That's why it's important to know how and when you need to complete your Texas Medicaid renewal to ensure continued coverage. Members of the public must register for the meeting here. Subject to an overall cap on the Uncompensated Care (UC) Pool, the following expenditure authorities are granted for the period of the Demonstration: Through September 30, 2019, expenditures for care and services that meet the definition of medical assistance contained in section 1905(a) of the Act that are incurred by hospitals and other providers for uncompensated costs of medical services provided to Medicaid eligible or uninsured individuals, and to the extent that those costs exceed the amounts paid to the hospitals pursuant to section 1923 of the Act. The letter is linked below. Some forms cannot be viewed in a web browser and must be opened in Adobe Acrobat Reader on your desktop system. 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. This guidance is for individuals who are enrolled in the following programs: FMSAs may suspend providing face-to-face orientations for CDS employers through Jan. 31, 2022. Ensure individuals who are no longer eligible are successfully transitioned to other coverage such as CHIP and the Affordable Care Act (ACA) Health Insurance Marketplace, or to the Healthy Texas Women program. HHSC extended nursing facility minimum data set (MDS) assessment authorizations by 90 days for those expiring from April 2020 to May 9, 2021. In September 2021 the Urban Institute estimated that 1.3 million Texas enrolled in Medicaid at the end of 2021 would be ineligible and, therefore, disenrolled in 2022 when the continuous coverage provisions ended. HHSC must also ensure that individuals who are no longer eligible for Medicaid are successfully transitioned to other coverage options. The important thing to bear in mind is if a state cannot renew a beneficiary's Medicaid eligibility automatically, a renewal form, pre-populated or not, will be sent to the Medicaid recipient. This is a guest blog by Melissa McChesney, health policy advisor for, View specific recommendations made by Texas advocates to the Texas Health and Human Services Commission (HHSC) on how it can ensure eligible clients stay enrolled in their Medicaid coverage. You can call the Texas Medicaid hotline toll-free at: 1-800-252-8263. The DSRIP funding pool has been extended four years, through Sept. 30, 2021. On Aug. 19, 2016, HHSC sent a letter to CMS to facilitate discussions on the longer term extension of the Medicaid 1115 Demonstration Waiver. STAR is the primary managed care program providing acute care services to low-income families, children, pregnant women, adoption assistance and permanency care assistance, and former foster care children. Pending Applications include over $5 billion directed to hospital services (CHIRP); $600 million directed to physicians (TIPPS); $170 million directed to behavioral health services (BHS); $20 million directed to Rural Health Clinics (RAPPS); and $1.1 Billion directed to nursing facilities services (QIPP). How the virus spreads, symptoms, prevention and treatment. DPP BHS is a proposed value-based payment program to incentivize Community Mental Health Centers to continue providing services that are aligned with the Certified Community Behavioral Health Clinic model of care to persons enrolled in Medicaid STAR, STAR+PLUS, and STAR Kids programs. Anyone that helps to complete the application must initial the part completed, or sign the form showing that the assisting individual helped complete it as described in A-113, Application Assistance. Given the current state of the eligibility and enrollment systems in Texas, stakeholders have grave concerns about the impact that restarting Medicaid disenrollments will have on an already overloaded system. The extension years better align the DSRIP transition timeline with the overall goals to create a sustainable, integrated managed care program. On Oct. 6, 2016, HHSC sent the letter below to CMS in advance of negotiations on the 1115 Waiver extension. Changes to the RHP Planning Protocol for DY6A are consistent with the approved DY6 Program Funding and Mechanics Protocol. Re-sizing will allow for adjustments to uncompensated care pool based on actual charity care. HHSC and the Centers for Medicare and Medicaid Services have agreed to a 15-month extension of the Texas 1115 Waiver. On Jan. 19, 2018, CMS approved the DSRIP Protocols - the Program Funding and Mechanics Protocol and the Measure Bundle Protocol. These continue funding for current DPPs, launch new DPPs, and incorporate innovations from DSRIP into Medicaid managed care. These processes will ensure that budget neutrality will continue to support funding needs and flexibility moving forward. For example, Utah suspended renewals for its Childrens Health Insurance Program (CHIP) at the beginning of the pandemic, and when renewals resumed, an unprecedented 41% of children in the CHIP program lost coverage, the vast majority (around 89%) because of a procedural issue, not because the state determined they were no longer eligible. Ensure