1. Health Care Policy Update
August 10, 2016
Elizabeth LaMair

2. HHS System Transformation
Overview
Managed Care Updates
1115 Waiver
HHS System Transformation

3. Managed Care Updates – Things Every Consortium Should be Talking About
Quick Reference Guide for Medicaid and CHIP Managed Care -- New chapters will be published in September:
Electronic Visit Verification (EVV)
FQHCs and RHCs
Health Homes
Members with Special Healthcare Needs (MSHCN)
Preadmission Screening and Resident Review (PASRR)
Service Management for MSHCN
Telemedicine & Telehealth

4. Managed Care Updates – New Procurements
Two upcoming HHSC managed care procurements
CHIP RSA -- start date 9/1/18
STAR+PLUS DFW –- start date 2/1/19

5. Managed Care Updates – STAR Kids
Program still on track for 11/1/16 start date
Check the HHSC website for member and provider FAQs, provider training and tips, upcoming information sessions and enrollment events
New continuity of care and screening and assessment (SAI) requirements

6. 1115 Waiver – Future Extensions
HHSC expects that discussions will begin after the CMS reviews the UC Study
Agency understands that Community Centers serve a large percentage of uninsured through DSRIP, and is pressing to preserve this structure
CMS will attend the 1115 Waiver Summit in August
HHSC has a clear understanding that a large percentage of the populations served through CC DSRIP projects is uninsured
Summit will be a chance for the agency to highlight the DSRIP program accomplishments to CMS leadership

7. 1115 Waiver Updates – DSRIP Rules
HHSC published the 2nd set of draft rules on DSRIP DY6 on 7/29/16
The draft rules closely mirror the DSRIP Program Funding and Mechanics (PFM) Protocol language that HHSC posted on 6/8/16
Pubic Hearing on 8/26/16 at the Brown Healty Building in Austin
Send comments by 8/25/16 to Jolene Rasmussen at

8. 1115 Waiver Updates – UC Study
CMS required an independent evaluation of uncompensated care (UC) costs and Medicaid hospital payments
The purpose of the study is to provide:
The impact of DSRIP funding on uninsured and Medicaid shortfall; and
An estimate of Texas hospital uncompensated care burden if the state fully funded Medicaid costs and if the state opted to expand Medicaid to low- income adults as allowed under the Affordable Care Act (ACA)
Draft report submitted to the CMS on 7/15/16, final report due 8/30/16
The study will help determine the size of the UC pool going forward. Will also impact DSRIP negotiations.

9. 1115 Waiver Updates UC Study – Total Uncompensated Care for Hospitals
$3.6B
Medicaid Shortfall
$5.3B
Uncompensated Care for Uninsured
$8.9B
Total Uncompensated Care

10. 1115 Waiver Updates Total UC Shortfall
$8.9B
Total Hospital Uncompensated Care
$6.0B
Hospital DSRIP Funds & Expansion Savings
$2.9B Total UC Shortfall
Current UC funding amount of $3.1B (12 months).
HHSC is trying to make the case that $1.3 billion in DSRIP funds for hospitals should not be subtracted, making the total UC shortfall $4.2 billion.
HHSC does not anticipate significant changes to the final report

11. HHS Transition
July 22, 2016 – final HHS Transition Plan posted on HHSC website
Chief Deputy Executive Commissioner – oversees:
Medical and Social Services Division
State Operated Facilities Division
Chief Operating Officer – oversees:
Policy and performance, transformation, regulatory services, IT, financial services, procurement and contracting, system support services
DARS abolished 9/1/16, DADS abolished 9/1/17
Change – regulatory services moved under COO
Under the new structure, DARS will be abolished on September 1, 2016, when client services and vocational rehabilitation-related programs transfer to the Medicaid and Social Services Division and other programs transfer to the Texas Workforce Commission.
DADS will also be abolished on September 1, 2017, when its remaining functions transfer to the Regulatory Services and State Operated Facilities Divisions.

12. HHS Transition – Client Services
Medical & Social Services Division
IDD & Behavioral Health
Medicaid & CHIP
Health, Developmental & Independence Services
Access & Eligibility
Client services are placed under one Division at HHSC, effective 9/1/17