texas medicaid renewal 2022

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. Answer some basic questions in our prescreening tool to find which benefits and support services you might be able to get. TDD users can call: 512-424-6597. TTY users can call 1-855-889-4325. Expenditures made under contracts that do not meet the requirements in section 1903(m) of the Act specified below. STAR. No prior authorization will be required on the COVID-19 lab test by Medicaid and CHIP health plans or by traditional Medicaid. Changes to the RHP Planning Protocol for DY6A are consistent with the approved DY6 Program Funding and Mechanics Protocol. As noted in the sections below, some Medicaid and CHIP flexibilities have been extended through Nov. 30, 2022. Call the Marketplace Call Center at 1-800-318-2596 to get details about Marketplace coverage. 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. DSRIP funds are scheduled to phase out during the final year of the current THTQIP demonstration on October 1, 2021. In response to COVID-19, HHSC requires all health plans to extend the timeframes for the number of days members, legally authorized representatives or authorized representatives can request an appeal through Nov. 30, 2022: Effective July 1, 2021, health plans must enforce the normal, regular and established timeframes that members have to request for continuation of benefits. HHSC must also ensure that individuals who are no longer eligible for Medicaid are successfully transitioned to other coverage options. 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. 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. Medicaid and CHIP will cover COVID-19 testing for Medicaid or CHIP clients. Beginning Sept. 1, 2021 health plans must offer service coordination visits in person when requested by the member receiving services. RAPPS is a proposed directed payment program for rural health clinics that provide primary and preventive care to persons in rural areas of the state enrolled in Medicaid STAR, STAR+PLUS, and STAR Kids programs. Children's Medicaid. Program Description Goals and Objectives 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. Number of days members, legally authorized representatives or authorized representatives have to request a fair hearing. If the applicant or client declines to register to vote during an in-person interview, ask the client to sign Form H1350, Opportunity to Register to Vote. To permit section 1915(c)-like Home and Community Based Services (hereinafter HCBS) members to self-direct expenditures for HCBS long-term care and supports as specified in paragraph 43(h) of the STCs. Further, nearly two-thirds of Texans enrolled in Medicaid are from communities who have suffered disproportionate health and economic impacts from the pandemic (15% of Texas Medicaid enrollees are Black and 49% are Latino). Attention: Basundhara Raychaudhuri, Waiver Coordinator, Policy Development Support 2022 Every Texan. 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. Waiver Authorities To the extent necessary to enable the State to vary the amount, duration, and scope of services offered to individuals, regardless of eligibility category, by providing additional, or cost-effective alternative benefit packages to enrollees in certain managed care arrangements. Medicaid and CHIP clients age six months and older are eligible to receive a COVID-19 vaccine. Fee-for-service Medicaid 1915(c) waiver case managers and service coordinators for Community Living Assistance and Support Services (CLASS), Texas Home Living (TxHmL), Deaf-Blind with Multiple Disabilities (DBMD) and Home and Community-based Services (HCS), Community First Choice service coordinators, Preadmission Screening and Resident Review (PASRR) habilitation coordinators, Community Living Assistance and Support (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services Program (HCS), Normally 60 days to request an MCO internal appeal, now. All Medicaid laws, regulations and policies apply to this expenditure authority except as expressly waived or listed as not applicable. This request to extend preserves the innovations, collaboration, and improved value of care through a continuous five-year extension of our current demonstration period. These processes will ensure that budget neutrality will continue to support funding needs and flexibility moving forward. The site is secure. Prioritizing visits for younger children, especially those due for routine vaccines. Re-sizing will allow for adjustments to uncompensated care pool based on actual charity care. Delayed or skipped treatment often leads to worsening conditions andgreater use of high-cost care. Added clarification about prior therapy criteria for clients with atopic dermatitis. Copyright 2016-2022. HHSC will provide more information if there are changes. Normally fair hearings determinations are made within 60 - 90 days of the date HHSC receives a request for a fair hearing, now. To the extent necessary to enable the state to provide a greater duration of hospital services for individuals with severe and persistent mental illness. 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. HHSC will work with stakeholders to develop requirements for DY9-10. 