Palliative Care Interdisciplinary Advisory Council

Palliative Care Interdisciplinary Advisory Council

Palliative Care Interdisciplinary Advisory Council June 14, 2018 Full Council Meeting #10 10 a.m. Palliative Care Interdisciplinary Advisory Council Welcome and Introductions 2 Welcome and IntroductionsAppointments Thank You Our sincere gratitude and appreciation to the members who have participated on the council since its inception. For those members who are no longer on the council we hope to continue working together to improve palliative care services in the

state of Texas. 3 Welcome and IntroductionsAppointments Reappointments Physicians Dr. Robert Fine, Dallas Dr. Amy Moss, Grapevine Advocate Jennifer Carr Allmon, Austin 4 Welcome and IntroductionsAppointments Welcome to our new council members Physicians Dr. Gary Gross, Tyler

Dr. Joshua Reed, Abilene Advance Practice Registered Nurse Heather Paterson, Dallas Nurse Jo Ann Carmona, Edinburg Spiritual Professional Jerry Fenter, Beaumont Advocate

Bhavani Madisetti-Vemireddy, Round Rock 5 Meeting Overview Main Objectives Welcome new appointments Election of presiding officer Review and approve meeting minutes

Review and possible adoption of bylaws Staff update on program initiatives Palliative care data update Discuss palliative care website Defining palliative care and hospice care presentation by Ms. Erin Perez Review and discuss potential topics for the 2018

legislative report Hear from our stakeholders 6 Palliative Care Interdisciplinary Advisory Council Election of Presiding Officer 7 Election of Officer PCIAC will elect from its members a Chair 1. The regular term of office for a presiding officer is two years, with the Chair serving until August 31 of each odd-numbered year and the Vice-Chair serving until August 31 of each even-numbered year.

2. The Chair and Vice-Chair remain in their positions until the Council selects a successor; however, a presiding officer may not remain in office past his or her membership term. 3. In the event the Chair and Vice-Chair offices are vacant simultaneously, the election for Chair will precede that for Vice-Chair. 8 Election of Officer Responsibilities of the Chair 1. Report to HHSC; 2. Participate in agenda planning and preparation for Council meetings; 3. Provide leadership in conducting Council meetings; 4. Promote, maintain, and encourage a participatory environment; 5. Identify the need for, and work with Council Liaison, to call meetings to accomplish the work of the Council; 6. Ensure the Council adheres to its charge;

9 Election of Officer Responsibilities of the Chair 7. Call for the development of subcommittees (if applicable and with approval of agency staff); and 8. Confer with HHSC staff to acquire the support needed for Council operations. 10 Election of Officer Example Election Process Members are allowed to nominate themselves or another member. Prior to a vote, each nominated member will

make a short statement. Members will have an opportunity to discuss the nominations. Members will write the name of their candidate on the confidential ballot. The votes will be tallied and the nominee with the most votes will become Chair. The council will then do the same process to elect the Vice Chair. 11

Election of Officer Example Election Process In the event of a tie between two candidates, the floor will be open for any additional member discussion. A second vote will take place in the same manner as the first. In the event of another tie, the chair and/or vice chair will be determined by the flip of a coin. Prior to voting, the council should determine whether they want a run off if no candidate receives more than 50% of the votes on the initial ballot. 12 Palliative Care Interdisciplinary Advisory Council

Review and Approval of Meeting Minutes from October 23, 2017 13 Palliative Care Interdisciplinary Advisory Council Review and Possible Adoption of Bylaws 14 Palliative Care Interdisciplinary Advisory Council Staff Updates 15 Staff Updates Healthcare Quality Plan Strategic

Priorities 1. Keeping Texans healthy 2. Providing the right care in the right place at the right time 3. Keeping patients free from harm 4. Promoting effective practices for chronic disease 5. Supporting patients and families facing serious illness 6. Attracting and retaining high performing providers and other healthcare professionals 16 Staff Updates Quality and Program Improvement Initiatives: 1. MCO Alternative Payment Models (APM) 2. MCO/DMO Pay-for-Quality (P4Q) 3. Hospital Quality Payment Program 4. Delivery System Reform Incentive Payment (DSRIP) Program 5. Nursing Home Quality Incentive Payment Program (QIPP)

