Meeting summary

Quick recap

The meeting focused on discussing challenges with HHSC contracts, particularly around CCMS (Case Management Services) implementation and performance measures. Providers raised concerns about the 24-hour waiting period requirement and service termination rules, which were creating operational difficulties. The group also explored questions about Dr. Laguna's sphere of influence and how to effectively engage with HHSC leadership. There was significant discussion about private insurance billing challenges and the need to better understand and navigate Medicaid managed care systems. The conversation concluded with updates about upcoming changes to the billing structure and a reminder about the upcoming general membership meeting.

Next steps

• Anna: Ask Noelle to discuss or provide examples of appropriate topics and her purview for HHSC leadership meetings, potentially at the upcoming general membership meeting or next month's call.

• Anna: Share the previously distributed list of funded providers/contracts with the group again, and share in the chat.

• Anna: Reach out to Bill to determine if he received the detailed list of provider funding by region and service level, and follow up as needed.

• Anna: Take note to include questions about provider capacity, waitlists, and the accuracy of provider lists (especially for women/children and detox) as topics for discussion with HHSC leadership.

• Anna: Consider including a panel/session at the San Antonio meeting on Medicaid managed care/private insurance billing challenges, and invite relevant organizations (e.g., Cenikor, La Hacienda) to share their experiences.

• Deirdre: Facilitate a conversation at the next meeting with Noelle present to clarify expectations and input for future HHSC leadership meetings, and give a heads-up to members so they can attend and provide input.

• Heather's data person and Deirdre's data person: Connect to discuss data-related issues and approaches.

• Doug: Share the link to the list of funded providers in the chat (already done during meeting, but requested by Heather).

  
  

Summary

HHS Leadership Meeting Scope Clarification

The board discussed the scope and purpose of upcoming meetings with HHS leadership, particularly focusing on Dr. Laguna's role and influence. They clarified that while Dr. Laguna cannot address financial or rate-related issues, she does have authority over contracts and the HHSC QM audit tool. The group agreed to seek more clarity from Noelle about what topics can be effectively discussed in these meetings, with plans to address this at the next board call before the upcoming San Antonio meeting.

State Contract Performance Measure Changes

The group discussed concerns about increased performance measures for state contracted programs, which rose from 75% to 95%, and the need to engage Dr. Laguna as an advocate for additional resources and tools to meet these requirements. They noted that many new for-profit and private providers are now receiving contracts, and Deirdre suggested checking if these providers are already members of their organization. Doug agreed to share a list of funded providers from the website.

Performance Measures and AI Adoption

The team discussed performance measures and data sources, with Heather suggesting they ask what data sources are used to determine performance measures and how they can inform those metrics. Deirdre clarified that while there are no financial liabilities tied to performance measures in their current contract, there could be corrective action plans. The group also touched on the use of AI tools in the field, particularly for treatment case notes, and the need to get AI tools approved before they can be used. Crystal mentioned that some organizations have already adopted AI tools for behavioral health, and Deirdre noted that they would need to liaise with the MH side of the house regarding AI tool approvals. The conversation ended with Doug sharing a link to a list of awards and expressing hope for a productive conversation in San Antonio.

CCMS Completion Rate Challenges

The team discussed challenges with CCMS (Case Management Services), particularly regarding the requirement to enroll clients 24 hours before intensive residential treatment, which has led to delays and inefficiencies. Crystal explained that CCMS has three main outcome measures, including unduplicated enrollments into CCMS, intensive residential, and completion of intensive residential, with a target of 60% completion rate for residential treatment. Vaughan raised concerns about the discrepancy between CCMS and TRA/TRF completion targets, and Crystal shared that CCMS aims for 100% completion among intensive clients with case managers, though this goal was not based on actual provider workflows.

Contract Funding and Care Challenges

The team discussed funding allocation for staff and client incentives in contracts, noting that while client incentives were encouraged, they chose to prioritize staff expenses. Deirdre raised concerns about the difficulty of engaging people in treatment compared to 10 years ago, while Heather highlighted issues with provider availability, particularly for women's and children's programs, and the challenges of referring clients to detox services. The group agreed to address these concerns with Dr. Laguna and advocate for the ability to make contract changes, while Jennifer mentioned the need to obtain a final list of providers and funding dispersion by region to better understand the continuum of care.

Insurance Billing and Funding Challenges

The group discussed challenges with comparing funding distributions between cycles due to shifts in distribution methods, with Anna offering to share a comparison list. They explored issues around Medicaid and private insurance billing, with Carrie noting difficulties in getting recognized by insurance companies and maintaining contracts, while Doug suggested organizing a session with Cinecor to address these challenges. The conversation concluded with discussions about using ARPA funds for facility improvements to make services more attractive to private insurance clients, and Anna announced plans to address these topics at the upcoming general membership meeting.