everything is filled in correctly, without any typos or absent blocks. The January 15, 2021, approved extension included STCs related to new processes and reporting requirements for the states Directed Payment Programs. Subject to CMS timely receipt and approval of all deliverables specified in STC 37 (Transition Plan for DSRIP Pool) relating to the creation and implementation of the sustainability plan and associated milestones for DSRIP transition, the following expenditure authorities are granted for the 9th and 10th years of the Demonstration (FFY 2020 and FFY 2021): Expenditures for incentive payments from DSRIP pool funds for the Delivery System Reform Incentive Payment Program. Further, the ongoing health risks associated with the pandemic make it of the utmost importance that Texas take the necessary steps to avoid massive coverage losses in 2022. TIERS mails Form H1010-R, which is pre-populated with basic client information. The last list will be sent at the beginning of January. To serve as a document for households to designate an authorized representative (AR). HHSC is also not proposing changes to hypotheses, data sources, statistical methods, and/or outcome measures for the evaluation of the UC Pool or components related to the overall impact of the THTQIP demonstration. To limit exposure to COVID-19, providers may adjust in-office medical and dental checkups. Beneficiary Groups, Eligibility Requirements, and Benefits CHIRP is the successor to the Uniform Hospital Rate Increase Program, which is currently in its fourth year of operation. Texas Medicaid has a wide variety of programs that help low-income women, families, seniors, and kids stay healthy, including: . Superior HealthPlan wants to help you get well and stay well. Waiver Authorities asked to complete a phone interview by calling 1-800-699-9075. The user-friendly drag&drop interface allows you to add or move areas. The Build Back Better (BBB) legislation passed by the House would remove the connection between Medicaid enrollment and the federal PHE. The extension request includes a request to create Public Health Provider-Charity Care Program. Amount, Duration, and Scope of Services - Section 1902(a)(10)(B), Freedom of Choice - Section 1902(a)(23)(A), Self-Direction of Care for HCBS Members - Section 1902(a)(32), 2:00 p.m. 1115 Waiver - Public Hearing webinar. APD/CCU is no longer the point of contact for completing renewal packets. While timeliness improved temporarily in 2020, SNAP timeliness for October 2021 was below 70% for new applications, and only 10% of SNAP renewals were processed in a timely manner. 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. Members who turn 21 on or after March 18, 2020 remain entitled to medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPDST) services, known in Texas as the Texas Health Steps Comprehensive Care Program. The bill also provides important. No waiver of freedom of choice is authorized for family planning providers. Contact your state Medicaid office for more information about Medicaid or CHIP renewal. Overview of Proposed Fast Track 1115 Extension Application, 2:00 p.m. HHSC Executive Council Meeting for Public Comment. The bill also provides important guardrails to determine how a state should resume Medicaid disenrollment. 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. When individuals lose Medicaid coverage, have a gap in coverage and then re-enroll, their health care costs are often, than if they received continuous coverage. Many of the other programmatic details discussed in this document will be worked out through amendments to the program protocols, which HHSC will work to submit to CMS in late 2015 - early 2016. The program includes testing and treatment provided on or after Feb. 4, 2020 and began accepting claims May 6, 2020. TIPPS funds will be distributed to eligible physician groups based on each physician groups achievement of performance requirements collected twice per year. To obtain a copy of the waiver attachments, ask questions, obtain additional information, obtain a hard copy of the waiver extension, or submit comments regarding this proposed extension application individuals may contact Amanda Sablan by U.S. mail Texas Health and Human Services Commission Attention: Amanda Sablan, Waiver Coordinator, Policy Development Support, PO Box 13247, Mail Code H-600, Austin, Texas 78711-3247, telephone 512-487-3446, fax Attention: Amanda Sablan, Waiver Coordinator, at 512-206-3975, or email at: [email protected] until December 27, 2020. Your healthcare provider will work with local public health officials to determine if you should be tested for COVID-19. In response to COVID-19, HHSC is also extending the timeframes for the following through Nov. 30, 2022: If the timeframe for a member to request a fair hearing would have expired in March 2022, they will have an extra 30 days from that expiration date to request a fair hearing. The second re-sizing will take place in DY16 to take effect in DY17 (FY2028). HHSC has submitted a request to the Centers for Medicare and Medicaid Services for an initial 15-month extension of the 1115 Medicaid Demonstration Waiver, as specified in the letter below. Every Texan is a nonpartisan nonprofit under federal tax guidelines. Texas Medicaid Application Pdf 2020-2022 - US Legal Forms All rights reserved. What if I have questions about Texas Medicaid and CHIP renewal? Please see below for the extension approval letter from CMS and the Standard Terms and Conditions for the extension. Under terms of this demonstration, the state provides managed medical assistance through the following programs. 