MEDICAID IN THE LEGISLATURE
While there’s more work to be done, the 2015 Texas Leg- islature again responded to TMA’s call for simplification and protections in the Medicaid program. Among them:
• Senate Bill 207 by Sen. Juan “Chuy” Hinojosa (D-McAllen) outlines clear criteria for Medicaid fraud investigations by the Ofice of Inspector General, including clarifications that fraud does not include unintentional technical, clerical, or administrative errors.
• Senate Bill 760 by Sen. Charles Schwertner, MD (R-George- town), increases oversight and accountability of Medicaid HMOs’ network adequacy by, among other provisions, raising current Medicaid access criteria and suspending enrollment in health plans if they fail to maintain adequate networks.
• Senate Bill 200 by Sen. Jane Nelson (R-Flower Mound) re- organizes the Texas Health and Human Services Commis- sion and provides for a host of simplifications to Medicaid managed care, including streamlined enrollment and credentialing processes.
• House Bill 839 by Rep. Elliott Naishtat (D-Austin) ensures children have continued health care coverage when re- leased from a correctional facility by eliminating rules that cut off juveniles’ eligibility for Medicaid when they enter a detention facility.
errors meant five letters. With the new system, however, a single letter will list all of the corrections needed at once. The ACA requirement for Medic-
aid reenrollment was a large impetus for the changes, Ms. Scheib says. The March 24, 2016, deadline applies to physicians participating in traditional fee-for-service Medicaid and managed care.
The changes also follow HHSC’s
transition last summer to a new Med- icaid claims administrator after the state sued the former Medicaid con- tractor, Xerox, for fraud-related charg- es. With the switch to Accenture in August 2014, TMA officials say HHSC identified a number of problems that created unnecessary administrative burdens for physicians, including en- rollment and prior authorization de- lays, and the agency has since worked with Accenture to improve.
ONE-STOP CREDENTIALING SHOP HHSC officials say the enrollment upgrades on their end also will go a long way to help clear up credential- ing crunches on Medicaid HMOs’ end so they can maintain their networks. The agency is notifying health plans of physicians’ reenrollment status so HMOs can help with outreach, as well. “We want to make sure the networks are robust,” Ms. Scheib said. In addition, the 2015 legislature
passed TMA-backed Senate Bill 760 by Sen. Charles Schwertner, MD (R- Georgetown), which strengthens existing state requirements for expe- dited credentialing as part of an over- all plan to beef up Medicaid HMO network adequacy. The bill — which at press time still awaited Gov. Greg Abbott’s signature — increases over- sight and accountability of Medicaid HMOs’ network adequacy by, among other provisions, raising current Med- icaid access criteria and suspending enrollment in health plans if they fail to maintain adequate networks. Meanwhile, plans afoot to create a one-stop data repository for creden-
56 TEXAS MEDICINE August 2015
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76