You can call the Texas Medicaid hotline toll-free at: 1-800-252-8263. HHSC will work with stakeholders in the coming months both on the renewal request and the protocol changes. All rights reserved. CHIRP is a proposed directed payment program that provides increased Medicaid payments to hospitals for inpatient and outpatient services provided to persons with Medicaid enrolled in STAR and STAR+PLUS programs. The renewal continues Medicaid managed care statewide along with the Uncompensated Care pool and the Delivery System Reform Incentive Payment program . ARs or representative payees also may take Form H0025 to the client to complete. No prior authorization will be required on the COVID-19 lab test by Medicaid and CHIP health plans or by traditional Medicaid. A gap in coverage may lead to interruptions in access to medications, therapies, and other medical treatments. Texas Medicaid has a wide variety of programs that help low-income women, families, seniors, and kids stay healthy, including: . If you use the Consumer Directed Services (CDS) option, you or your LAR should work with your MCO and service coordinator or case manager to develop a backup plan if you dont have one. ES. To serve as a document for an AR's acknowledgement of an AR's responsibilities. No waiver of freedom of choice is authorized for family planning providers. This is an in-person and virtual hearing. A gap in coverage may lead to interruptions in access to medications, therapies, and other medical treatments. Temporary Change on Living in Same Home Prohibitions. The program is limited to publicly-owned and operated community mental health clinics, local behavioral health authorities, and local mental health authorities, local health departments, and public health districts. Two programsMedicaid and the Childrens Health Insurance Program (CHIP)provide health care coverage for more than 5 million Texans; primarily children, pregnant women, and seniors and people with disabilities who are in or near poverty. Delayed or skipped treatment often leads to worsening conditions and. Click here for instructions on opening this form. Unless specifically indicated in the DY7-10 MBP as only a DY7-8 or DY9-10 requirement, all requirements apply to DY7-10. All Medicaid laws, regulations and policies apply to the Demonstration Expenditure authority except as expressly waived or listed as not applicable. Your health plan can cover teleservices, including in your home. What if I have questions about Texas Medicaid and CHIP renewal? Form H1010-R is sent with Form H1830-R during the two months before the review date. More information is available on the HRSA website. Your provider agency and MCO service coordinator must support you in developing those plans. Overview of Proposed Fast Track 1115 Extension Application, 2:00 p.m. HHSC Executive Council Meeting for Public Comment. for processing Supplemental Nutrition Assistance Program (SNAP) and Medicaid applications within federally-required timeframes was consistently above 90%. This is an in-person and virtual hearing. Form H1010-R is sent with Form H1830-R when the household has another Texas Works program up for renewal during the fourth month of a six-month certification or the 10th month of 12-month certification. To serve as a renewal/review application for Medical Programs in TIERS. They can also help you if you would like to apply for Medicaid and CHIP. Medicaid is currently working as it should, as a bulwark that supports families, including during an unprecedented national emergency such as the pandemic. These changes may include: Contact your provider to find out more information. HHSC should increase efficiencies in the administrative renewal process, which will go a long way to reducing workload for HHSC eligibility and enrollment staff, call center workers, and community-based assisters. To provide applicants and recipients the opportunity to register to vote. Benefit Coverage If you have a prior authorization that is set to expire in December 2020 it will be extended for 90 days. The letter is linked below. A summary of requirements in the revised draft and a summary of stakeholder feedback on the first draft of the DY7-8 PFM have also been posted. Poor planning or execution in Texas could trigger a mass disenrollment of, individuals from Medicaid. 1115 Transformation Waiver: Extension Application Public Hearing on June 2, 2021 at 10:00 am on the campus of UT Southwestern Medical Center, T. Boone Pickens Building, Auditorium, 6001 Forest Park Road, Dallas, Texas 75235. HHSC sought feedback on the 1115 Waiver Fast Track extension proposal posted below and submitted the proposal to CMS (see the CMS webpage for the Texas Healthcare Transformation and Quality Improvement Program). This draft PFM was submitted to CMS for approval. On June 23, 2016, CMS approved the DY6 Program Funding and Mechanics Protocol (PFM), which is Attachment J in the waiver's Special Terms and Conditions. Freedom of Choice - Section 1902(a)(23)(A) The State will deliver services authorized under the MDCP section 1915(c) waiver through the STAR Kids managed care model for those individuals not in state conservatorship. The PFM includes the requirements for