The user-friendly drag&drop interface allows you to add or move areas. Texas Health and Human Services Commission The recipient is also instructed to provide any required . State and federal government websites often end in .gov. The renewal continues Medicaid managed care statewide along with the Uncompensated Care pool and the Delivery System Reform Incentive Payment program . Your healthcare provider will work with local public health officials to determine if you should be tested for COVID-19. Added clarification about prior therapy criteria for clients with atopic dermatitis. Employer orientations scheduled through the end of Jan. 2022 will be virtual or by telephone. 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. A subsequent rebasing exercise to without waiver PMPMs is included effective FFY 2028 using FFY 2026 expenditures. Medicaid recipients who have renewals due during the pandemic will receive a notice from us on the next steps to take to maintain their Medicaid coverage after the pandemic ends. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The completed renewal form must be signed, dated, and returned to the Medicaid agency. The proposed waiver extension application is posted at the link provided below. On Jan. 19, 2018, CMS approved the DSRIP Protocols - the Program Funding and Mechanics Protocol and the Measure Bundle Protocol. Safety net providers, already reeling from pandemic-related disruptions and demands, would face increased uncompensated care. That's why it's important to know how and when you need to complete your Texas Medicaid renewal to ensure continued coverage. The extension request includes a request to create Public Health Provider-Charity Care Program. If schools are unable to provide instruction using alternative methods of delivery, families can work with their primary care provider and health plan to access needed services during this time. Persons age 65 and older, and adults age 21 and older, with physical disabilities that qualify as SSI eligibles and meet the nursing facility LOC as defined by the state. You or your legally authorized representative (LAR) should talk to your in-home care provider, service coordinator or case manager about what to do if your provider cant come to work because they are sick. Texas Health & Human Services Commission. The overarching goal of these guardrails is to minimize the number of eligible people who lose Medicaid for a procedural reason. Copyright 2016-2022. 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: TX_Medicaid_Waivers@hhsc.state.tx.us until December 27, 2020. People who are concerned that they might have COVID-19 should contact their healthcare provider via phone before going to a clinic or hospital to prevent spread in healthcare facilities. For more information, read about theTexas Healthcare Transformation and Quality Improvement Program on the federal Medicaid website. More information is available on the HRSA website. The Texas 1115 Medicaid Transformation Waiver is a five year waiver expiring on Sept. 30, 2016. This is a virtual-only meeting. It also means that states will continue to receive enhanced . 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. Budget Neutrality TTY users can call 1-855-889-4325. 9/02/2022. E-mail inquiries should be sent to: medicaid@hhsc.state.tx.us. The January 15, 2021, approved extension included STCs related to new processes and reporting requirements for the states Directed Payment Programs. HHSC is conducting a public hearing to solicit feedback on the 1115 Waiver application. Cost Sharing The waiver extension application submitted in Sept. 2015 was attached to the letter. HHSC is still in negotiations with CMS on the request for an additional 21 months (Jan. 1, 2018 through Sept. 30, 2019). Complete all necessary information in the required fillable areas. 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. All Medicaid laws, regulations and policies apply to this expenditure authority except as expressly waived or listed as not applicable. Beginning Aug.1, 2021 pharmacies will no longer provide early refills. 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. Beneficiary Groups, Eligibility Requirements, and Benefits Waiver Authorities However, beginning in late 2019, high turnover of eligibility workers led to significant delays in processing applications. The Biden Administration rescinded what's called a 1115 waiver that . Title. Beneficiary Groups and Eligibility Requirements Attention: Basundhara Raychaudhuri, Waiver Coordinator, Policy Development Support Eligibility groups affected by the demonstration can be found beginning in Section C. BENEFICIARIES SERVED THROUGH THE DEMONSTRATION in the STCs. These sessions are to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic. All rights reserved. HHSC will work with stakeholders to develop requirements for DY9-10. Financial Management Services Agencies (FMSAs) can help you make CDS budget revisions as needed. The agreement will take the program through December 2017 and will maintain its current funding. In the months leading up to the pandemic, SNAP and Medicaid timeliness was far lower than the norm. This document describes DSRIP proposals in the extension request, where they can be found in the current waiver, if applicable, proposed effective dates for each proposal, and a summary of stakeholder comments received on each proposal. These protocols cover the requirements for participation in DSRIP for Demonstration Years 7-8, Oct. 1, 2017 through Sept. 30, 2019. On June 23, 2016, CMS approved the DY6 Program Funding and Mechanics Protocol (PFM), which is Attachment J in the waiver's Special Terms and Conditions. The extension does not make any changes to eligibility requirements. Delivery of Medically Dependent Children Program (MDCP) Services. Please see below for the extension approval letter from CMS and the Standard Terms and Conditions for the extension. Call the Marketplace Call Center at 1-800-318-2596 to get details about Marketplace coverage. Medicaid and CHIP clients age six months and older are eligible to receive a COVID-19 vaccine. Medicaid Supplemental Payment & Directed Payment Programs, Form H1010-R, Your Texas Works Benefits: Renewal Form. Texas HHSC must take all necessary steps to transition these individuals to other programs for which they may be eligible, such as CHIP, Healthy Texas Women, and the ACA Health Insurance Marketplace, and to reduce the number of individuals who become uninsured following a Medicaid denial. 