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. ODDS. Work with your provider and your service coordinator or case manager to develop a backup plan if one is not in place. E-mail inquiries should be sent to: [email protected]. RAPPS funds will be distributed to enrolled RHCs who meet program requirements. Benefits Pursuant to CMS direction, HHCS has submitted that document for re-approval. Pool sizes are $3.1 billion in DY7-8, $2.91 billion in DY9, $2.49 billion in DY10, and $0 in DY11. All rights reserved. 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.". Approval of this Fast Track extension will sustain the achievements of the demonstration and support the needs of beneficiaries and Texans. View specific recommendations made by Texas advocates to the Texas Health and Human Services Commission (HHSC) on how it can ensure eligible clients stay enrolled in their Medicaid coverage here. This extension does not apply to current authorizations for one-time services, new requests for authorization or pharmacy prior authorizations. Health plans are currently identifying and informing eligible members of the option to upgrade, and conducting the STAR+PLUS HCBS Program assessment for program eligibility. HCBS for SSI-Related State Plan Eligibles. Rural Access to Primary and Preventive Services. Texas Health and Human Services Commission 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 . All rights reserved. At the Executive Waiver Committee held on May 14, 2015, HHSC outlined several proposed components on how to continue and strengthen the DSRIP program in the waiver renewal period. Under the BBB, states will continue to receive the 6.2 percentage point FMAP increase until April 2022, regardless of when the PHE expires (that declaration will continue to affect other important public health policies). 2022 Medicaid Renewal Process in ONE | Full Access High Desert Click here for instructions on opening this form. TTY users can call 1-855-889-4325. 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. Medicaid Continuous Coverage Extended with Renewal of the PHE Eligibility groups affected by the demonstration can be found beginning in Section C. BENEFICIARIES SERVED THROUGH THE DEMONSTRATION in the STCs. HHSC will work with stakeholders in the coming months both on the renewal request and the protocol changes. Beginning Aug.1, 2021 pharmacies will no longer provide early refills. Telehealth should be the primary modality for service coordination visits if in-person is not feasible. The Texas Health and Human Services Commission (HHSC) is extending these flexibilities through January 31, 2022, because it includes teleservices that are being analyzed in alignment with House Bill 4. Then, beginning in April, states may resume disenrollment of Medicaid beneficiaries who have either been determined ineligible or who simply missed a required step in the renewal process and can be disenrolled with no actual eligibility determination (a procedural denial). Freedom of Choice - Section 1902(a)(23)(A) number to set up this interview. Copyright 2016-2022. Hypotheses under the MMC component of the THTQIP extension evaluation will remain the same, but HHSC will update the study populations associated with each hypothesis to focus on recent or forthcoming changes in services or benefits provided to populations served under the THTQIP. We believe Texas can be the best state in the United States, and your support of our public policy work is an indispensable part of getting there. Eligibility 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. TDD users can call: 512-424-6597. The proposed waiver extension application is posted at the link provided below. The extension will not change the array of benefits provided under the current 1115 waiver authority. 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. Pursuant to the waiver's terms and conditions, Texas submitted a waiver extension request to the Centers for Medicaid and Medicare Services on Sept. 30, 2015. HHSC formally submitted the Transition Plan below to CMS on March 24, 2015. Below please find links to the submitted cover letter, application and interim evaluation report. The Build Back Better (BBB) legislation passed by the House would remove the connection between Medicaid enrollment and the federal PHE. Based on preliminary findings HHSC believes the THTQIP demonstration waiver is on track to meet its intended objectives. Texas Health & Human Services Commission. Medicaid is currently working as it should, as a bulwark that supports families, including during an unprecedented national emergency such as the pandemic. To serve as a document for an AR's acknowledgement of an AR's responsibilities. (Located between Inwood Road and Mockingbird Lane, and between Maple Avenue and Harry Hines Boulevard). 