Item 1

Welcome, introductions, and opening remarks

Item 2

Consideration of June 10, 2021, meeting minutes (vote required)

Item 3

Medicaid and Children’s Health Insurance Program (CHIP) activities

Item 4

1115 waiver update

Item 6

Electronic Visit Verification (EVV)
Erica Brown,
Deputy Director, HHSC Office of Policy and Program
SB 1991, 86th Legislature, Regular Session, 2019, amended Chapter 531,Texas Government Code, by adding new §§531.1131(f) and 531.1135requiring HHSC to adopt rules describing the due process procedures an MCO must follow to recoup an overpayment made to a health care provider related to missing EVV information; and requiring that, as part of the process to recoup such an overpayment, an MCO gives a provider at least 60 days to correct a deficiency in a claim before the MCO begins any efforts to recoup overpayments. Texas Government Code §531.1131(e) requires HHSC to adopt rules describing due process procedures an MCO must follow when engaging in recoupment efforts related to fraud or abuse.

Item 7

HHSC Interest Lists waiver programs
Dana Williamson, Director of Policy Development Support, HHSC Medicaid/CHIP Services

The primary purpose of the proposed amendments is to implement Texas Government Code §531.0601, Long-term Care Services Waiver Program Interest Lists. That section provides that individuals who are enrolled in but become ineligible for the medically dependent children (MDCP) waiver 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 programs. The proposed amendments describe the circumstances under which these actions may be taken. They include the following sections: §9.157 in inTAC, Title 40, Chapter 9, Subchapter D, Home and Community-BasedServices (HCS) Program and Community First Choice (CFC); §§9.158, 9.566,and 9.567 in TAC, Title 40, Chapter 9, Subchapter N, Texas Home Living(TxHmL) Program and Community First Choice (CFC); §§42.202, 42.211,and 42.402 in TAC, Title 40, Chapter 42, Deaf Blind with Multiple Disabilities(DBMD) and Community First Choice (CFC) Services; §45.202 and 45.211 in TAC, Title 40, Chapter 45, Community Living Assistance and Support Services and Community First Choice (CFC) Services; and §353.1155 in TAC, Title 1, Chapter 353, Medically Dependent Children Program.

Item 8

Informational Items:
Disaster Rule Flexibilities for Community Behavioral Health Providers
-Lizet Alaniz, Rules Coordinator, 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 TAC, Title 26, Subchapter Z, §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 it ensures continuity of services for individuals receiving community-based behavioral health services.

Item 9

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 for Individuals with Intellectual and Developmental Disabilities (ICF/IID). Adding a new rule to TAC, Title 26,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).

Item 10

Hospital Augmented Reimbursement Program (HARP)
- Eva Dorman, Financial Analyst, HHSC Provider Finance Department

The proposed new rule describes a new program to preserve financial resources many Texas hospitals depend on to provide access and quality care to Medicaid clients and the uninsured
.
Subject to approval by the Centers for Medicare and Medicaid Services (CMS), HARP would be created through the Medicaid state plan. State plan programs and services do not impact 1115Waiver budget neutrality. HHSC intends to submit state plan amendments to CMS requesting authorization to make payments as described under new TAC, Title 1, §355.8070 to non-state government owned and operated hospitals and to private hospitals.

Item 11

Pediatric long-term care facility reimbursement
Samuel West, Director, HHSC Provider Finance for Long-term Services and Supports

This proposal amends the payment rate methodology for pediatric nursing facilities, to base the methodology upon the unadjusted federal per diem rate for rural Medicare skilled nursing facilities for the most recent federal fiscal year. The proposal removes language related to the pediatric nursing facility rate methodology currently in TAC, Title 1, §355.307, and moves this language to a new rule in the same subchapter at §355.316. The amendment separates the pediatric care facility reimbursement methodology from there imbursement methodology used for nursing facilities in general. The proposal also makes general edits to improve clarity. The reimbursement methodology revision will lead to higher reimbursement rates than exist under the current methodology, leading to higher quality and greater access to care for medically fragile children in Texas.

Items 13 & 14

13 .Proposed next meeting: November 10, 2021, at 9:00 a.m.

14. Adjourn