Items 1 & 3

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

3. Approval of June 15, 2017, meeting minutes (Vote required)

Item 2

Comments from the Associate Commissioner for Medicaid and Children's HealthInsurance Program (CHIP) Services Department, Jami Snyder, Health and
Human Services Commission (HHSC).

Item 4

Texas Medicaid Fee-for-Service Access Monitoring Review Plan (/sites/default/files/documents/about-hhs/communications-events/meetingsevents/
mcac/082417-4.pdf)
State Medicaid programs must comply with federal rules at 42 C.F.R. §§ 447.203-204 intended to establish a standardized, transparent, data-driven
process for states to document that fee-for-service provider payment rates are consistent with Social Security Act § 1902(a)(30)(A), 42 U.S.C.A. §
1396(a)(30)(A). This section of the Act requires states to have methods and procedures to assure payments to providers are "sufficient to enlist
enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general
population in the geographic area." In its initial plan submitted to theCenters for Medicare & Medicaid Services (CMS) in October 2016, HHSC
indicated a follow-up plan in 2017 was necessary to address the requirement of rate comparisons and to present data pertaining tochildren with
disabilities. HHSC presents a draft of the 2017 Texas Medicaid Fee-For-Service Access Monitoring Review Plan to the Committee as an informational item
and is prepared to take questions the Committee has about the plan.
- Brian Dees, Senior Policy Advisor, Program and Policy Section, Medicaid and CHIP Services Department, HHSC
- Michelle Long, Program Specialist, Medical and Social Services Division, HHSC

Item 5

Delivery System Reform Incentive Payment (DSRIP) Program Demonstration Years Seven to Eight (/sites/default/files//documents/abouthhs/
communications-events/meetings-events/mcac/082417-5.pdf)
HHSC proposes new rules to Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter D, Division 7, relating to DSRIP Program
Demonstration Years seven to eight, including §354.1691, relating to Definitions; §354.1693, relating to Regional Healthcare Partnerships (RHPs);
§354.1695, relating to Participants; §354.1697, relating to RHP Plan Update; §354.1699, relating to RHP Plan Update Review; §354.1701, relating to
RHP Plan Update Modifications; §354.1703, relating to Independent Assessor; §354.1705, relating to Categories; §354.1707, relating to Performer
Valuations; §354.1709, relating to Category A Requirements for Performers; §354.1711, relating to Category B Requirements for Performers;
§354.1713, relating to Category C Requirements for Performers; §354.1715, relating to Category D Requirements for Performers; §354.1717, relating
to Uncompensated Care Hospital Requirements; §354.1719, relating to Disbursement of Funds; and §354.1721, relating to Remaining Funds for
Demonstration Years seven to eight; Chapter 355, Subchapter J, Division 11, §355.8205, relating to DSRIP for Demonstration Years seven to eight; and
§355.8206, relating to Funding for DSRIP Monitoring Program for Demonstration Years seven to eight. On Dec. 12, 2011, the CMS approved Texas's
request for a new Medicaid demonstration waiver entitled "Texas Healthcare Transformation and Quality Improvement Program" in accordance with
section 1115 of the Social Security Act. The DSRIP program is one of the three main components of this waiver. The initial waiver was approved
through Sept. 30, 2016, and an initial extension was granted through Dec. 31, 2017. HHSC has requested an additional 21 months that would extend
the waiver through Sept. 30, 2019. The framework for DSRIP payments is governed by the Program Funding and Mechanics (PFM) protocol that is
referenced in the waiver's Special Terms and Conditions. HHSC developed the draft PFM protocol proposal for the requested additional 21 months
(demonstration years seven to eight) and submitted it to CMS on May 17, 2017. These proposed new rules closely mirror the PFM protocol proposal
that HHSC submitted to CMS.
- John Scott, Director of Operations, Texas Healthcare Transformation Waiver, HHSC

Item 6

Reimbursement Methodology for Certified Registered Nurse Anesthetists (/sites/default/files/documents/about-hhs/communications-events/meetingsevents/
mcac/082417-6.pdf)
HHSC proposes an amendment to TAC Title 1, Part 15, Chapter 355, Subchapter J, Division 12, §355.8221 relating to Reimbursement Methodology for
Certified Registered Nurse Anesthetists.
The proposed amendment adds Anesthesiologist Assistants (AAs) to the reimbursement methodology and adjusts the percentage payment for a
supervised anesthesia service for both Certified Registered Nurse Anesthetists (CRNAs) and AAs. CRNAs and AAs will be reimbursed the lesser of the
CRNA's or AA's billed charges or 50 percent of the calculated payment for a supervised anesthesia service. For example, if the calculated payment for
a supervised anesthesia service is $100, the payment to the CRNA or AA would be $50. Previously, both CRNAs and AAs were reimbursed at the
lesser of billed charges or 92 percent of the solo physician's reimbursement. In Texas, CRNAs and AAs may not practice independently and must
provide services under the supervision of a physician. There is an estimated fiscal impact for the proposed rule change. Additional rate adjustments
related to anesthesia conversion factors are anticipated to be effective Oct. 1, 2017.
- Megan Wolfe, Senior Rate Analyst, HHSC Rate Analysis

