Quick recap

In a meeting with limited attendance, the group discussed significant funding cuts affecting service providers, particularly Santa Maria's reduced capacity for pregnant and parenting women clients. They explored challenges with contract models shifting to cost reimbursement, requiring detailed expense reporting, and concerns about timely contract execution for fiscal 2026. The discussion also covered difficulties with private insurance enrollment and billing, with Noelle offering to raise these concerns in an upcoming meeting with HHSC, particularly regarding where to refer clients given Santa Maria's reduced bed capacity.

Next steps

• Noelle to ask HHSC in Monday's meeting about where providers should refer clients who can no longer be served due to funding cuts, particularly pregnant and parenting women.

• Noelle to inquire with HHSC about the status of TRF and TRA contracts for fiscal year 2026 and address concerns about the inability to backdate claims if contracts are not executed by September 1st.

• Noelle to follow up with HHSC regarding the cost reimbursement requirements for fee-for-service contracts and reporting expectations.

• Barbara to begin consolidating operations at the Parker Road facility as Jacqueline facility closes next Tuesday.

• Barbara to continue meeting with stakeholders in Harris County regarding the impact of reduced capacity to serve clients.

  
  

Summary

Follow-Up Meeting With Limited Attendance

The group begins their meeting with a small attendance, noting that Yvonne will not be joining as she is on another call. Luci mentions that they will proceed with the agenda points from their previous meeting, and Noelle indicates she's ready to follow up on a couple of items and answer any questions from the group.

Santa Maria Funding Crisis Impact

Barbara explains that Santa Maria has experienced over 40% funding cuts for pregnant and parenting women clients, forcing them to close the Jacqueline facility for single women's treatment and consolidate operations at their Parker Road facility in Houston. She expresses concern about the reduced capacity to serve clients and the impact on referrals from the justice system, CPS, hospitals, and incarceration, noting that when they asked state officials about the cuts and where to refer clients, they received no clear answers. Additionally, Barbara mentions they had to close their detoxification unit due to insufficient funding, while Luci observes that the state appears to be pushing for outpatient services despite these not being appropriate for many clients who need residential care.

Contract Changes and Reporting Concerns

Luci and the team discuss concerns about fee-for-service contracts moving toward cost reimbursement models, requiring detailed expense reporting. Noelle explains that overages must be spent on allowable expenses, which may require changes in accounting practices to make reports cleaner, with potential quarterly reporting requirements. Barbara raises an urgent concern about TRF/TRA contracts for fiscal 2026, noting that HHSC has stated for the first time that claims cannot be backdated if contracts aren't executed by September 1st, while Noelle mentions hearing that some providers might receive contracts just a day before the deadline.

Insurance Challenges in Treatment Services

Luci discusses challenges with private insurance enrollment, noting that counselor interns aren't recognized by insurance companies and clients often can't afford admission fees or co-payments. Barbara shares that Santa Maria has obtained contracts with Blue Cross Blue Shield and United Healthcare but hasn't successfully billed them due to requirements that every note be QCC'd by someone with an NPI number, which they lack staff for. She explains that commercial insurance companies require clinical services every day of the week and are looking for reasons to deny residential treatment claims. Both confirm that if insurance denies services based on medical necessity, clients can be placed on HHSC funding if the provider can prove the denial.

Bed Capacity Reduction Concerns

As the meeting concludes, Noelle offers to bring up concerns at her upcoming Monday meeting with HHSC. Barbara requests that Noelle ask about where they should refer women since their bed capacity is being reduced from over 170 to about 106, effective the last week of August, which will force them to start turning clients away next week. Noelle acknowledges the request and mentions she will phrase it strategically to get answers despite the ongoing procurement process.