Items 1 & 3

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

3. Approval of August 24, 2017, meeting minutes (Vote required)

Item 2

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

Item 4

Reform of Cost Reporting Process for Home and Community-based Services (HCS), Texas Home
Living (TxHmL), and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related
Conditions (ICF/IID) Providers

HHSC proposes amendments to Texas Administrative Code (TAC) Title 1, Part 15, Chapter 355, Subchapter
A (relating to Cost Determination Process) § 355.102, §355.105, and §355.112; Subchapter D (relating to
Reimbursement Methodology for Intermediate Care Facilities for Individuals with an Intellectual Disability or
Related Conditions (ICF/IID) §355.456; and Subchapter F (relating to Reimbursement Methodology for
Programs Serving Persons with Mental Illness or Intellectual or Developmental Disability) §355.722, and
§355.723.

Effective January 1, 2018, HHSC plans to implement a cost report reform initiative for HCS and TxHmL and
ICF/IID providers by requiring only even-year cost reports beginning with the providers’ 2018 fiscal year cost
reports. These proposed amendments are at §355.105(c)(1) for ICF/IID providers and at §355.722(a) for
HCS and TxHmL providers. This change requires HHSC to also propose amendments to §355.102(d) so
that all providers attend state-sponsored cost report training every other year for the even-year cost report.
Current language requires providers to attend cost report training for odd-year cost reports.

A proposed amendment to 1 TAC §355.112(h)(2)(B) requires ICF/IID and HCS and TxHmL providers to
submit an Attendant Compensation Report for odd years beginning with the rate year that starts September
1, 2017. An amendment to §355.112(j) updates a citation related to completion of cost reports functioning as Attendant Compensation Reports in the ICF/IID program. Additionally, an amendment to §355.112(t)(2)
updates language regarding provider requests for recalculation of recoupment.

Finally, HHSC proposes to adopt new rule text at §§ 355.456(j)(8) and 355.723(f)(10) that will in effect repeal the Total Medicaid Spending Requirement in the ICF/IID reimbursement methodology and the HCS and
TxHmL reimbursement methodology beginning September 1, 2017. Providers who chose to receive the
Medicaid rates in effect on August 31, 2015, (i.e., providers who chose to “opt out” of the September 1, 2015, rate increases in order to be exempt from the Total Medicaid Spending Requirement) will receive the rates that were adopted effective September 1, 2015, effectively eliminating the rate differential between providers who “opted in” and providers who “opted out.”

- Victor Perez, Director, HHSC Rate Analysis for Long-Term Services and Support

Item 5

School Health and Related Services (SHARS)

HHSC proposes to amend Texas Administrative Code (TAC) Title 1, Part 15, Chapter 355, Subchapter J,
Division 23, §355.8443 (relating to Reimbursement Methodology for School Health and Related Services
(SHARS)).

SHARS is a joint program of HHSC and the Texas Education Agency that allows school districts to obtain
federal Medicaid reimbursement for the provision of health-related services to students in special education.
The proposed amendment will update the rule language to allow HHSC to retain one percent of the total
certified Medicaid allowable costs for direct medical services and transportation services in the SHARS
program to fund HHSC administrative activities, such as increased oversight of the SHARS program by
HHSC. This amendment is being proposed to comply with the 2018-19 General Appropriations Act (S.B. 1,
85th Legislature, Regular Session, 2017 (Article II, HHSC, Rider 34(a)(11))) and is intended to improve the quality and consistency of SHARS program compliance monitoring and audits and to provide school districts with enhanced technical guidance and feedback on SHARS program issues.

This proposed amendment is intended to reduce financial liability to HHSC and will allow HHSC to establish and maintain a SHARS audit reserve fund.

- Nadia Bobb, Rate Analyst, HHSC Rate Analysis for Acute Care Services

Items 6, 12, & 13

6. Nursing Facility Life Safety Code

HHSC proposes amendments to TAC Title 40, Chapter 19 (relating to Nursing Facility Requirements for
Licensure and Medicaid Certification) to implement the Centers for Medicare & Medicaid Services (CMS)
adoption of the 2012 edition of the National Fire Protection Association (NFPA) 101 - Life Safety Code (LSC) and 2012 edition of the NFPA 99 - Health Care Facilities Code. The CMS rules adopting these resources eliminate all references to the previously adopted 2000 edition of the LSC and require a nursing facility to comply with the 2012 NFPA 101 and 2012 NFPA 99.

The proposal replaces references to previous editions of NFPA 101 and NFPA 99 and revises and
reorganizes most rules in Chapter 19, Subchapter D, relating to Facility Construction. The proposal also
revises 40 Tex. Admin. Code § 19.1701, relating to Physical Environment, and 40 Tex. Admin. Code §
19.2208, relating to Standards for Certified Alzheimer's Facilities, to make the rule language consistent with the new federal language in the Code of Federal Regulations. The proposal places divisions in Subchapter D to further organize the subchapter. This reorganization makes the rules easier for nursing facilities and surveyors to navigate by having the applicable rules for a particular facility in one place.

- Calvin Green, Director Policy, Rules, and Training, LTC Regulatory, HHSC

12. Proposed next meeting: February 15, 2018, at 9:00 a.m.

13. Adjourn