1. Opening Comments – Michael Vaclav, DDS, Medical Care Advisory Committee Chair
2. Comments from the Deputy Director for Policy Development – Kay Ghahremani, Health and Human Services Commission (HHSC)
3. Cost Containment Update – Gary Jessee, Assistant Commissioner for Access and Intake, and Teresa Richard, Director for Center for Policy and Innovation, Department of Aging and Disability Services (DADS)
4. Approval of Feb. 2012 Minutes

Information Items

5. Medicare Equalization Exemptions
   HHSC is amending 1 Texas Administrative Code (TAC) §354.1143 concerning the coordination of Medicaid with Medicare Parts A, B, and C (Medicare Equalization).  The amended rules authorize HHSC to make higher cost-sharing payments for dual eligibles for certain services if HHSC determines that a higher payment amount is necessary to ensure adequate access to care or would be more cost-effective to the state.
   Lisa Kirsch, HHSC
6. Default Assignment Process in Medicaid and Children’s Health Insurance Program (CHIP) Managed Care
   HHSC is amending 1 TAC §353.2, §353.403, §370.4, §370.301, and §370.303 regarding the default assignment process for primary care providers and dental home providers in  Medicaid managed care and the CHIP, and adding new §353.1001 and §353.1003 governing children’s Medicaid dental services.
   Scott Schalchlin, HHSC
7. Waiver Payments to Hospitals and for Physician Services
   HHSC is adding new 1 TAC §355.8201 and §355.8202 implementing the provider eligibility requirements and payment methodologies approved by the Centers for Medicare and Medicaid Services under the Texas Healthcare Transformation and Quality Improvement Program Demonstration Waiver. 
   Chris Dockal, HHSC
8. Hospital Specific Limit Methodology
   HHSC is adding new 1 TAC §355.8066 related to the hospital specific limit calculation as it applies to the disproportionate share hospital (DSH) program and the Texas Healthcare Transformation and Quality Improvement Program Demonstration Waiver. 
   Chris Dockal, HHSC
9. Disproportionate Share Hospital Reimbursement
   HHSC is amending 1 TAC §355.8065 to update the Texas DSH payment methodology in response to a petition for the adoption of a rule.
   Chris Dockal, HHSC

Notice of Proposed Rules/Action Items:

