State Medicaid Managed Care Advisory Committee Complaints, Appeals, and Fair Hearings Subcommittee

Summary/Charge: Focuses on more effectively leveraging complaints data to identify potential problems in the Medicaid program, opportunities for improved MCO contract oversight and increasing program transparency. Also focuses on appeals and fair hearings processes, including implementation of an independent external medical reviewer. Members present: Karl Sarrao, Tyra Hinton,  Jane Concha, Yulanda Haynes-Mims Call to order, roll call, and introductions. The meeting was convened by Karl Sarrao, Chair. A quorum was present. Approval of May 2, 2024, draft meeting minutes. The minutes were approved as drafted. Update on new HHSC Medically Dependent Children Program medical necessity review process and denials Lisa B. Glenn, MD Senior Associate Medical Director Medically Dependent Children Program (MDCP) 1915 (c) waiver program Home and community-based services for individuals aged 20 years and under “Waives” off criteria for nursing facility or in-patie