Gary Jessee, Texas Medicaid Managed Care (MMC) Director, was the invited speaker but was unable to come as of the day before the meeting.
Instead, Monica Thyssen (Monica.Thyssen@hhsc.state.tx.us) and Rudy Villarreal (Rudy.Villarreal@hhsc.state.tx.us) from the MMC office attended. Monica said she would follow up with answers to all questions and both agreed to return with Gary Jessee at a later date to inform and discuss with the Coalition. Both also invited Coalition members to contact them with questions and concerns.
Some of the issues of discussion are listed below. I am leaving out the (many) questions/issues that Monica and Rudy agreed to check on. Some things just need a policy decision from the Director, so we will work on that too.
Texas Medicaid is now engaged in a federally mandated provider re-enrollment process with a deadline in March 2016. Of thousands of providers, only 200 have submitted re-enrollment.
It was recommended that Matt Ferrara be included when Gary Jessee attends a Coalition meeting, particularly in relation to the SUD High-Density Learning Collaborative.
It was agreed that Coalition Steering Committee should plan a “HHSC Day with the Coalition.”
Rudy on Medicaid reimbursement rates. Basis of MMC contracts but no requirement that certain rates are paid. Only group that is tied to state Medicaid rate is nursing homes.
Rudy suggested that this webpage may be of interest re MMC contracts: http://www.hhsc.state.tx.us/medicaid/managed-care/umcm/
Rate setting for Medicaid at HHSC: staff look at a number of information points such as Medicare rates, other states, etc. and arrive at rates. Noted that the rates are not comparable to commercial BH rates.
HHSC does not have the authority to approve MMCO rates and schedules.
There is no analysis of access related to contracts and/or rates that go on at HHSC. There is no available vendor with this information “on the shelf” for Medicaid. Note from TCHM: off the shelf products for commercial markets are a start since evidence shows that Medicaid population needs are generally greater. HHSC has put on hold looking for an off the shelf model because of SB 760 on network adequacy.
Note from TCHM: Medicaid rates would go a long way to increase access in Medicaid and make MCOs pay attention.
Anecdotal stories are relevant especially until data are available
Perhaps there could be funding for a relevant study of rates and access.
HHSC staff paying attention to cross-agency planning, legislation, and leadership on BH.
MMCOs do not get penalized per se for PPE like hospitals do. MMCOs paid for care coordination but not the entity providing the hospital service. TCHM: MMCOs push for release of inpatient and community does not have services to support when released.
Rebecca Wells, PhD, UT School of Public Health in Houston, re evaluation of some DSRIP BH projects. Here are Dr. Wells slides: Tx_Healthy_Minds_2015_0112_Wells_handout
Discussion with Speaker staffer Heather Fleming re: MH Select Committee
Next time we will invite staff from Four Price’s office that was unable to attend meeting.