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AGENDA:
Medical Care Advisory Committee
March 11, 2010
9 a.m.
Meeting Site:
John H. Winters Building
Public Hearing Room
701 W. 51st St.
Austin
Opening Comments – Linda Ponder, Medical Care Advisory Committee Chair Comments from the Associate Commissioner – Billy Millwee, Medicaid and CHIP Associate Commissioner, Health and Human Services Commission (HHSC) Approval of Jan. 2010 Minutes
NOTICE OF PROPOSED RULES/ACTION ITEMS:
HHSC proposes to amend §355.8021, Reimbursement Methodology for Home Health Services, under Title 1, Part 15, Chapter 355, Subchapter J, Division 2 of the Texas Administrative Code (TAC). The rule is revised to reflect the current reimbursement methodology and to delete information that is no longer applicable related to determining rates for home health agencies (HHA) and for durable medical equipment, prosthetics, orthotics and supplies. The proposed revision outlines the reimbursement methodology utilized to calculate Medicaid payment rates for therapy, nursing, and aide services for HHAs. The proposed language updates the list of sources that may be used to determine payment rates for these providers. The rule updates terminology and deletes obsolete information and references. James Hollinger, Rate Analyst, HHSC Rate Analysis for Acute Care Services HHSC proposes to add new §354.1070, Definitions, and amend §354.1071, Additional Claim Information Requirements, and §354.7072, Authorized Inpatient Hospital Services, in Title 1, Part 15, Chapter 354, Subchapter A, Division 6, relating to present-on-admission requirements, preventable adverse events, and potentially preventable readmissions. Senate Bill (S.B.) 203, 81st Legislature, Regular Session, 2009, requires the adoption of rules regarding the denial or reduction of reimbursement under the Medicaid program for preventable adverse events, sometimes referred to as “never events,” that occur in a hospital setting. S.B. 203 also requires that HHSC impose the same reimbursement denials or reductions for preventable adverse events as Centers for Medicare and Medicaid Services imposes in Medicare for the same types of health care-associated adverse conditions and the same types of health care providers and facilities. Patricia Hervey, Manager, HHSC, Medicaid Acute Care Services HHSC proposes to add new §354.1063, Preventable Adverse Events, within Title 1, Part 15, Chapter 354, Subchapter A, Division 5, Physician and Physician Assistant Services.
S.B. 203 (81st Legislature, Regular Session, 2009) directs HHSC to adopt rules regarding the denial or reduction of reimbursement for preventable adverse events, sometimes referred to as “never events,” that occur in a hospital setting. S.B. 203 also directs that HHSC impose the same reimbursement denials or reductions for preventable adverse events as the Medicare program imposes for the same types of health care-associated adverse conditions and the same types of health care providers and facilities. Patricia Hervey, Manager, HHSC, Medicaid Acute Care Services HHSC proposes to amend Title 1, Part 15, Chapter 355, Subchapter J, Division 4, § 355.8068, Supplemental Payments to Certain Urban Hospitals Section 355.8068 describes Medicaid supplemental payments to certain publicly owned or affiliated urban hospitals. HHSC is updating the language in the rule to: change the calculation period from a state fiscal year to a federal fiscal quarter; use claims adjudicated during the calculation period to compute supplemental payments (rather than claims with dates of service during the calculation period); provide for a fourth-quarter payment reconciliation; and detail the process by which HHSC will recover an overpayment. The amendment also adds information related to potential reductions to billed charges, used in the calculation of charge room, for claims that involve preventable adverse events and other similar circumstances. Finally, the rule amendment adds definitions for terms that were not previously defined. The proposed changes are consistent with recent changes to other administrative rules governing Medicaid supplemental payments to hospitals. The goal of the proposed changes is to present the payment calculation methodology in language and a format that is easier to understand and to clarify HHSC’s procedures in the event a recoupment is necessary.
Jill Seime, Senior Rate Analyst, HHSC, Rate Analysis Department Public Comment
Proposed Next Meeting – July 2, 2010 Adjourn
Contact: Jesse Rodriguez, Committee Coordinator, Medicaid/CHIP Division, 512-491-1382, FAX 512-491-1953, jesse.rodriguez2@hhsc.state.tx.us
This meeting is open to the public. No reservations are required and there is no cost to attend this meeting.
People with disabilities who wish to attend the meeting and require auxiliary aids or services should contact Rodriguez at 512-491-1382 at least 72 hours before the meeting so appropriate arrangements can be made.
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