TX Register Updates: NF Payment Increase, Medicaid Managed Care
The following information was obtained from the August 23 issue of the Texas Register.
HHSC intends to submit to CMS a request to amend the CBA waiver program to remove cost containment service limits, allow individuals to transfer between waivers when medically necessary for services to continue to ensure health and safety, and other changes.
HHSC intends to submit Transmittal Number 13-024 to add provisionally licensed psychologists as an additional type of provider that can perform psychological counseling and services under the direct supervision of a licensed psychologist.
Finally, HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance to update Medicaid payment rates for the NF program to provide a two percent.
For more information, see the Texas Register.
HHSC adopted amendments to §352.17, Out-of-State Medicaid Provider Eligibility, which implements SB 140, 83rd Texas Legislature, Regular Session, 2013, to authorize enrollment of laboratories as in-state providers in the Texas Medicaid program, regardless of where the facility is located and under certain conditions.
HHSC adopted amendments to §§353.903, 353.905, 353.907, and 353.913, Outpatient Pharmacy Services in the Medicaid managed care program, to comply with legislation passed by the 83rd Legislature that impact the outpatient pharmacy benefits requirements for Medicaid and CHIP managed care organizations.
HHSC adopted amendments to §§354.1601, 354.1602, 354.1611, 354.1613, 354.1621, 354.1622, 354.1632, 354.1633, and 354.1634, Texas Healthcare Transformation and Quality Improvement Program, and new §354.1635, RHP Plan Modification. Sections 354.1601, 354.1602, 354.1613, 354.1621, 354.1622, 354.1632, 354.1633, and 354.1634. The changes are related to expanded Medicaid managed care.
HHSC adopted an amendment to §355.112, Attendant Compensation Rate Enhancement, to simplify Attendant Compensation Rate Enhancement reporting requirements for day habilitation services in the HCS, TxHmL, and ICF/IDD programs.
HHSC adopted an amendment to §355.307, Reimbursement Setting Methodology, to comply with SB 1, which requires HHSC to develop and implement a Medicaid reimbursement methodology for the pediatric long term care facility rate class that includes the existing facility-specific prospective cost-based interim reimbursement rate and adds an annual cost-based retrospective cost settlement process.
HHSC adopted amendments to §355.503, Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs, and §355.507, Reimbursement Methodology for the Medically Dependent Children Program, which establish reimbursement methodologies for these providers.
HHSC adopted amendments to §355.7103, Rate-Setting Methodology for 24-Hour Residential Child-Care Reimbursements, to reference the uniform cost report excusal rules and to outline how the rates will be determined.
HHSC adopted amendments to §355.8052, Inpatient Hospital Reimbursement, and §355.8060, Reimbursement Methodology for Freestanding Psychiatric Facilities, and the repeal of §355.8054 and §355.8055, Children’s Hospital Reimbursement Methodology and Reimbursement Methodology for Rural and Certain Other Hospitals. Among the changes: rebase rural hospital rates by implementing a facility-specific prospective full cost standard dollar amount based on historical costs, trended forward for inflation and limited by a floor and a ceiling.
HHSC adopted amendments to §355.8061, Outpatient Hospital Reimbursement, to effectively monitor and reduce costs.