March 24, 2015 at 12:01 PM - Quality Management Committee - Regular Meeting

1. CALL TO ORDER

2. ESTABLISHMENT OF QUORUM

3. PUBLIC COMMENT - Persons wishing to comment must sign-in on the "Agenda Item Request to Speak" form provided at the entrance of the Committee meeting room at least five (5) minutes prior to commencement of the Committee meeting.  Commenters shall limit their comments to three (3) minutes and comments must be appropriate to the agenda item(s).  See the "Public Comment" section of the preceding General Information page for additional Public Comment-related requirements and information.

4. CONSENT AGENDA:

4.A. Approve minutes of Quality Management Committee meetings:

4.A.1. April 9, 2013.  (ACTION)

4.B. Recommend receipt of information relating to U.S. Department of Health and Human Services (DHHS) Poverty Guidelines:

4.B.1. Annual update of the DHHS Poverty Guidelines from Federal Register, Vol. 80, No. 14, January 22, 2015, pp. 3236 - 3237; and

4.B.2. Historical DHHS Poverty Guidelines, 1965 - 2014 from Table 3.E8, Annual Statistical Supplement to the Social Security Bulletin, 2014.
(INFORMATION)

4.C. Recommend receipt of notice of annual increase adjustments of Nueces Aid Program’s Eligibility Guidelines; adjustments effective March 1, 2015 for:

4.C.1. Household Resources as required by Program’s Handbook Policy No. NA002, Attachment 2, Sections I-B, I-C-1, I-C-22, and I-F; and

4.C.2. Household Income as required by Program’s Handbook Policy No. NA002, Attachment 4, Section I-F-3.

4.D. Recommend receipt of summary information relating to Nueces Aid Program pharmacy service Utilization for calendar years ended December 31, 2013 and December 31, 2014:

4.D.1. Pharmacy Program;

4.D.2. Pharmacy Volume by Year;

4.D.3. Cost and Utilization Summary Report;

4.D.4. Therapeutic Class Total Report; and

4.D.5. Top 100 Utilized Drugs by Dollars. (INFORMATION)

4.E. Recommend receipt of summary information relating to Nueces Aid Program for calendar years ended December 31, 2013 and December 31, 2014:

4.E.1. Program Enrollment;

4.E.2. Program Applications Processed; and

4.E.3. Program Eligibility:

4.E.3.a. Eligibility Demographics; and

4.E.3.b. Enrollment by Zip Code.  (INFORMATION)

4.F. Recommend receipt of summary information relating to the Nueces Aid Program and suspected fraud cases under investigation, fraud cases closed, persons disqualified, and related recoveries, pursuant to Texas Health and Safety Code, §61.066 for calendar years ended December 31, 2013 and December 31, 2014.  (INFORMATION)

5. REGULAR AGENDA:

5.A. Recommend ratification of Service Agreement renewals with the Texas Medical Foundation for the period January 1, 2015 - December 31, 2016:

5.A.1. Non-Medicare Medical Records Review; and

5.A.2. Quality Assessment, Utilization Review, and Coding Review.  (ACTION)

6. CLOSED MEETING - Notice is hereby given that the Quality Management Committee may elect to go into closed meeting session(s) at any time during the meeting to discuss any matter(s) listed on the agenda, when so authorized by the provisions of the Open Meetings Act, Texas Government Code, Chapter 551; the Texas Health and Safety Code, Chapter 161, §161.031(a)(6), §161.0315(f), and §161.032; or the Texas Occupations Code, Chapters 151 and 160; and that the Committee specifically expects to go into a closed session(s) on the matters listed below. In the event the Committee elects to go into closed session(s) regarding an agenda item(s), the section(s) of the Open Meetings Act authorizing the closed session will be publicly announced by the presiding officer. Should any final action, final decision, or final vote be required in the opinion of the Committee with regard to any matter considered in closed session(s), then the final action, final decision, final vote shall be either: (a) in the open meeting covered by the Notice upon reconvening of the public meeting; or (b) at a subsequent public meeting of the Committee upon notice thereof, as the Committee shall determine pursuant to applicable laws.

6.A. Receive confidential reports on medical and health care services provided under the Indigent Care Agreement and/or Membership Agreement, pursuant to Texas Health and Safety Code, Chapter 161, Subchapter D, §161.031(a)(6), §161.0315(f), and §161.032:

6.A.1. Annual Record Review Reports:

6.A.1.a. 2013; and

6.A.1.b. 2014.

6.A.2. Primary Care Record Reviews:

6.A.2.a. 2013; and

6.A.2.b. 2014.

6.A.3. Dental Services Report Record Reviews:

6.A.3.a. 2013; and

6.A.3.b. 2014.

7. OPEN MEETING:

7.A. Consider final action, decision, or vote on matters deliberated in Closed Meeting.  (ACTION AS NEEDED)

8. ADJOURN