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. 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). If the BBB plan passes, HHSC should follow the guardrails outlined by the bill in order to reduce coverage losses of eligible beneficiaries and to draw down the additional FMAP dollars for the states Medicaid program from April through September 2022. The 21 additional months also allows for the 86th Legislature to respond to any federal changes and sufficient time for Texas to develop a new 1115 Waiver proposal. H0090-I. All 2022 Medicaid renewals must be processed in the OregONEligibility (ONE) system. Dedicating specific rooms for sick visits and well visits. Effective immediately service coordination visits may be completed in person when requested by the member receiving services. You feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19. TDD users can call: 512-424-6597. The Sign-Up Period at HealthCare.Gov Ends on January 15, How to Improve Texas Property Tax System Update, Consumer Protection in Private Health Care, Child and Adult Care Food Program (CACFP). A gap in coverage may lead to interruptions in access to medications, therapies, and other medical treatments. Children receiving SSI and disability-related (including SSI-related) Medicaid who do not participate in a 1915(c) waiver: these children will receive their state plan acute care services and their state plan long term services and supports (LTSS) through STAR Kids. Under the BBB, states will continue to receive the 6.2 percentage point FMAP increase until April 2022, regardless of when the PHE expires (that declaration will continue to affect other important public health policies). Also included below are the proposed changes to the DY9-10 PFM webinar along with the accompanying frequently asked questions documents, the summary of stakeholder feedback on the first draft DY9-10 PFM, and the revised DY9-10 PFM with changes made based on stakeholder feedback. When unable to administratively renew a persons Medicaid, HHSC must provide adequate time a minimum of 30 days for clients to return requested information and should accept reasonable explanations of inconsistencies or to allow for self-attestation of certain eligibility criteria for which documentation may be difficult for individuals to obtain. TIPPS is a proposed value-based directed payment program for certain physician groups providing health care services to persons with Medicaid enrolled in STAR, STAR+PLUS, and STAR Kids programs. For an individual to be eligible for HCBS services, the State must have determined that the individuals cost to provide services is equal to or less than 202 percent of the cost of the level of care in a nursing facility. The following Medicaid COVID-19 flexibilities have been extended through January 31, 2022. The Texas directed payment programs proposed within Medicaid Managed Care include: Comprehensive Hospital Increase Reimbursement Program. Note that unless indicated specifically as a requirement only for DY7-8, all previous DY7-8 requirements also apply to DY9-10. Expenditures Related to Managed Care Organization (MCO) Enrollment and Disenrollment. There are no significant policy changes requested under this extension application. Click here for instructions on opening this form. public health emergency (PHE) remains in force, Medicaid beneficiaries are generally able to maintain health coverage. Texas seeks the same agreement along with pending waiver amendments. 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. Please see the document "Waiver Renewal - Discussion of Key DSRIP Issues" posted below. PEMS Assistance Experiencing High Request Volumes. Texas will replace the DSRIP component of the evaluation with a component on the new DPPs, including evaluation questions assessing how the DPPs support providers transition from DSRIP; broaden the focus of the Medicaid Managed Care (MMC) component of the evaluation to incorporate evaluation questions on overall MMC performance over time; incorporate evaluation questions on the new PHP-CCP, including questions assessing the intersection between the existing Uncompensated Charity Care (UCC) pool and PHP-CCP; and incorporate additional evaluation questions assessing cost outcomes for the demonstration as a whole. School Health and Related Services (SHARS) are provided to students with a disability to ensure individuals benefit from special education programs. HHSC has updated the draft DY7-8 Measure Bundle Protocol and submitted it to CMS for review and approval. E-mail inquiries should be sent to: [email protected]. To the extent necessary, to enable the State to operate the STAR+PLUS program on a less than statewide basis. Quick Info. Expenditure authority for inpatient hospital stays related to COVID-19 to extend the 30-day spell of illness limitation described in the