participation in DSRIP during DY6. You or your legally authorized representative (LAR) should talk to your in-home care provider, service coordinator or case manager about what to do if your provider cant come to work because they are sick. Expenditures for the provision of HCBS waiver-like services as specified in Table 5 and Attachment C of the STCs that are not described in section 1905(a) of the Act, and not otherwise available under the approved State plan, but that could be provided under the authority of section 1915(c) waivers, that are furnished to STAR+PLUS enrollees who are ages 65 and older and ages 21 and older with disabilities, qualifying income and resources, and a nursing facility institutional level of care. Copyright 2016-2022. Before sharing sensitive information, make sure youre on an official government site. QIPP is a value-based directed payment program that provides incentive payments to eligible nursing facilities participating in the Medicaid STAR+PLUS program. Coming Soon: PA on the Portal Modernization Effective October 10, 2022. The program is proposed to begin on October 1, 2021, as a part of DSRIP transition. Texas managed care plans will be required to meet all requirements of section 1903(m) of the Act except the following: Section 1903(m)(2)(H) of the Act, Federal regulations at 42 CFR 438.1, to the extent that the rules in section 1932(a)(4) are inconsistent with the enrollment and disenrollment rules contained in STC 23(c) of the Demonstrations Special Terms and Conditions (STCs), which permit the State to authorize automatic re-enrollment in the same managed care organization (MCO) if the beneficiary loses eligibility for less than six (6) months. To offset the cost of covering additional people, Texas is receiving a 6.2 percentage point increase in its Federal Medical Assistance Percentage (FMAP) match for Medicaid . Due to these application processing issues, Texas HHSC took the rare step of pushing SNAP renewals out 6 months. Expenditure authority to allow Medicaid beneficiaries to exceed the $200,000 inpatient hospital benefit limitation for COVID-19 related stays. A central feature of Texas November 2020 application was stability through budget certainty for our health care systems across Texas in the midst of the ongoing public health emergency. Childrens primary and preventive Medicaid dent al services are delivered through a capitated statewide dental services program (the Childrens Dental Program) to most children under 21. The extension will also create financial stability for Texas Medicaid providers, as HHSC works to transition the valuable work identified through Delivery System Reform Incentive Payment (DSRIP) innovations. Unfortunately, before the pandemic, enrollment in Medicaid and CHIP was declining. 10/10/2022. TDD users can call: 512-424-6597. More information about vaccination is available on the Texas DSHS website. Safety net providers, already reeling from pandemic-related disruptions and demands, would face increased uncompensated care. Rural Access to Primary and Preventive Services. Due to these application processing issues, Texas HHSC took the rare step of pushing SNAP renewals out 6 months. The Build Back Better (BBB) legislation passed by the House would remove the connection between Medicaid enrollment and the federal PHE. Those children in state conservatorship who are eligible for the MDCP section 1915(c) waiver will receive those services through the STAR Health managed care program under the 1915(a) authority, rather than under the 1115 authority, and through contract with the STAR Health managed care organization. Changes to the RHP Planning Protocol for DY6A are consistent with the approved DY6 Program Funding and Mechanics Protocol. This extension request continues current budget neutrality policies through the end of the extended demonstration period. Texas Incentives for Physicians and Professional Services. Evaluation Design Below please find links to the submitted cover letter, application and interim evaluation report. The initial draft DY9-10 PFM along with a file showing a summary of proposed changes to the DY9-10 PFM is posted below. On April 22, 2020, the federal Health Resources and Services Administration (HRSA) launched a new COVID-19 uninsured program to support reimbursement to providers and facilities for testing and treatment of the uninsured. The plan includes milestones related to Health IT adoption and health information exchange (HIE), which will benefit stakeholders involved in and served by the 1115 waiver. For this reason, the Texas Health and Human Services Commission (HHSC), the legislature, and leadership must take necessary steps to: The stakes in Texas are high. Please see below for the extension approval letter from CMS and the Standard Terms and Conditions for the extension. The document below contains summaries of comments received during the statewide public meetings, including the webinar, that were held on the 1115 Waiver Extension Application. The STAR Kids Program provides acute and long-term service and supports to children with disabilities. Mail Form H1350 to a client who did not have a face-to-face interview who declines the