The Weekly Insight: February 13, 2017

13th Feb 2017

The Weekly Insight: February 13, 2017

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This past week saw very little in the way of Legislative activity, however that does not mean the week did not have some significant policy moments.


The Week in Review: February 6-10

The State Medicaid Managed Care Advisory Committee met and discussed expedited credentialing and the need to involve long term services and support providers, which presently the system does not however HHSC stated that LTSS will be included in future discussions. There was also discussion about including Consumer Directed FMSAs (financial services providers).

Carving in the formulary into MCOs as their responsibility was discussed at this meeting and other meetings. This seems to be finally getting wheels. The state has insisted on using one state formulary until recently. The hurdle appears to be the supplemental rebates and how that will work when the health plans are receiving them.

The need for end of life engagement in quality and value of health care was discussed. Lastly, provider enrollment and credentialing are still high priorities for the provider groups.

The Palliative Care Interdisciplinary Advisory Council met where two policy considerations were discussed. The Committee believes that the draft of SB512 and HB995, 85th Legislature, are significantly deficient allowing, among other things, people with legal power of attorney to overrule doctors, in essence allowing them to practice medicine. The Council also is in significant opposition to Sunset language related to the Board of Pharmacy and Board of Medical Examiners that exempts physicians and palliative care providers from prescription monitoring, believing that it is too narrow. Palliative care providers serve more than cancer patients and in different settings. The language as proposed is too narrow.

The Hospital Payment Advisory Committee met to address to items that were informational, since they had already been published in the Texas Register. The first rule related to general provisions in managed care entities and using them to channel funding through for local projects. The second and more significant item addresses the ability of the state to change the rates and direct the changing of rates for hospitals in several different categories.  Flowing additional funds for hospital services prospectively through managed care entities, rather than retrospectively reimbursing hospitals for services provided but not fully reimbursed through Medicaid, would increase the ability of the state and its managed care contractors to pursue approaches to provider reimbursement that prioritizes achieving health outcomes versus the delivery of services. There are broad policy implications as this can be used as a mechanism in dealing with a Medicaid shortfall since the ability to use Uncompensated Care funds for this purpose was taken away by CMS. There are some considerations currently being discussed that would look at the spell of illness limitation under Medicaid and this could be a mechanism for addressing this issue perhaps.

The Week Ahead: February 13-17

Texas Insight will be covering the following meetings this week:

February 13, 2017

House Appropriations Committee

7:30 am

Texas Brain Injury Advisory Council (webcasting available)

11:30 am — Austin

February 15, 2017

House Appropriations Committee (Medicaid, Behavioral Health, Child Protective Services)

7:30 am — Austin

February 16, 2017

Medical Care Advisory Committee (webcasting available)

9:00 am — Austin

Proposed Medicaid Payment Rates for the Special Review of Ambulatory Surgical Centers and Hospital Ambulatory Surgical Centers (webcasting available)

1:30 pm — Austin

Proposed Medicaid Payment Rates for the Medical Policy Review of Respiratory Equipment and Supplies (webcasting available)

1:30 pm — Austin

Proposed Medicaid Payment Rates for the Medical Policy Review of Mobility Aids (webcasting available)

1:30 pm — Austin

PUBLIC HEARING NOTICE: Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Review (webcasting available)

1:30 pm — Austin

PUBLIC HEARING NOTICE: Proposed Medicaid Payment Rates for the Quarterly Healthcare Common Procedure Coding System Updates (webcasting available)

1:30 pm — Austin

House Appropriations begins deliberations while Senate Finance is addressing Articles IV (Judiciary), VII (Business and Economic Development), and VIII (Regulatory). Texas Insight will not be covering meetings addressing Articles IV, VII, or VIII.

This summary contains supplemental information from reliable sources where that information provides clarity to the issues being discussed. Power Point tables used in the presentations may also be used in this summary. Names of individuals may be misspelled but every attempt has been made to ensure accuracy. Tables and Text have been used from executive and legislative agencies and departments’ presentations and publications.

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