Fee Reconciliation Process under the Texas Medicaid Disease Management Program
January 2005
Texas Health and Human Services Commission
Lewin assisted Texas' Health and Human Services Commission (HHSC – the state's Medicaid agency) in designing the detailed mechanisms by which cost performance would be measured. The contractor's administrative fees are 80% at risk for cost performance, and 20% at risk for quality performance. Lewin evaluated vendors' price bids and then worked extensively with HHSC to develop and negotiate the measurement criteria with the selected contractor. Lewin has also developed appropriate algorithms for identifying patients in each targeted disease category, specifying situations where persons will be excluded from the program, and designing and negotiating all aspects of HHSC's financial relationship with its disease management contractor.