opportunity to register to vote, based on receipt of Form H0025. These sessions are to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic. RAPPS focuses on the management of chronic conditions. State and federal government websites often end in .gov. Registered in U.S. Patent and Trademark Office. HHSC has submitted a state plan amendment to implement increased reimbursements for public ground ambulance services, which it intends to serve as a basis of a directed-payment program in managed care; in managed care, the estimated annual payments could be $150 million. There are no significant policy changes requested under this extension application. Effective Feb. 1, 2022, FMSAs can permanently conduct new employer orientation virtually (i.e. On Dec. 21, 2017, the Centers for Medicare and Medicaid Services approved a five-year renewal of the Texas 1115 Transformation Waiver from October 2017 to September 2022, Demonstration Years 7-11. Today, Texas serves over four million Texans through Medicaid and CHIP programs, and 95% are covered under the Medicaid managed care model. 2022 Every Texan. CHIRP is the successor to the Uniform Hospital Rate Increase Program, which is currently in its fourth year of operation. number to set up this interview. HHSC is conducting a public hearing to solicit feedback on the 1115 Waiver application. The bill also provides important. If you have any questions or need help with your Texas Medicaid or CHIP renewal, call Member Services: CHIP, STAR and STAR+PLUS: (877) 373-8977. Mail Code H-600 Texas Health & Human Services Commission. DPP BHS funds will be distributed to enrolled CMHCs who meet program requirements. This guidance will remain in effect until the end of the public health emergency (PHE). This decision appears to have improved SNAP timeliness for November, but it is still far below the norm (83% for new applications, and 25% for renewals). PO Box 13247 Beneficiary Groups, Eligibility Requirements, and Benefits The maximum financial resources for an individual are $4,000 and $6,000 for a couple. You can call the Texas Medicaid hotline toll-free at: 1-800-252-8263. Significant changes in care delivery due to COVID-19 may prevent Delivery System Reform Incentive Payment (DSRIP) program providers from achieving Category B goals for Medicaid and Low-Income or Uninsured (MLIU) Patient Population by Provider (PPP), improving Category C measures (pay-for-performance measures) of health care quality, and earning related incentive payments. Also posted is a summary of DY7-8 requirements. TIERS mails Form H1010-R, which is pre-populated with basic client information. On Oct. 6, 2016, HHSC sent the letter below to CMS in advance of negotiations on the 1115 Waiver extension. STAR+PLUS provides acute and long-term service and supports to older adults and adults with disabilities. The current evaluation design includes 5 evaluation questions and 13 hypotheses. Benefits Please note that the meetings are listed in the document alphabetically by city, rather than by date. Prescreening Tool. The household completes the form when reapplying for TANF, Medical Programs and SNAP. In the months leading up to the pandemic, SNAP and Medicaid timeliness was far lower than the norm. During any temporary closure of schools for in-person classroom attendance, schools may continue to provide instruction using alternative methods of delivery such as telemedicine or telehealth. If a state follows these provisions, it will receive a 3.0 percentage point FMAP increase through June and a 1.5 percentage point increase through September 2022. people who will lose coverage for procedural reasons once states are allowed to restart Medicaid disenrollments in 2022, and. To avoid further overloading Texas eligibility and enrollment systems, HHSC should follow federal guidance and limit the number of renewals they attempt in any given month after the Medicaid continuous coverage provision is lifted. In response to COVID-19, HHSC requires all health plans to extend the timeframes for the number of days members, legally authorized representatives or authorized representatives can request an appeal through Nov. 30, 2022: Effective July 1, 2021, health plans must enforce the normal, regular and established timeframes that members have to request for continuation of benefits. Persons age 65 and older, and adults age 21 and older, with physical disabilities that qualify as SSI eligibles and meet the nursing facility LOC as defined by the state. Start tool. Coverage losses of this magnitude would be devastating for the low-income children and families who rely on Medicaid and would only deepen existing racial and ethnic disparities. audio-visual) in addition to allowing in-person orientations, based on member preference. The overarching goal of these guardrails is to minimize the number of eligible people who lose Medicaid for a procedural reason. P.O. Pursuant to CMS direction, HHCS has submitted that document for re-approval. The Standard Terms and Conditions for the 15-month waiver extension require Texas to submit a report conducted by an independent evaluator of the state's Uncompensated Care program that studied the impact of the UC pool on overall UC in