10. Inpatient Hospital Reimbursement
    HHSC proposes to amend 1 TAC §355.8052 to transition from the use of Medicare Severity Diagnosis Related Grouping to the All Patient Refined Diagnosis Related Grouping for hospital inpatient reimbursement.
    Chris Dockal, HHSC
11. Physicians/Other Practitioners 
    HHSC proposes to amend 1 TAC §355.8085, §355.8093, and §355.8281 to add language indicating that physicians specializing in internal medicine, family practice, or pediatrics will receive enhanced payments for certain evaluation and management services and vaccine administration services as a result of section 1202 of the Health Care and Education Reconciliation Act.  The enhanced payment will not apply to physician assistants, nurse practitioners or clinical nurse specialists. Additionally, the Medicaid reimbursement methodology for physician-administered drugs is added. 
    Megan Blood, HHSC
12. Licensed Midwives Services
    HHSC proposes to amend 1 TAC §354.1252 and §354.1253 to describe the conditions under which a licensed midwife (LM) may participate in the Texas Medicaid program and provide certain pregnancy and labor and delivery services. 
    Stacey Johnston, HHSC
13. Birthing Centers and Licensed Midwives
    HHSC proposes to amend 1 TAC §354.1261 and §354.1262 to remove language stating that the Texas Medicaid Program does not reimburse for services provided by an LM and amends language to allow HHSC to reimburse freestanding birthing centers for services that an LM has determined are required during the labor, delivery, and immediate postpartum periods.  Because Texas Medicaid is required to reimburse freestanding birthing centers and birth attendants separately, the amendment also adds language to prohibit services provided by an LM from being considered birthing center services.  The rules also require freestanding birthing centers in the Texas Medicaid program to be licensed to provide a level of service commensurate with the skills of the physician, certified nurse midwife (CNM), or LM, who acts as a birth attendant. 
    Stacey Johnston, HHSC
14. Midwives and Birthing Center Services Reimbursement
    HHSC proposes to amend 1 TAC §355.8161 and §355.8181 by adding a Medicaid reimbursement methodology for LM services; adding LMs as a provider type that can be reimbursed for services provided in a freestanding birthing center; and clarifying that enhanced payments to certain physicians will not apply to CNMs or LMs. 
    Brooke Jenkins, HHSC
15. Family Planning Reimbursement
    HHSC proposes to amend 1 TAC §355.8581 and repeal §355.8582, §355.8583, and §355.8584 to delete obsolete language and consolidate family planning reimbursement information.
    James Hollinger, HHSC
16. Cost Reports/Rate Setting
    HHSC proposes to amend 1 TAC §355.105, §355.112, §355.306, §355.308, §355.503, §355.505, §355.507, §355.509, §355.510, §355.511, §355.513, §355.5902, and §355.6907, to adopt uniform rules for how some providers may be automatically excused from submitting a cost report and to add Day Activity and Health Services to the Community-Based Alternatives (CBA) and Medically Dependent Children Program waiver programs. 
    Pam Robers, HHSC
17. Referring Provider Claim Information Requirements
    HHSC proposes to amend 1 TAC §354.1001 and §354.1121 by adding a requirement for providers to include the name and national provider identifier (NPI) of the eligible provider, the ordering or referring provider, and the supervised and supervising provider on a Medicaid claim submitted based on a referral or order based on the supervised provider's evaluation of the Medicaid recipient and adding a definition of NPI. 
    Don Mann, HHSC
18. Advisory Committees
    HHSC proposes to amend 1 TAC §351.3 by adding three new advisory committees, amending the title of one committee and updating the expiration date of one committee. 
    Judy Devore, HHSC
19. Mental Health Case Management
    HHSC proposes on behalf of the Department of State Health Services (DSHS) to repeal 25 TAC §§412.401 - 412.417 and proposes new 25 TAC §§412.401 - 412.416 related to requirements for providing mental health case management services and the requirement that mental health services for adults with bipolar disorder, schizophrenia, or clinically severe depression, and for children with serious emotional illnesses, be accomplished using disease management practices. 
    Ross Robinson, DSHS
20. Day Activity and Health Services
    HHSC proposes on behalf of DADS, new sections, amendments to certain sections, and the repeal of certain sections in 40 TAC Subchapter J, Eligibility, and Subchapter H, CBA Program, in Chapter 48, Community Care for Aged and Disabled; Chapter 51, Medically Dependent Children Program; and Chapter 98, Adult Day Care and Day Activity and Health Services Requirements, regarding the provision of day activity and health services.
    Corliss Powell, DADS
21. Home and Community-based Services
    HHSC proposes on behalf of DADS to amend 40 TAC §§9.153, 9.158, 9.166, 9.170, 9.174, 9.177, 9.178, 9.188, 9.189, and 9.190 regarding nursing assessments; medication administration; the review and update of a person directed plan; the submission of service plan claims; conflict of interest and financial impropriety toward an individual; certification by an appropriate fire safety authority for four-person residences; the use of restraints; and person-first language.  
    Corliss Powell, DADS
22. Nursing Facility Trust Fund Audit
    HHSC proposes on behalf of DADS Services to amend 40 TAC §19.405 and §19.2314 regarding the management of personal funds in nursing facilities.
    Corliss Powell, DADS
23. *Public Comment
24. Proposed Next Meeting - Thursday, Aug. 9, 2012 at 9 a.m.
25. Adjourn

*Public comment will be taken following each item, after a staff presentation, and/or before a vote on an action item.