Weekly Insight: January 30, 2017

30th Jan 2017

Lots happened in the Texas healthcare world last week, and there’s plenty coming up this week too. Here are all the reports from the past seven days:

Last Week

This past week witnessed several major events and meetings related to Health and Human Services in Texas.

On Tuesday,Value-Based Payment and Quality Improvement Advisory Committee, which provides a forum to promote public-private, multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid, other publicly funded health services and the wider health care system.  With most of the agenda items being presentations and trainings the major policy discussion occurred around Determinants in Population Health where the different social and non-medical issues in communities have to be addressed to implement successful prevention programs.  Also through the quality strategic planning presentation and then the subsequent Vision and Mission exercise, the stage was set to begin moving the Committee toward addressing quality based payment enhancements to existing programs and to develop new approaches.

Not discussed yet was the impact that any change to the Affordable Care Act might have including the Block Granting of Medicaid where the need for the state to manage meaningful quality based payments will become more critical.

On Thursday, The Intellectual and Developmental Disability (IDD) System Redesign Advisory Committee met.  The Committee was  created by Senate Bill (SB) 7 of the 83rd Texas Legislature (Regular Session) and advises HHSC on the implementation of the acute care services and long-term services and supports (LTSS) system redesign for people with intellectual and developmental disabilities.

There was considerable discussion about the State Supported Living Center Dental Pilot.  For some time now, DADS and HHSC have been in discussion about how to use the State Supported Living Centers to support community objectives.  One way that had been proposed involves using the SSLCs to provide services for residents of the community with services not easily available in the community.  For instance, SSLCs operate wheel chair and medical device repair and in some rural communities this is not easy to access.  There had been discussion about the SSLC filling that need.  This pilot is designed to address the dental needs of individuals who may have complex dental service demands and who cannot access a dentist in the community.  Many of the potential patients will need sedation dentistry and other specializations.  This effort would address those needs.  It is with cautious optimism that some members approached this concept.  They did not want the effort to simply be a way to continue the life of SSLCs.  Having observed this effort over some time, Texas Insight views this as a very viable option for community services that are not being met now.  Discussions have been ongoing with CMS over how to make this concept work.  There is potential to have the services provided by SSLC dentists while being served in clinics away from the SSLC.  This looks, at first blush, as a win for everyone.

Another issue that was thoroughly discussed is the IDD RFP.  HHSC released RFP # 529-16-0108B for the establishment of a pilot program involving a managed care strategy. Specifically, the pilot program is based on capitated payment to deliver Medicaid long-term services and supports (LTSS) integrated with Acute Care services under the Medicaid program to individuals with intellectual and developmental disabilities and related conditions (IDD) in accordance with the specifications contained in this RFP.  The IDD Pilot Program will be conducted in at least one but no more than four Regions as determined by HHSC based on the Regions proposed by Respondents. As previously stated, the number of eligible Pilot Participants per SDM is not to exceed 400 with the total number of Pilot Participants across the entire IDD Pilot Program not to exceed 1,600. Unfortunately since the RFP is in mid-procurement, HHSC was not free to answer very many questions.  Awards for the RFP are set for this spring.

The DayHab option under the new federal rules was also discussed.  HHSC has taken a small 180 degree turn on this issue now looking to keep DayHab providers as part of the mix but making them more relevant for community services and engagement.  This concept is represented in the agency Legislative Appropriations Request but that request will need refinement.  With HHSC set to appear before Senate Finance on Monday, that refinement will not be able to be included in the presentation.  Part of the issue is that because DayHabs are not regulated, no one knows for certain how many of them there are across the state.

In addition,  the Drug Utilization Review Committee and the Perinatal Advisory Committee met covering routine business.  Both these reports are still in development and under review.

This Week

Texas Insight will be covering the following meetings this week:

January 30, 2017

January 31, 2017

February 1, 2017

February 3, 2017

The Texas House has no hearings scheduled for the week.  The Texas Senate Finance Committee will meet on Article II, health and Human Services.  Texas Insight will be covering the hearings on Article II.