Health Care Policy Update August 10, 2016 Elizabeth LaMair elamair@txcouncil.com 512-794-9268

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

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

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

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

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

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 jrasmussen@txcouncil.com

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.

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

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

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.

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