6. Texas Healthcare Learning Collaborative Portal 7. Advisory Committees and workgroups 17 Staff Updates MCO APM Requirements: HHSC MCO contract requires a minimum percentage of provider payments linked to quality-based APMs. Measurement year begins January 2018 to coincide with P4Q start date. Annual percentage increases to 4th year target. Period Year 1 (CY 2018)

Year 2 (CY 2019) Year 3 (CY 2020) Year 4 (CY 2021) Minimum Overall APM Ratio Minimum Risk-Based APM Ratio >= 25% >= 10% Year 1 Overall APM % +25% Year 2 Overall APM % + 25%

Year 1 Risk-Based APM % +25% Year 2 Risk-Based APM % + 25% >= 50% >= 25% 18 Staff Updates Current Initiatives Summary of Achievements, 2016-2017 Published inaugural legislative report with recommendations and guidance for increasing the availability of patient and family focused palliative care in Texas.

Launched and continue to update the first Texas Health and Human Services (HHS) system palliative care website resource for patients, families, and interdisciplinary professionals. Planned and administered the first annual palliative care interdisciplinary continuing education event awarding approximately 250 hours. 19 Staff Updates Current Initiatives Summary of Achievements, 2016-2017 Engaged palliative care stakeholders from across the state, continually updating its comprehensive contact list for the state of Texas.

Developed methods to track and report on Texass inpatient hospital palliative care registry grade and other measures of palliative care access. Commissioned a statewide, population based data collection initiative to assess completion of advance care planning documents in Texas, including analysis of selected demographic groups. 20 Staff Updates Current Initiatives Summary of Achievements, 2016-2017 Raised the profile of palliative care as a significant area of opportunity for improving overall healthcare quality in Texas. 21

Staff Updates Current Initiatives Palliative Care Video Project Interviewing at least two palliative care service providers, Dr. Craig Hurwitz and Ms. Erin Perez, and two people, including family members, who have received palliative care services. Educational video will be used on the HHS Palliative Care website. Timeline: Preproduction: 6/1/2018 to 6/30/2018 Production: 7/1/2018 to 7/27/2018 Postproduction: 7/28/2018 to 8/31/2018 22 Staff Updates Current Initiatives Fall continuing education (CE) event Will discuss possible learning objectives and topics

later in the meeting (possible topics include: 2018 legislative report, Do-Not-Resuscitate orders/advance care planning, and opioids) The Planning Committee will work with Department of State Health Services Goals: Credit for multiple disciplines Include at least one ethics credit Live event available in person and through webinar 23 Staff Updates Current Initiatives Fall CE Event Proposed Timeline

June Determine CE topics, presenters, and Planning Committee members July Work with presenters and Planning Committee to organize event and complete CE packet: Planning committee disclosure forms Speaker biographical information Learning needs assessment/learning objectives Program structure and content Evaluation 24 Staff Updates Current Initiatives Fall CE Event Proposed Timeline, cont.

August CE packet due (60 Days Prior to event) Promotional efforts Registration form/link to webpage Save the date announcement September Promotional efforts Registration October CE event Post event: Evaluation and certification 25 Palliative Care Interdisciplinary

Advisory Council Palliative Care Data Update 26 Palliative Care Data Palliative Care Data Currently tracking or developing data in five areas: 1. Hospitals reporting palliative care programs 2. Interdisciplinary health professionals with a palliative care specialty or credential 3. Palliative care fellows 4. Individuals completing advance care planning documents 5. Disparities in infrastructure across regions 27 Palliative Care Data

Hospitals Reporting Palliative Care Service Programs U.S. & Texas, 2012-2015 Data Staff Bed Size 50 > 300 Number Percent Number Percent Source Year CAPC U.S. 2012/ 2013

1,591/ 2,393 67% 659/ 732 90% In-house Texas 2014 87/205 42% 42/59

71% In-house Texas 2015 96/207 46% 41/58 71% In-house Texas 2016 98/201

49% 44/58 76% Note: Results are based on CAPC cohort definitions. Analyses were limited to general medical and surgical, cancer, or heart hospitals with fifty or more licensed beds based on data from the American Hospital Association Annual Survey of Hospitals. Veterans Administration and Indian Health Service 28 facilities were excluded. Palliative Care Data Palliative Care by Profession in Texas Professional Category Physicians with Palliative Specialty Number Number 2015

