Family Planning & Expanded Primary Health Care
Project Director’s Conference Call
December 9, 2015
Agenda Items:
1. HHSC Transition
· On September 1, 2015 all Family Planning (FP) and Expanded Primary Health Care (EPHC) program staff were transferred from the Department of State Health Services (DSHS) to the Health and Human Services Commission (HHSC). This transfer completes the recommendations from the Sunset Advisory Committee and the decision by the 84th Legislature to merge women’s health appropriation strategies into a single strategy within the HHSC budget.
· Contractor changes include: email address changes from DSHS to HHSC suffix.
o FP program mailbox - *****@***state. tx. us
o EPHC program mailbox - *****@***state. tx. us
o EPHC reports mailbox - *****@***state. tx. us
o FP and EPHC staff - firstname. *****@***state. tx. us
o Any emails sent to DSHS address should automatically forward to the appropriate HHSC address. Call one of us if you have issues.
o All telephone numbers have remained the same.
2. Contracting Updates
· EPHC contract extensions were issued from 9/1/2015 through 8/31/2016. Many have been returned and are executed; some require change of language by legal and those are being worked on right now.
· FP contract renewals were issued for 9/1/2015 through 8/31/2016. Some require redoing the language and those are being done right now in conjunction with our legal group and our procurement and contracting services group that does the actual contract development.
· Contact your Contract Manager with questions.
3. Quality Assurance (QA) Update
· A Corrective Action Plan (CAP) template was emailed to contractors. The template:
o was developed to provide guidance when responding to findings on the onsite evaluation report;
o is effective for all contractors who have a QA visit on or after January 1, 2016.
· Training regarding the CAP process and the template will be offered in January. The training is for anyone who is involved with developing a CAP and will provide an overview of the process to develop an acceptable CAP using the new template.
· Webinars will be offered:
o January 26 from 10:00 to 11:30
o January 27 from 1:00 to 2:30
o January 28 from 10:00 to 11:30
o An email for registration and login information will be sent prior to the webinar.
4. Billing Update
· The last TMHP claim pay files for EPHC and FP have been processed for dates of service 9/1/14 through 8/31/15.
· Contractors with a fee for service contract without a categorical contract in either FP and/or EPHC will need to submit a Financial Reconciliation Report (FRR) by the close of business December 31, 2015.
· The FRR forms for fiscal year 2015 are on the Community Health Services (CHS) “Forms” web page.
5. FP End-of-Year Report
· FP Program will have an FY15 end of year report similar to last year.
o Instructions will be sent in January.
6. EPHC Annual Report & EPHC\FP and Outreach and Program Promotion Quarterly Report
· EPHC will have a combined report with PHC similar to the annual report last year. It is legislatively mandated for PHC. The FY2015 350 annual report was due in October and it is for both programs.
o Contractors that have been contacted regarding corrections and/or missing information need to send those in by December 15th.
· The initial outreach and program promotion/marketing plan was due in October.
o A few are still missing - please send in right away.
o For future - please note due dates in your contract and send in the reports by those dates.
· First quarter progress report on your annual plan are due December 31, 2015. This report provides updates with on the types of outreach and promotion conducted during the first quarter.
7. Medicaid Re-enrollment
· Federal re-enrollment regulation requires providers to complete the re-enrollment by March 2016. However, this re-enrollment process is systematically creating and sending accounts receivable or deficiency letters to Program 300 providers.
· Accounts receivable or the deficiency letter will not stop processing your application. The TMHP contact center has been instructed to notify providers that when the DSHS chooses to close accounts receivables we will notify providers at that time.
o No action on your part is required.
o Contact your contract manager with questions.
8. Program Changes
· New Women’s Health Advisory Committee (WHAC)
o This committee will help design a couple of new programs that will be coming online this summer.
· The EPHC program will come to an end and stop providing services on 8/31/15.
o Claims will be paid up until the end of October as our normal period for claims filing.
· The current FP program contracts will end on 6/30.
o An amendment process will start this spring to amend everybody’s contract to have an end date of 6/30.
o New FP program will launch on 7/1.
· The Health Texas Women’s (HTW) program will launch on 7/1. It is a combination of EPHC and the Texas Women’s Health Program (TWHP).
o Will operate similarly to the TWHP program – same billing functionality but will have expanded services; will not be limited to contraceptive-related services.
· Eligibility criteria for HTW and FP:
o HTW –
§ Women ages 15 to 44.
§ 200% or below the federal poverty level (FPL).
§ U. S. citizens or legal immigrants.
§ Not pregnant.
§ Eligibility will be handled through the TIERS system so eligibility will be handled as it is now for the TWHP.
o FP –
§ Women and men.
§ 64 and younger.
§ 250% or below of the FPL.
§ Texas resident.
§ Eligibility will continue to be determined at the point of service, so contractors will still determine eligibility onsite.
· Services - HTW will have:
o contraceptive services,
o breast and cervical cancer screening, including diagnostic services,
o screening and treatment of chronic conditions, and
o immunizations.
· Services - FP will have:
o contraceptive services,
o breast and cervical cancer screening and diagnostic services,
o screening for chronic conditions,
o immunizations, and
o limited prenatal services.
· A tentative list of codes for each of these programs can be found on the website, which is on the bottom of the agenda for the WHAC. Click on the link, then click on the link to the advisory committee. Another page comes up and on that page there is a PDF that lists all the CPT codes that were proposed to the advisory committee.
· Advisory committee passed the benefits package on November 13th and that was taken to the Executive Commissioner of HHSC, who approved the package on November 23rd.
o These may not be the only codes covered. We are still reviewing quite a few other codes to include in the future, maybe even before the launch.
· Request for Proposals (RFP) for FP and HTW will be released sometime early spring.
o The FP RFP process will function as it always does.
o HTW’s contracts will go through HHSC for a portion of the funds. Most of the funds are going to be paid on a fee for service basis as you file claims for these women to TMHP.
o Some funds will be allocated for categorical contracts with providers who see a minimum number of clients and request additional funds to pay for other costs associated with the operation of their HTW program.
§ Costs could range from payment for presumptive eligibility for clients whose eligibility cannot be determined within that 45 day window for whatever reason that usually takes to get a Healthy Texas Women client state eligible.
§ Or it could pay for outreach activities, community education activities, equipment, or other costs associated with the provision of the program.
· All FP, EPHC and Title X providers are encouraged to apply for both programs.
o More information about the FP and EPHC programs will be provided on an ongoing basis up until the RFPs are released.
· Policy change posted to the policy manuals.
o FP or EPHC will not be covering emergency contraception as a covered service.
§ Counseling services for abortion services will not be covered. These services are not prohibited but they are not covered services under the program. Program will not reimburse you for those services going forward.
9. FP & HTW Rules and RFP
· FP rules are being repealed from DSHS and transferred to HHSC.
· TWHP rules are being repealed from DSHS and new rules are being created at HHSC for the HTW program.
· Changes have been drafted for both sets of rules. The current rules for both FP and TWHP will be presented for repeal at the DSHS Council meeting on February 24, 2016. The FP and HTW proposed rules will be presented at the HHSC Council meeting on February 26, 2016.
· FP, TWHP and HTW rules will be posted on the Texas Register on April 1, 2016 and open for public comment until May 2, 2016.
· Anticipate rules for both FP and HTW will be effective July 1, 2016.