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. A central feature of Texas November 2020 application was stability through budget certainty for our health care systems across Texas in the midst of the ongoing public health emergency. Under normal circumstances. The extension request reflects the same terms and conditions agreed to and approved by the Centers for Medicare and Medicaid Services on January 15, 2021, subject to any pending waiver amendments. HHSC and CMS will continue negotiating a longer term extension. HHSC also projects a pool size up to $500 million in expenditures from the Public Health Provider Charity Care Program for FY 2022 and FY 2023. 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. STAR+PLUS provides acute and long-term service and supports to older adults and adults with disabilities. The program includes testing and treatment provided on or after Feb. 4, 2020 and began accepting claims May 6, 2020. Effective immediately health plans may allow service coordination visits to be completed in person when requested by the member receiving services for the following groups: Telehealth should be the primary modality for service coordination visits if in-person is not feasible. HHSC and the Centers for Medicare and Medicaid Services have agreed to a 15-month extension of the Texas 1115 Waiver. This group consists of persons age 21 and older, who meet the nursing facility level of care (LOC), who qualify as members of the 217-Like HCBS Group, and who need and are receiving HCBS as an alternative to nursing facility care. Normally fair hearings determinations are made within 60 - 90 days of the date HHSC receives a request for a fair hearing, now. Overview of Proposed Fast Track 1115 Extension Application, 2:00 p.m. HHSC Executive Council Meeting for Public Comment. Pursuant to CMS direction, HHCS has submitted that document for re-approval. To serve as a renewal/review application for Medical Programs in TIERS. HHSC must also ensure that individuals who are no longer eligible for Medicaid are successfully transitioned to other coverage options. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Effective immediately service coordination visits may be completed in person when requested by the member receiving services. SSI-Related Eligibles. The maximum financial resources for an individual are $4,000 and $6,000 for a couple. are Latino). 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). Per the Texas waiver terms, HHSC must submit a transition plan to CMS by March 31, 2015 based on the experience with the DSRIP pools, actual uncompensated care trends in the state, and investment in value based purchasing or other reform options. Expenditures Related to Managed Care Organization (MCO) Enrollment and Disenrollment. Approval of this Fast Track extension will sustain the achievements of the demonstration and support the needs of beneficiaries and Texans. Individuals can be eligible for HCBS under STAR+PLUS depending upon their medical and / or functional needs, financial eligibility designation as a member of the 217-Like STAR+PLUS HCBS Group or an SSI-related recipient, and the ability of the State to provide them with safe, appropriate, and cost-effective LTC services. All rights reserved. Also posted is a summary of DY7-8 requirements. Learn more about the July 2021 Extension Application below. To the extent necessary, to enable the State to restrict freedom of choice of provider through the use of mandatory enrollment in managed care plans for the receipt of covered services. Yet, when Medicaid disenrollments resume, the more than 5 million Texans who rely on Medicaid will become highly vulnerable to the loss of coverage and care. Enrollment Box 14700 (Located between Inwood Road and Mockingbird Lane, and between Maple Avenue and Harry Hines Boulevard). You feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19. HHSC extended nursing facility minimum data set (MDS) assessment authorizations by 90 days for those expiring from April 2020 to May 9, 2021. The following Medicaid recipients are excluded from the Childrens Dental Program, and will continue to receive their Medicaid dental services outside of the Demonstration: Medicaid recipients age 21 and over; all Medicaid recipients, regardless of age, residing in Medicaid-paid facilities such as nursing homes, state supported living centers, or Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/ID); and STAR Health Program recipients. 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. This extension would provide financial and operational certainty for Texas providers to continue serving Medicaid and low-income uninsured populations that benefit from the waiver while the Trump administration determines its policies regarding Section 1115 Demonstration Waivers. 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. HHSC sought feedback on the 1115 Waiver Fast Track extension proposal posted below and submitted the proposal to CMS (see the CMS webpage for the Texas Healthcare Transformation and Quality Improvement Program). Medicaid is currently working as it should, as a bulwark that supports families, including during an unprecedented national emergency such as the pandemic. Texas seeks the same Special Terms and Conditions previously agreed to and approved by CMS. H0926. The initial draft Demonstration Year (DY) 7-10 MBP, an accompanying Excel file of Related Strategies, the summary of stakeholder feedback on the initial draft DY7-10 MBP, and the revised DY7-10 MBP incorporating changes from stakeholder feedback is posted below. 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. HCBS for SSI-Related State Plan Eligibles. HHSC will not automatically renew IPCs and ID/RC assessments expiring on or after Dec. 31, 2020.

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