2017 % Increase 275 332 21% 51 78 53% 224 254 13%

Certified APRN 46 73 59% Certified Hospice Medical Director 19 26 37% Palliative Medicine Fellow 20

27 35% Primary Secondary 29 Palliative Care Data Advance Care Planning Two questions included as part of 2018 Texas Behavioral Risk Factor Surveillance System (BRFSS) survey: 1. If a terminal illness or serious accident left you unable to communicate, would a family member, friend, doctor, or other person know your medical or health care treatment

preferences? 2. An advance directive is a written legal document that outlines a persons wishes for future medical or health care treatment if that person can no longer communicate. Do you have a written advance directive? 30 Palliative Care Data Advance Care Planning BRFSS is the states primary tool for tracking health behaviors and risks among adults Includes a standardized national questionnaire and state added questions

10,000 completed interviews expected by end of 2018 Over 2,000 interviews completed as of April 30 Comprehensive questionnaire and large sample will allow for powerful cross tabulations by age, region, income, insurance, health status, gender, race/ethnicity, health status, and other factors 31 Palliative Care Data Texas Palliative Care Programs by Public Health Region 32

Palliative Care Data PC Programs by Public Health Region, 2016 PHR # Hospitals ( 50 beds) # with PC Program % with PC Program 1 7 5 71%

2 5 2 40% 3 57 30 53% 4 13 5

39% 5 9 3 33% 6 40 19 48% 7 24

15 63% 8 18 9 50% 9 6 2 33% 10

5 2 40% 11 17 6 35% 201 98 49% Total

33 Palliative Care Interdisciplinary Advisory Council Palliative Care Information and Education Webpages 34 Webpage Updates Palliative Care Information and Education Webpages Patient webpage https:// hhs.texas.gov/services/health/palliative-care

Patient webpage in Spanish https:// hhs.texas.gov/es/servicios/salud/cuidados-palia tivos Provider webpage https:// hhs.texas.gov/doing-business-hhs/provider-por tals/health-services-providers/palliative-care-pr oviders 35 Webpage Updates The sites will continue to evolve, including: Translating the Provider page into Spanish

Creating graphics to help support the messaging Continuing to develop language and resources Educational video 36 Webpage Updates Long-Term Care Provider Search The Long-Term Care Provider Search includes information about two types of long-term care

providers: Residential Home or community-based Purpose of update: identify and link to palliative care/hospice providers listed in Provider Search Visit the webpage here, https://apps.hhs.texas.gov/LTCSearch/ This website was previously called the Quality Reporting System 37 Palliative Care Interdisciplinary

Advisory Council Defining Palliative Care and Hospice Care in Texas Presentation by Erin Perez, APRN, NP 38 Defining Palliative Care and Hospice Care in Texas Introduction In 2014, CAPC estimated 90 million Americans were living with a serious illness. 68% of Medicare recipients had four or more complex comorbidities. CAPC estimated there could be 6 billion dollars/year of national savings- should appropriate utilization of palliative care be implemented. (CAPC,2014) 39

Defining Palliative Care and Hospice Care in Texas Introduction The CDC, estimated in 2014 there was 1.4million hospice patients across 4,000 hospices. The New England Journal of Medicine (2013) and the American Cancer Society (2017) both published statements identifying a palliative care identity crisis There is ongoing confusion and misunderstanding regarding the definitions and differences between PC and HC. The identity crisis and labeling of each type of care has resulted in a national and international movement to educate clinicians and consumers about the roles, differences, and benefits of receiving PC and HC . 40 Defining Palliative Care

and Hospice Care in Texas Introduction In a recent lit review, terms advanced, serious illness, and locally advanced were noted to be used interchangeably in articles where the meaning of PSC and HC were unclear or inappropriate to the context. (ACS, 2017; CAPC, 2014; CDC, 2016;Institute of Medicine (IOM), 2014; Ollove, 2017; Parikh, Kinch, Smith & Temel, 2013) 41 Defining Palliative Care and Hospice Care in Texas Background Life threatening illnesses and complex diseases require extensive resources of time, money, and man power. The Common Wealth Fund reports have persistently found the U.S. is the country with the

highest health care expenditures in the presence of the worst health care outcomes, in comparison to eleven other well-developed nations. (The Common Wealth Fund, 2017) 42 Defining Palliative Care and Hospice Care in Texas Background At the state and national levels, clinicians face the challenges of improving access to PCS and becoming better financial stewards of the health care resources at hand. (Parikh, Kinch, Smith & Temel, 2013) Despite the growing body of evidence to support the positive benefits of early PC and HC, clinicians and consumers face continued ignorance regarding the differences between the two service lines. (CAPC, 2017; TPIAC, 2016; IOM, 2014) 43