Item 7

Reimbursement Methodology for Preadmission Screening and Resident Review (PASRR) Specialized Services (/sites/default/files/documents/abouthhs/
communications-events/meetings-events/mcac/082417-7.pdf)
HHSC proposes a new rule to TAC Title 1, Part 15, Chapter 355, Subchapter C, §355.315, relating to Reimbursement Methodology for PASRR
Specialized Services. Effective Dec. 1, 2017, HHSC plans to implement an array of PASRR Specialized Services for Medicaid clients that reside in
nursing facilities as required by the CMS under 42 C.F.R. §§ 483.100 to 483.138. This rule project proposes the reimbursement methodology for those
services. HHSC will develop the payment rates for PASRR Specialized Services based upon rates for other programs that provide similar services. If
payment rates are not available from other programs that provide similar services, payment rates will be determined using a pro forma approach.
- Victor Perez, Director, HHSC Rate Analysis

Item 8

Amendments to Disallowance Provisions in Directed Payment General Provisions (/sites/default/files/documents/about-hhs/communicationsevents/
meetings-events/mcac/082417-8.pdf)
HHSC proposes amendments to TAC Title 1, Part 15, Chapter 353, Subchapter O, §353.1301, relating to General Provisions. In March of 2017, HHSC
adopted a series of rules governing delivery system and provider payment initiatives through Medicaid managed care organizations (MCOs). These
initiatives are, generally, funded through intergovernmental transfers from local governmental entities. Given that these programs are not funded
with state general revenue, HHSC must ensure, to the greatest extent possible, that no state dollars are at risk through the operation of these
programs. A disallowance by CMS is one potential risk to general revenue, unless HHSC can ensure that funds from another source are available.
Section 353.1301(j) describes the procedure HHSC would use in the case of a disallowance. The rule delineates between a disallowance for
impermissible provider-related donations and all other disallowances. At present, if there is a disallowance for impermissible provider-related
donations, the rule requires HHSC to recover the disallowed amount from transferring governmental entities responsible for the non-federal share
of the disallowed payments. If there is a disallowance for reasons other than an impermissible provider-related donation, HHSC reserves the right to
recoup the disallowed amount from MCOs, providers, or governmental entities.
In an effort to provide HHSC more flexibility when determining the appropriate entity from which to recoup, HHSC proposes to amend §353.1301 to
remove the requirement that it recover only from governmental entities in the case of a disallowance for impermissible provider-related donations.
Instead, HHSC will reserve the right to recoup from MCOs, providers, or governmental entities in any disallowance. In order to ensure that there is no
risk to general revenue, to the greatest extent possible, HHSC will require that if a recoupment for a disallowance results in a subsequent
disallowance, the entity that HHSC initially recouped against will face a recoupment for the subsequent disallowance.
In addition, HHSC will clarify the heading for §353.1301(k) by changing the name from "Recoupment" to "Overpayment."
- Charles Greenberg, Director of Policy, Office of Chief Counsel, HHSC

Item 9

Amendments to Uniform Hospital Rate Increase Program (/sites/default/files/documents/about-hhs/communications-events/meetingsevents/
mcac/082417-9.pdf)
HHSC proposes amendments to TAC Title 1, Part 15, Chapter 353, Subchapter O, §353.1305, relating to the Uniform Hospital Rate Increase Program.
In March of 2017, HHSC adopted rules governing a provider payment initiative through Medicaid MCOs called the Uniform Hospital Rate Increase
Program (UHRIP) (42 TexReg 13). Under the UHRIP initiative, a service delivery area (SDA) may apply to receive an increase in certain hospital rates
which would vary by class of hospital. Although UHRIP was supposed to begin in September 2017 and be available to any SDA, operational issues
necessitated a delay. Such issues included lack of readiness by MCOs, lack of program understanding among providers, and incomplete approvals
from the CMS. HHSC proposes to amend the UHRIP rules in three ways.
First, HHSC proposes to amend §353.1305(b)(7) and (8), the definitions of "rural private hospital" and "rural public hospital" to be consistent with a
revised definition of "rural hospital" that was adopted earlier this year in §355.8052 (relating to Inpatient Hospital Reimbursement). The definitions in
this rule would now refer to the definition of "rural hospital" in §355.8052.
Second, HHSC proposes to add §353.1305(k) which would allow for a limited Dec. 1, 2017, entry into UHRIP for a subset of SDAs. Specifically, if HHSC
received an approval from CMS for any particular SDA by April 15, 2017, that SDA would be able to participate in UHRIP for dates of service beginning
Dec. 1, 2017.
Third, HHSC standardizes references to SDAs throughout the section.
- Selvadas Govind, Director for Hospitals, HHSC Rate Analysis

Items 10, 11, & 13

10. Nursing Facility Applications and Informal Reviews (/sites/default/files/documents/about-hhs/communications-events/meetings-events/mcac/082417-
10.pdf)
The Department of Aging and Disability Services (DADS) proposes to amend TAC Title 40, Part 1, Chapter 19, Subchapter C, §19.212, relating to Time
Periods for Processing License Applications; and Subchapter X, §19.2322, relating to Medicaid Bed Allocation Requirements.
The proposed amendments clarify the deadline for HHSC to receive a nursing facility license application. The proposed amendments also allow
HHSC to pend an application for up to six months to allow an applicant to comply with licensure requirements. The proposed amendments further
enable HHSC to pend an application for renewal if the facility is subject to a proposed denial or pending licensure revocation.
In addition, the proposed amendments also allow an existing nursing facility to request an informal review when the nursing facility has been denied
an increase in Medicaid bed allocations or was subject to decertification or de-allocation of Medicaid beds.
- Bobby Schmidt, Manager, DADS Regulatory Services

11. Public comment

13. Adjourn