Texas Legislature, Regular Session, 2019 ii. Health and Human Services Commission’s prior authorization data collection effort iii. Durable medical equipment iv. Other clinical oversight and benefits topics
b. Clinical Oversight and Benefits »
i. Texas Government Code §533.005, as adopted by Senate Bill 1177, 86th Texas Legislature, Regular Session, 2019 ii. Health and Human Services Commission’s prior authorization data collection effort
iii. Durable medical equipment
iv. Other clinical oversight and benefits topics
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c. Complaints, Appeals, and Fair Hearings » - i. Updates on appeals notices ii. Changes to appeals data iii. Appeals, Independent Review Organization, and fair hearings timeline from the client’s perspective iv. Other complaints, appeals, and fair hearings topics
c. Complaints, Appeals, and Fair Hearings »
i. Updates on appeals notices ii. Changes to appeals data
iii. Appeals, Independent Review Organization, and fair hearings timeline from the client’s perspective
iv. Other complaints, appeals, and fair hearings topics
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d. Network Adequacy » - i. Texas Government Code, Chapter 531, as amended by Senate Bill 670, 86th Texas Legislature, Regular Session, 2019 . Expanded coverage of telemedicine and telehealth services . New telemedicine and telehealth monitoring requirements . New Federally Qualified Health Center (FQHC) facility fees ii. Texas Government Code, Chapter 531, as amended by House Bill 1063, 86th Texas Legislature, Regular Session, 2019 . Cost effectiveness research iii. Other network adequacy topics
d. Network Adequacy »
i. Texas Government Code, Chapter 531, as amended by Senate Bill 670, 86th Texas Legislature, Regular Session, 2019 . Expanded coverage of telemedicine and telehealth services
. New telemedicine and telehealth monitoring requirements
. New Federally Qualified Health Center (FQHC) facility fees
ii. Texas Government Code, Chapter 531, as amended by House Bill 1063, 86th Texas Legislature, Regular Session, 2019
. Cost effectiveness research
iii. Other network adequacy topics
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e. Service and Care Coordination » - i. Coordination activities between managed care service coordinators and fee for service programs ii. Other service and care coordination topics
e. Service and Care Coordination »
i. Coordination activities between managed care service coordinators and fee for service programs ii. Other service and care coordination topics
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6. Health and Human Services Commission updates » - a. Medicaid/CHIP Services Advisory Committee appointment updates b. Legislative implementation update c. Business plan implementation update
6. Health and Human Services Commission updates »
a. Medicaid/CHIP Services Advisory Committee appointment updates b. Legislative implementation update
c. Business plan implementation update
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7. Texas Government Code, Chapter 533, as amended by Senate Bill 1207, 86th Texas Legislature, Regular Session, 2019: Prior authorization timelines and reconsiderations
7. Texas Government Code, Chapter 533, as amended by Senate Bill 1207, 86th Texas Legislature, Regular Session, 2019: Prior authorization timelines and reconsiderations
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12. Recommendation to amend SMMCAC Texas Administrative Code rule
12. Recommendation to amend SMMCAC Texas Administrative Code rule
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10. Behavioral Health Data Mart
10. Behavioral Health Data Mart
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8. STAR+PLUS procurement update
8. STAR+PLUS procurement update
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9. Uniform Hospital Rate Increase Program
9. Uniform Hospital Rate Increase Program
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11. Adoption assistance update
11. Adoption assistance update
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13. Public comment
13. Public comment
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Items 14 & 15 » - 14. Review of action items and agenda items for future meeting 15. Adjourn and thank you
Items 14 & 15 »
14. Review of action items and agenda items for future meeting 15. Adjourn and thank you