Defining Palliative Care and Hospice Care in Texas Gaps Currently there are gaps in state and national health policy legislation and CAPC health policy researchers are taking the lead to aid state advocacy projects. (IOM, 2014; CAPC, 2017) Specific PC health policy initiatives are coming to fruition in the form of state legislation defining PC and HC, new benefit lines, increased education and formal legislation. 44 Defining Palliative Care and Hospice Care in Texas Texas Currently no definitions exist in Texas law to guide clinicians and patients in the use of PC, not

relating to HC. Defining PC and HC in the Texas Health and Safety Code will be the first step in advancing the correct/appropriate utilization and implementation of PC and HC, garnering public awareness of the services, and decreasing confusion about their use. This will set the stage for funding and education opportunities and pilot programs for those in need of PC and HC. 45 Defining Palliative Care and Hospice Care in Texas Texas- Local Problem The lack of standardized and recognized definitions of PC and HC presents consumers and clinicians with several risks including: 1. Health care clinicians lack formal health care education on the differences between PC and HC.

2. Patients lack access to PC or HC and confront unnecessary access barriers. 3. Consumers and clinicians lack awareness of the differences and benefits of each service line, leading to a lack of true informed consent for treatment. 4. Patients at brink of death are dying in the hospital as a result of non-beneficial and/or non-desired medical care as patients endure a high symptom burden and families and medical teams experience emotional and ethical distress. (IOM,2014; TPIAC,2016) 46 Defining Palliative Care and Hospice Care in Texas Texas- Local Problem The lack of standardized and recognized definitions of PC, nonHC, presents consumers and clinicians with several risks including: 1. Health care clinicians lack formal health care education on the differences between PC and HC. 2. Patients lack access to PC or HC and confront

unnecessary access barriers. 3. Consumers and clinicians lack awareness of the differences and benefits of each service line, leading to a lack of true informed consent for treatment. 4. Patients at brink of death are dying in the hospital as a result of non-beneficial and/or non-desired medical care as patients endure a high symptom burden and families and medical teams experience emotional and ethical distress. (IOM,2014; TPIAC,2016) 47 Defining Palliative Care and Hospice Care in Texas Proposed Next Steps for Texans 1. Define Palliative Care in the Texas Health and Safety Code during the 86th Legislative session. Supportive Palliative Care (SPC) is delivered by a specialized interdisciplinary healthcare team comprised of at minimum one

prescribing healthcare clinician, nurse, social work, chaplain, not to exclude other health care professionals which enhance the quality of life of the patient and the family. SPC is defined and, means: patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering at any age or stage of serious (high risk mortality/life limiting) illness . SPC is distinct from hospice as it is not based on prognosis and does not require the patient to decline curative treatment. SPC throughout the continuum of a serious illness includes: addressing physical, intellectual, emotional, cultural, social and spiritual needs, and facilitating patient autonomy and information to support informed decision making. SPC may be provided together with treatments designed to modify or cure a disease. 48 Defining Palliative Care and Hospice Care in Texas 2. SPC Services means services provided by a medically directed certified agency utilizing and implementing an interdisciplinary SPC program to include at minimum:

Meaningful 24/7 response to patient/family crisis May be provided across the settings (home, personal care home, Long-Term Care Facility (residential/skill), Long-Term Acute Care, ARU, clinic, acute inpatient hospital). These services do not include hospice care services. Specifically not designed to feed sister/partner hospice agencies. 49 Defining Palliative Care and Hospice Care in Texas Palliative Care Standards of Services If SPC is provided within a licensed healthcare entity, the licensee shall have written policies and procedures for the comprehensive delivery of these services. For each patient receiving PC, there shall be documentation in the plan of care regarding evaluation of the patient and what services will

be provided. The licensees policies and procedures shall address the following minimal elements of SPC and how they will be provided and documented: 50 Defining Palliative Care and Hospice Care in Texas Palliative Care Standards of Services (1) Assessment and management of the patients pain and other distressing symptoms; and (2) Goals of care and advance care planning; and (3) Provision of, or access to, services to meet the psychosocial and spiritual needs of the patient and family; and (4) Provision of, or access to, a support system to help the family cope during the patients illness, and (5) As indicated, the need for bereavement support for families by providing resources or

referral. - Adopted from Colorado legislation 51 Defining Palliative Care and Hospice Care in Texas Reminder: The top 5% account for the 50-60% of all U.S. health care spending in a year. About 50% recover and have lower costs. About 10-11% in retrospective are in their last year of life.

