Medical Care Advisory Committee
August 9, 2012
Department of Aging and Disability Services
Public Hearing Room
701 West 51st St.
- Opening Comments: Michael Vaclav, DDS, Medical Care Advisory Committee Chair
- Comments from the Deputy Executive Commissioner for Health Services Operations: Billy Millwee, Health and Human Services Commission
- Approval of May 2012 Minutes
The Texas Health and Human Services Commission (HHSC) is adding 1 Texas Administrative Code (TAC) §354.1133 and amending 1 TAC §380.207, related to the Medical Transportation Program (MTP). The proposal requires a parent, guardian, or another adult authorized by a parent or guardian to accompany a child who receives an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) service (known in Texas as Texas Health Steps) or who receives a service or benefit provided by MTP. The authorized adult cannot be a provider of EPSDT or MTP services for which reimbursement is sought or an affiliate of a provider of such services. - Dimitria Pope, HHSC
NOTICE OF PROPOSED RULES/ACTION ITEMS:
The Texas Health and Human Services Commission proposes to amend 1 TAC §§380.101, 380.203, 380.205, 380.209, and 380.301 related to the Medical Transportation Program (MTP). The proposal eliminates the use of advanced funds in MTP and uses contracted lodging and meal services and reimbursement for verified mileage expenses for all clients. - Dimitria Pope, HHSC
The Texas Health and Human Services Commission proposes new Chapter 352 and the repeal of 1 TAC §§354.1006, 354.1173, and 354.1442 related to provider enrollment. The proposal will bring Texas Medicaid into compliance with the new federal provider enrollment requirements for Medicaid and the Children’s Health Insurance Program. These requirements include requiring providers to re-enroll every 3-5 years; pre- and post- enrollment site visits; stricter ownership and control interest guidelines for corporations and groups; background checks; collection of enrollment fees from certain entities; and sharing information between the state programs and the federal government. - Marianna Zolondek, HHSC
The Texas Health and Human Services Commission proposes new 1 TAC §§371.1001, 371.1003, 371.1005, 371.1007, 371.1009, 371.1011, 371.1013, 371.1015, and 371.1017, concerning provider enrollment requirements for Medicaid and other health and human services (HHS) programs in Texas and the repeal of 1 TAC §§371.1000, 371.1621, 371.1623, 371.1625, and 371.1627. New rules for provider enrollment are necessary to bring Texas Medicaid into compliance with new federal requirements. The proposed new rules delete unnecessary language, revise or eliminate obsolete terminology, and provide better and more helpful organization. The proposed repeals place the rule information in a more appropriate location with other provider enrollment requirements. - Karen Nelson, Office of the Inspector General, HHSC
The Texas Health and Human Services Commission proposes to amend 1 TAC §§354.1801, 354.1803, 354.1809, and 354.1811; add new 1 TAC §§354.1807 and 354.1813; and to repeal 1 TAC §§354.1802, 354.1804, 354.1807, 354.1813, and 354.1815 concerning the Vendor Drug Program pharmacy participation requirements. The proposal reflects new federal requirements including new enrollment and provider integrity requirements for providers of Medicare, Medicaid, and Children’s Health Insurance Program services, including providers of covered outpatient drugs. Additionally, the proposal clarifies that pharmacies enrolled in the Medicaid program are not required to enroll in Medicare; adds a new enrollment requirement for central fill pharmacies; and clarifies that claims are subject to post payment review and recoupment if fraud is discovered. - Andy Vasquez, HHSC
The Texas Health and Human Services Commission proposes to repeal and replace 1 TAC §§354.1430 and 354.1432, concerning Telemedicine and Telehealth Benefits and Limitations; and add new 1 TAC §354.1436, concerning Telemonitoring Benefits and Limitations. The proposal expands services provided by use of advanced telecommunications services; changes the definition of telemedicine to allow providers of telemedicine services to be persons who are acting under physician delegation and supervision; creates a new telehealth benefit to allow providers who are licensed or certified health professionals acting within the scope of the health professional's license or certification to participate; and creates a new telemonitoring benefit that allows remote monitoring and transmission of a patient’s health data. - Don Mann, HHSC
The Texas Health and Human Services Commission proposes to amend 1 TAC §357.17 related to fair hearings. The proposal verifies that a client receiving services through a managed care organization (MCO) must exhaust their MCO's expedited appeals process before making a request for an expedited fair hearing from HHSC. - Elizabeth LaMair, HHSC
- Reimbursement Methodologies for Early and Periodic Screening, Diagnosis and Treatment Dental Services
The Texas Health and Human Services Commission proposes to amend 1 TAC §355.8441 related to the reimbursement methodology for dental services. The proposal allows publicly-owned dental providers, including mobile dental units and clinics, to continue receiving additional federal funding under the Texas Health Care Transformation and Quality Improvement 1115 Waiver. - Rozsalind Brown, Rate Analysis Department, HHSC
The Texas Health and Human Services Commission proposes to amend §355.8141 related to the reimbursement methodology for hearing aid devices and services. The proposal adds reimbursement methodology language pertinent to hearing aid devices and services and eliminates outdated references to the Texas Department of Health and outdated program and policy language. - James Hollinger, Rate Analysis Department, HHSC
The Texas Health and Human Services Commission proposes new rules and amendments to Chapters 358, 359, 360, and 361 related to the treatment of income and resources in determining financial eligibility for Medicaid for the Elderly and People with Disabilities, Medicare Savings Programs, the Medicaid Buy-In Program, and the Medicaid Buy-In for Children Program. For purposes of this proposal, prepaid tuition programs and higher education savings plans are collectively called "tuition savings programs." Currently, HHSC excludes assets or resources in tuition savings programs when making eligibility determinations for Medicaid programs. This proposal would apply the exclusion to Medicaid programs for the elderly and people with disabilities. - Janice Quertermous, Office of Family Services, HHSC
- Discussion of the MCAC By-laws
- *Public Comment
- Proposed Next Meeting: Thursday, November 8, 2012 at 9 a.m.
*Public comment will be taken following each item, after a staff presentation, and/or before a vote on an action item.
Contact: Carol Chavez, Committee Coordinator, Medicaid and CHIP Division, 512-491-1763, FAX 512-491-1953, firstname.lastname@example.org.
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 Chavez at 512-491-1763 at least 72 hours before the meeting so appropriate arrangements can be made.