state plan for an additional 30 days to allow a Medicaid beneficiary to stay up to 60 days in a hospital. STAR+PLUS and MMP members who were discharged from a NF on or after March 18, 2020, currently do not reside in a NF, and still have NF Medicaid should reach out to their health plan for more information about requesting an upgrade to STAR+PLUS HCBS. A gap in coverage may lead to interruptions in access to medications, therapies, and other medical treatments. Similar coverage losses. More information is available on the HRSA website. Below please find links to the submitted cover letter, Extension Appendices, and Preliminary Evaluation Findings (Supplement A-Preliminary Draft Results). Below are some common questions about the renewal process and a list of resources that are available to help you get the care you need. Before sharing sensitive information, make sure youre on an official government site. The site is secure. Prioritizing visits for younger children, especially those due for routine vaccines. The program is proposed to begin on October 1, 2021, as a part of DSRIP transition. See Texas budget neutrality demonstration. Medicaid and CHIP Services Information for People Receiving - Texas The Childrens Dental program provides dental care to children under the age of 21. Poor planning or execution in Texas could trigger a mass disenrollment of, individuals from Medicaid. The maximum financial resources for an individual are $4,000 and $6,000 for a couple. QIPP is currently in its fourth year of operation. Learn more about the July 2021 Extension Application below. 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. 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. Delayed or skipped treatment often leads to worsening conditions andgreater use of high-cost care. 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. However, beginning in late 2019, high turnover of eligibility workers led to significant delays in processing applications. Extending the waiver will not have a significant impact on enrollment. The draft DY7-8 Measure Bundle Protocol contains proposed Category A Core Activities; the Category B system definition; Category C Measure Bundles for Hospitals and Physician Practices, Measures for Community Mental Health Centers, and Measures for Local Health Departments; and the Category D Statewide Reporting Measure Bundle for all provider types. Box 14700 Texas is requesting that in response to the public health emergency, CMS allow a one-time adjustment to budget neutrality to account for impacts of COVID-19 on enrollment and expenditures. 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. Before sharing sensitive information, make sure youre on an official government site. The programs include Comprehensive Hospital Increased Reimbursement Program, Texas Incentives for Physician and Professional Services Program, Rural Access to Primary and Preventive Services Program, and Directed Payment Program for Behavioral Health Services. HHSC is still in negotiations with CMS on the request for an additional 21 months (Jan. 1, 2018 through Sept. 30, 2019). This request to extend preserves the innovations, collaboration, and improved value of care through a continuous five-year extension of our current demonstration period. Updated authorities include the end of DSRIP in FFY 2021, COVID-19 related authorities, and the new Public Health Provider Charity Care Pool(PHP-CCP). Through a collaborative process, a waiver agreement was reached between CMS and Texas effective January 15, 2021. HHSC has updated the draft DSRIP PFM that describes proposed requirements for DSRIP participation in DY 7-8. Expenditures for the STAR+PLUS 217-Like HCBS Group. TANF and TANF Level Families Medicaid. Expenditures for all enrollees for inpatient hospital services that would not otherwise be covered under the State plan (as outlined in the STCs), and expenditures for prescription drugs for adults ages 21 and older enrolled in STAR or STAR+PLUS. STAR Kids. Childrens Dental. Form H1010-R is sent with Form H1830-R during the month before the last month of certification. HHSC seeks feedback on a draft request to extend and to amend the Texas Healthcare Transformation Quality Improvement Program waiver under section 1115 of the Social Security Act. Children receiving HCBS services through the Medically Dependent Children Program (MDCP) 1915(c) waiver: these children and young adults will receive the full range of state plan acute care services and state plan LTSS as well as MDCP 1915(c) HCBS waiver services through STAR Kids. Participation in DY 7-8 that individuals who are no longer provide early.... 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Beginning of January remove the connection between Medicaid enrollment and the Measure Bundle Protocol and submitted to! Review and approval the federal PHE will take place in DY16 to take effect in DY17 FY2028! Care pool based on each physician groups achievement of performance requirements collected twice per year Authorities asked to complete phone!
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