Remainder 40% of patients with multi-chronic conditions often are accompanied with: functional and cognitive impairment that have persistent high cost, year over year. (Kelly, et al, 2017) 52 Defining Palliative Care and Hospice Care in Texas National Academy of Medicine (NAM) Benefits of SPC By helping to clarify and honor patient values, goals and preferences, quality could be enhanced by avoiding preventable and unnecessary medical interventions that will not help achieve the patient goals and are unlikely benefit or may even harm the patient. (Gordon and Betty Moore Foundation; Kelly, et al, 2017)

53 Defining Palliative Care and Hospice Care in Texas Once the SPC definition is accepted, what is next to help Texans? Formal SPC service line recognition Benefit line creation 54 Defining Palliative Care and Hospice Care in Texas Texas SPC Target Population for Consideration The Serious Illness Denominator in SPC Serious Illness is defined as high risk of mortality AND negatively impacts a persons daily function or quality of life or excessively strains

their caregivers. Identification of patients/families with unmet SPC needs is difficult Lack of data and measurement data No gold standard: ? OASIS data or Minimum Data Set Many methods now seek people at high risk for increased health care cost. (Kelly, et al, 2017) 55 Defining Palliative Care and Hospice Care in Texas Texas SPC Target Population for Consideration The Serious Illness Denominator in SPC

Cost savings is not and should not be the primary focus of SPC benefit, but an indirect benefit. Reduction of cost is often one of the key components of risk sharing payment models. SPC programs often participate in cost avoidance to support the SPC business plan. (Kelly, et al, 2017) 56 Defining Palliative Care and Hospice Care in Texas Texas SPC Target Population for Consideration Sensitivity and Specificity: Avoid too narrow/too broad Mindful awareness of costs and resources Some high needs patients will not be the highest cost & vice versa 57

Defining Palliative Care and Hospice Care in Texas 1st - Develop an Accountability System to Define Principles and High Quality SPC Measures in Texas: Accountability and Certification The National Coalition of Hospice & Palliative Care Updating guidelines for community based SPC The Joint Commission/National Quality Assurance Synergy between the 2 for evidence, guidelines and standards Public Performance Value Based Payment New potential Medicare benefit; MCCM: hospices allowed to

perform SPC services; MACRA: ? New benefit line for actionable quality measures guide for further development (Kelly, et al, 2017) 58 Defining Palliative Care and Hospice Care in Texas Core Competencies for SPC Quality Measures Identification of target population Team- Interdisciplinary based care Caregiver training

Attention to social determinants of health Communication training and support Goals based care plans- Patient centered goals of care Symptom management - pharmacologic/ nonpharmacologic/CAM Accessibility 24/7 coverage Care coordination and transitional care Measurement of Value for Accountability and Improvement (Kelly, et al, 2017)

59 Defining Palliative Care and Hospice Care in Texas 1. Define SPC in Texas Health & Safety Code 2. Formal service line recognition of SPC 3. To move beyond, do we ask for a pilot/study vs. waiver from HHSC/CMS, or wait for a new bill creation to pass for formal benefit line inclusion? Greater flexibility potential to experiment and change direction if needed under ____? Following Californias step by step blue print for pilot study for SPC? New TPIAC workgroups to help identify/delineate needs of new SPC service benefit line based on value care. 60 Palliative Care

Interdisciplinary Advisory Council 2018 Legislative Report 61 Legislative Report 2018 Legislative Report Timeline JAN - MAY Jan - May: Workgroup (WG) calls to discuss possible report topics and policy recommendation options Discuss data needs for the report Research supporting

information for recommendations JUN Early Jun: WG calls continue, review draft topics and recommendation options Jun 14: Full Council Meeting Review proposed topics and recommendations, divide topics among WGs to draft legislative report Late Jun:

