The following information was obtained from the March 4 issue of the Texas Register:
Public Notices
HHSC intends to submit to CMS a request to amend the STAR waiver program, which would expand the number of counties in six of the current Medicaid managed care service areas, combine the Harris and Harris Expansion service areas into one Harris Service Area, and form a new Jefferson Service Area.
The counties added to the Bexar, El Paso, Lubbock, Nueces and Travis Service Areas are: Bandera, Hudspeth, Carson, Deaf Smith, Hutchinson, Potter, Randall, Swisher, Brooks, Goliad, Karnes, Kenedy, Live Oak and Fayette. The single Harris Service Area will add the following counties: Austin, Matagorda and Wharton. The new Jefferson Service Area will comprise the following counties: Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker.
HHSC intends to submit to CMS a request to renew the NorthSTAR waiver program for the period beginning October 1, 2011, through September 30, 2013.
HHSC intends to submit to CMS a request for amendments to the three STAR+PLUS program waivers to expand the program waivers to include Bexar Service Area – Bandera county; Harris/Harris Expansion Service Area – Austin, Matagorda, and Wharton counties; Nueces Service Area – Brooks, Goliad, Karnes, Kenedy, and Live Oak counties; and Travis Service Area – Fayette County. A new service delivery area would be added and serve the following counties: Jefferson Service Area – Chambers, Hardin, Jasper, Jefferson, Liberty, Newton, Orange, Polk, San Jacinto, Tyler and Walker.
For more information about these notices, see the Texas Register.
Proposed Rules
HHSC proposes to amend Title 1, Part 15, Chapter 354, Subchapter A, Division 32, §354.1415, Vendor Requirements and Conditions for Participation; §354.1416, Eligibility Criteria; and §354.1417, Definitions for Texas Medicaid Wellness Program Services. The amendments would align HHSC’s administrative rules with its revised approach to health management and ensure that the Texas Medicaid Wellness Program complies with the requirements set forth in §32.057 of the Human Resources Code.
HHSC proposes to repeal Title 1, Part 15, Chapter 355, Subchapter J, Division 34, Disease Management Program. The repeal of Division 34 includes the repeal of §355.8640, Reimbursement for the Disease Management Program. An excerpt:
Division 34, §355.8640 describes the payment structure for the Medicaid disease management program, as well as the percentage of the disease management vendor’s fees that are placed at risk if the vendor does not meet targeted savings and performance measures. The payment structure and at-risk fee components are specific to the former disease management program, which HHSC is replacing with the successor Texas Medicaid Health Management program, also known as the Texas Medicaid Wellness Program. HHSC and the selected program vendor will negotiate a new payment structure, including new at-risk components and performance measures. HHSC proposes the rule repeal to avoid the potential confusion regarding the application of the rule to the successor program.
See the Texas Register for details about the proposed changes.
