State Medicaid Managed Care Advisory Committee (SMMCAC) Clinical Oversight and Administrative Simplification Subcommittee Agenda

1. Call to order, roll call, and introductions. The meeting was called to order by Alfonso Velarde The subcommittee seeks to strengthen the oversight of utilization management practices to include prior authorization policies and processes used by manage care organizations (MCOs). Focuses on reducing Medicaid provider burden through administrative improvements in four areas: claims payments, eligibility information, provider enrollment processes and prior authorization submissions. Prior authorization discussions will focus on provider process issues and Health and Human Services Commission (HHSC) oversight of MCO prior authorization data. Also discusses specific Medicaid medical benefits as needed. In addition to the chair, members in attendance: Anthony Brocato, Janet Concha, Yulanda Haynes-Mims, Lindsey Vasquez, MD A quorum was present. 2. Managed care organization (MCO) credentialing requirements--Wesley Crow, Senior Manager, MCCO-- All Medicaid MCOs must utilize the