We are excited to ring in a new year and the first year of our new health care consulting and government relations firm – Treaty Oak Strategies. There are also many things that lie ahead for the healthcare system in Texas in 2022.
Legislatively, we are finally entering the interim after a long legislative session that took place during a public health emergency and followed by three special sessions. The Speaker requested interim charge recommendations by late November, and the Senate should be requesting recommendations soon. In addition to potential interim issues to discuss over the next year, there are a number of seats open making for an interesting year of elections and some uncertainty for the 88th Legislative session in 2023.
At the agency level there are also a lot of initiatives to watch. HHSC will finally launch the long-anticipated Medicaid autism services benefit in February. The agency spent a long time drafting the medical policy and updated the proposed rates but there are still questions as to whether there will be enough providers to participate to ensure access. The second major item to watch is the agency will finally implement several provisions from SB 1207, the Medicaid reform bill passed by the 86th Legislature. Provisions include a new independent review organization option for Medicaid clients if they have been denied a benefit and new, more client-friendly, adverse determination letters. Both provisions were put into law to ensure stronger protections for Medicaid clients.
And of course, nationally everyone is watching HHSC and CMS as the agencies continue to negotiate the 1115 waiver and the three new directed payment programs - see the last correspondence between HHSC and CMS.
HHSC received ARPA funding during the special session to make system changes necessary to implement day one of managed care, rather than requiring clients to wait in fee-for-service for a period of time before being assigned a health plan. The legislature also allocated APRA funds to HHSC to improve and streamline processes around Medicaid provider enrollment, credentialing and provider data management.
There is also a lot of work going on at TDI to implement major provisions from the 87th Session including rules related to the all payer claims database and price transparency requirements in HB 2090. And all eyes will be on HB 3459 which establishes a new law around prior authorization that could have major impacts on both health plans and providers based on how the agency implements.
On the federal level it is still unclear if any of the provisions in the Build Back Better Act related to healthcare and coverage options will be revived. There is a lot of press and speculation but it still unclear what provisions may move forward. We are also curious to see if CMS will release any new rules related to the operation or funding of Medicaid and CHIP programs. The recent executive order on strengthening Medicaid and the ACA reinforces this administration's position on ensuring access to coverage.
Finally, everyone is watching to see how states will handle the end of the official public health emergency (PHE), especially when it comes to Medicaid and CHIP eligibility determinations. Due to the public health emergency states have been required to keep people enrolled in Medicaid but when the PHE ends states will resume administering eligibility reviews. Depending on how each state approaches eligibility renewals could result in millions of uncovered individuals. CMS' announcement of $49.4 million to fund organizations that can connect more eligible individuals to Medicaid and CHIP may help with this large endeavor.
As usual, health care policy will not be dull this year. We are looking forward to what lies ahead and to get started in our first year of business!
Happy New Year!
Treaty Oak Strategies