the state, Medicaid provider rates, Medicaid beneficiary access to services, and a number of other areas. Texas advocates have made specific recommendations to HHSC on how it can best achieve these goals by creating a comprehensive plan that follows federal law, regulations, guidance, and established best practices. The program includes testing and treatment provided on or after Feb. 4, 2020 and began accepting claims May 6, 2020. HHSC has encouraged health plans to use this option when responding to COVID-19. E-mail inquiries should be sent to: [email protected]. Through a collaborative process, a waiver agreement was reached between CMS and Texas effective January 15, 2021. Texas Health & Human Services Commission. Similar coverage losses have been seen in other states where renewals were temporarily suspended. The final, approved DY9-10 PFM and an accompanying file showing final provider DY9-10 valuations and Minimum Point Thresholds (MPTs) is also included below. Texas HHSC must take all necessary steps to transition these individuals to other programs for which they may be eligible, such as CHIP, Healthy Texas Women, and the ACA Health Insurance Marketplace, and to reduce the number of individuals who become uninsured following a Medicaid denial. To serve as a screening document for advisors to make necessary referrals to other agencies. You can also call 2-1-1. Austin, Texas 78711-3247, [email protected], Fax The extension does not make any changes to eligibility requirements. Delivery of Medically Dependent Children Program (MDCP) Services. Expenditures Related to Managed Care Organization (MCO) Enrollment and Disenrollment. Without careful planning and execution by HHSC, resuming routine Medicaid renewals and disenrollments could cause widespread harms that ripple through the state and its health care system. Through QIPP, MCOs are directed to make payments to eligible nursing facilities once the facilities demonstrate meeting the required goals. Expenditures for the provision of state plan benefits and HCBS like services to individuals age 65 and older, or age 21 and older with disabilities, not eligible for these benefits under the state plan, who would otherwise be Medicaid-eligible under section 1902(a)(10)(A)(ii)(VI) of the Act and 42 CFR 435.217 in conjunction with section 1902(a)(10)(A)(ii)(V) of the Act, if the services they receive under STAR+PLUS were provided under a HCBS waiver granted to the State under section 1915(c) of the Act. This is a guest blog by Melissa McChesney, health policy advisor for UnidosUS. This request to extend preserves the innovations, collaboration, and improved value of care through a continuous extension through 2030 of our current demonstration period. The approach that HHSC takes over the next several months is critical. A link to the webcast and virtual registration for commenters wishing to provide testimony during the hearing will be included in the agenda posted in the Texas Register and on the HHSCs website. The renewal continues Medicaid managed care statewide along with the Uncompensated Care pool and the Delivery System Reform Incentive Payment program pool. Therefore, this application also requests that the Secretary exercise his authority under 42 CFR 431.416(g) to waive certain notice procedures in order to expedite a decision. Agent tip: "In 2022, if you have more than $8,400 in financial resources, or $12,600 as a married couple, you may not qualify for any Medicare Savings Program.". Before sharing sensitive information, make sure youre on an official government site. The extension years better align the DSRIP transition timeline with the overall goals to create a sustainable, integrated managed care program. HHSC must also ensure that individuals who are no longer eligible for Medicaid are successfully transitioned to other coverage options. All rights reserved. Enrollment HHSC will review and modify current MMC measures to examine access to care, care coordination, quality, outcomes, and satisfaction, as applicable to the new populations and/or benefits. Expenditures Related to COVID-19 Response. HHSC will submit a revision to the CMS-approved evaluation design incorporating these edits following approval of the THTQIP extension. On July 14, 2021, Texas submitted to CMS its request to extend and to amend the Texas Healthcare Transformation Quality Improvement Program waiver under section 1115 of the Social Security Act. Additional inpatient hospital care during COVID-19 Public Health Emergency. The evaluation design will include at least one evaluation question and corresponding hypothesis for each demonstration component under the 10-year extension (the new DPPs, MMC, PHP-CCP and UCC, and the Overall Demonstration). The extension request includes a reassessment of the charity care pools. The initial draft Demonstration Year (DY) 7-10 MBP, an accompanying Excel file of Related Strategies, the summary of stakeholder feedback on the initial draft DY7-10 MBP, and the revised DY7-10 MBP incorporating changes from stakeholder feedback is posted below. Prioritizing visits for younger children, especially those due for routine vaccines. 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