STATE “APPROVES” A TRIAL PERIOD!!!

RE:  STATE “APPROVES”  A TRIAL PERIOD!!!

On September 2, 2011, representatives of the Texas Healthcare Advocacy Association (THAA) met with House HHSC Committee Chairman Richard Pena Raymond (Dist 42), St. Rep. Sergio Munoz, Jr. (Dist 36) and HHSC Commissioner Tom Suehs and his Staff (Paula Swenson and Joe Vaigattie) to present our official request for a PRE Trial/Pilot Component.

After listening to our request and reviewing our documentation of over 100 letters of support servicing over 17,000 clients HHSC Commissioner Mr. Suehs, instructed his staff to proceed and find a method of providing a “test drive” before March 1^st, 2012. Chairman Raymond was also in agreement with Commissioner Suehs for some form of a simulation period. Barring any unforeseen circumstances, policies, or other legal issues our request for a trial phase has been tentatively APPROVED, with some adjustments.    

This is GREAT NEWS!!!
 
One of the biggest issues that surfaced was the federal HIPAA 90 day requirements; leading to some adjustments of our request. Essentially, clients/patients must be afforded a minimum of 90 day to select their MCO! According to the State this HIPAA cut off date is February 14^th, 2012. Because of this requirement the State can only provide “mock or dummy” participant data to providers and MCOs for any simulation testing.

As mentioned earlier, barring any unforeseen circumstances, policies or other legal issues, the State has agreed to provide a handful of mock client files to providers and MCOs to do “simulation” data entering/editing and billing/s prior to March 1^st, 2012. According to State officials this type of trial has never been proposed or done before. However, they believe it may lead to a smoother transition and will begin planning the specifics of our proposed trial phase. MCOs must also agree to this simulation. This mock trial period will only be done for LTCSS providers ie, DAHS, PHC, DME, etc

 What does this mean to you? Well in effect you will get to simulate billing/claims and other data entry requirements with each MCO; granted for a handful only! However it provides some measurement that the MCO and Providers (you) are capable and ready ie..billing. It should provide you with errors report and provide you with how many were “clean claims” ; something that is critical for everyone prior to March 1^st, 2012.

 So once again, your cooperation and hard work has gone a long way!!! Now all we have to do is make sure we attend all MCO trainings and wait for this “trial” phase. It will probably be in late January 2012 ; we will keep you posted on this.

 Please check our website for more information and pictures; www.texashaa.org

check regularly for updates on this matter.

We thank all of those who provided letters of support; we believe these documents and data made a significant impact on the HHSC Commissioner and Chairman Raymond.

I would also like to thank Mr. Jesus Navarro of Cielito Lindo Adult Day Care and Mr. Jon Scepanski of Apex Primary Care who made the time to make this meeting.

 It takes TEAMWORK!!!

Thank you all. GREAT TEAMWORK!!!

 Sergio Munoz, Sr.

THAA President