Continue working on drafts *The above dates are tentative. JUL Jul: WGs drafting sections and conducting calls Jul 25: Report Chapters should be complete AUG First Week of August: Report complete and posted online for stakeholder comments

SEP Sep: Report being routed Aug 10 or 17 (DATE through HHS TBD): Full Council Meeting Review and vote on legislative report Aug 11-20: Staff will work with Chair and WG leads to finalize the report and ensure accessibility Aug 17: Comment letters from Stakeholders due Aug 21: Final version of the report will be complete

and routed through Health and Human Services (HHS) OCT Oct 1: Final report due to Legislature Oct TBD: Full Council Meeting Goals Potential Program Goals More and earlier palliative care referrals More interdisciplinary professionals with a palliative care specialty or credential More palliative care fellows More training on palliative care for specialists and non-specialists

More people completing Advance Planning documents More facilities offering palliative care services More facilities with Joint Commission or other recognized certification More community based palliative care services Less disparity in access across the state 63 Goals Strategies to Achieve Goals How do we move forward on these goals? Promoting palliative care education- using the HHS palliative care website as a tool Providing continuing education credits in palliative care Measuring performance Identifying funding to support initiatives Galvanizing action through council recommendations 64

Development Steps Step 1: Review and discuss proposed topics and policy options Step 2: Divide and conquer Based on the approved topics, the work will be divided among the workgroups as appropriate Step 3: Workgroup Membership New members will join a workgroup Current members can change workgroups Each workgroup should have 4 7 members 65 Development Steps Step 4: Workgroup Breakout Session A recommendation template (see handout) is provided to assist in facilitating and developing recommendations Following the meeting, workgroup calls will be

organized to further develop and draft respective sections Step 5: Workgroup Breakout Reports Workgroup lead will provide an update based on the discussion Step 6: Consensus Statement Collectively, the council may review the consensus statement from the last legislative report and discuss any needed updates. To review the consensus statement, please click here and review on page 23 66 Workgroup Topics and Assignments Workgroup 1 1. Statutory palliative care definition 2. Next steps to leverage definition a. Medicaid pilots b. Licensing c. Service line delineation 3. Increasing access to SPC in:

a. Hospital settings b. Non-hospital settings Workgroup 2 4. Patient centered and value-based care 5. State dashboard 6. Linking payment to quality (Joint Commission) 67 Workgroup Assignments, cont. Workgroup 3 1. Support Palliative Care workforce 2. Supportive Palliative Care continuing education priorities a. Do-Not-Resuscitate Orders/Advance Planning b. Legislative report recommendations c. Opioids 3. Opioid policy 68

Legislative Report Recommendation Options: Questions to Consider What is the goal of the recommendation? Who are the key stakeholders impacted by/involved with this recommendation? What is the time frame for the recommendation? Is the recommendation as succinct as needed? Are any significant costs associated with the recommendation? Are any identifiable unintended consequences likely from the recommendation? Other considerations? 69 Current Workgroup Membership Workgroup 1: 1. Ms. Erin Perez Lead 2. Ms. Jennifer Allmon 3. Dr. Bruce Christensen 4. Dr. Craig Hurwitz

5. Mr. Cam Scott Workgroup 2: 6. Dr. Robert Fine Lead 7. Dr. Amy Moss Workgroup 3: 8. Dr. Mike Ragain Lead 9. Dr. Hattie Henderson 10.Mr. Nat Jones 70 Palliative Care Interdisciplinary Advisory Council Workgroup Breakout Session and Reports 71 Next Steps and Goals Next Steps:

Workgroup calls to further discuss recommendations and draft respective sections Workgroups will need to determine how often they would like calls to occur Important dates: July 25 - Report chapters should be complete First week of August - Report complete and posted online Aug 10 or 17 (Date TBD)- Review and vote on recommendations and legislative report 72 Palliative Care Interdisciplinary Advisory Council Staff Action Items

73 Palliative Care Interdisciplinary Advisory Council Public Comment Onsite participants, please come to the podium and provide your name and organization for the record. Comments may be submitted in writing to staff for inclusion in the meeting record. 74 Palliative Care Interdisciplinary Advisory Council Meeting Adjourned 75

Thank you For more information contact: Jimmy Blanton, Director Health Quality Institute Medicaid and CHIP Services [email protected] us Visit the PCIAC Advisory Council webpage to learn more: https:// hhs.texas.gov/about-hhs/lea dership/advisory-committee

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