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. Statewideness - Section 1902(a)(1) 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. A subsequent rebasing exercise to without waiver PMPMs is included effective FFY 2028 using FFY 2026 expenditures. This request to extend preserves the innovations, collaboration, and improved value of care through a continuous extension through 2030 of our current demonstration period. Under terms of this demonstration, the state provides managed medical assistance through the following programs. Effective May 10, 2021, MDS assessments will no longer be extended. The letter specifies that HHSC is on track to submit the required independent report analyzing the Uncompensated Care pool and Delivery System Reform Incentive Payment program on Aug. 31, 2016. 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. 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). The extension request includes a reassessment of the charity care pools. Beginning Sept. 1, 2021 health plans must offer service coordination visits in person when requested by the member receiving services. Medical office visit co-payments are waived for all CHIP members for services provided from March 13, 2020 through Nov. 30, 2022. The extension request is for 5 years, which will allow the 1115 waiver authority to run through 2027. HHSC will not automatically renew IPCs and ID/RC assessments expiring on or after Dec. 31, 2020. Before sharing sensitive information, make sure youre on an official government site. Mail Form H0025 when the client does not have a face-to-face interview or the client reports a change of address by telephone or by mail. Rural Access to Primary and Preventive Services. 1115 Transformation Waiver: Extension Application Public Hearing on June 15, 2021 at 10:00 am at the Health and Human Services Commission, Brown-Heatly Building, Public Hearing Room, 4900 North Lamar Blvd., Austin, Texas 78751. Beginning on Jan. 1, 2021 existing prior authorizations will no longer be extended. 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. STAR+PLUS provides acute and long-term service and supports to older adults and adults with disabilities. 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. Collectively, findings from the evaluation components above will inform whether Texas continued its progress towards meeting the goals of the Demonstration and help guide future program improvements. The completed renewal form must be signed, dated, and returned to the Medicaid agency. The site is secure. Beneficiary Groups, Eligibility Requirements, and Benefits Widespread coverage loss among eligible people would also wreak havoc on Texas health care system. 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). 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). Employer orientations scheduled through Jan. 2022 will be virtual or by telephone. Delivery of Medically Dependent Children Program (MDCP) Services. 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. The program is limited to publicly-owned and operated community mental health clinics, local behavioral health authorities, and local mental health authorities, local health departments, and public health districts. HHSC temporarily lifted the prohibition on service providers of respite and CFC PAS/HAB from living in the same home as the person receiving Home and Community-based Services and Texas Home Living program services. asked to complete a phone interview by calling 1-800-699-9075. The QDWI has even more stringent financial resources requirements. Safety net providers, already reeling from pandemic-related disruptions and demands, would face increased uncompensated care. STAR is the primary managed care program providing acute care services to low-income families, children, and pregnant women. To calculate the new rebased amount, without waiver PMPMs will be adjusted to account for annualized amounts of approved state-directed payments (pending state legislative approval) made in FFY 2022. Texas will develop a new evaluation design for the extension period and plans to incorporate the following updates into the design to reflect recent or future changes to the THTQIP demonstration waiver. The extension will not change the array of benefits provided under the current 1115 waiver authority. 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 . 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 has submitted a state plan amendment to implement increased reimbursements for public ground ambulance services, which it intends to serve as a basis of a directed-payment program in managed care; in managed care, the estimated annual payments could be $150 million. 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. The maximum financial resources for an individual are $4,000 and $6,000 for a couple. To limit exposure to COVID-19, providers may adjust in-office medical and dental checkups. Eligibility groups affected by the demonstration can be found beginning in section C table 2 State Plan Populations Affected by the Demonstration in the STCs. Texas advocates have made. 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