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Texas Register Updates: HCS, Medicaid MCOs, Etc.

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The following was obtained from the February 12 issue of the Texas Register:

Proposed Rules

  • HHSC proposes on behalf of DADS to amend Subchapter L, §2.553, concerning definitions; §2.554, concerning eligibility; §2.556, concerning MRA’s responsibilities; §2.559, concerning minimum qualifications; §2.562 concerning review process; new §2.555 concerning funding service coordination; and the repeal of §2.555 concerning assessing an individual’s need for service coordination, in Chapter 2, Mental Retardation Authority Responsibilities.Among other things, the proposed rules change the definition of frequency, add a “provision that requires the person providing service coordination to ensure that any concern with the implementation of an individual’s plan of services and supports identified as a result of monitoring be communicated to the entity providing the services and supports, such as the HCS Program provider, and that attempts are made to resolve the concern.”

    Send questions to Marcia Shultz at (512) 438-3532 and written comments (no later than 30 days after this issue of the Texas Register) to Texas Register Liaison, Legal Services-9R006, Department of Aging and Disability Services W-615, P.O. Box 149030, Austin, Texas 78714-9030, or street address 701 West 51st St., Austin, TX 78751; faxed to (512) 438-5759; or e-mailed to rulescomments@dads.state.tx.us.

    For details about the proposed rules, see the relevant section of the Texas Register.

  • HHSC also proposes to amend Subchapter D, §§9.151 – 9.155, 9.169 – 9.174, 9.177 – 9.179, 9.185, 9.186, 9.188, and 9.189, concerning purpose, application, definitions, description of the HCS program, and other subsections, to comply with Senate Bill 643 and Senate Bill 744. The proposed changes are designed, among other reasons, to ensure an individual’s freedom of choice of a qualified person or entity willing to provide the service at or below the direct services portion of the applicable HCS Program rate.Send questions to Cheryl Craddock-Melchor at (512) 438-4512 in DADS’ Provider Services. Send written comments (no later than 30 days after this issue of the Texas Register) to Texas Register Liaison, Legal Services-9R008, Department of Aging and Disability Services W-615, P.O. Box 149030, Austin, Texas 78714-9030, or street address 701 West 51st St., Austin, TX 78751; faxed to (512) 438-5759; or e-mailed to rulescomments@dads.state.tx.us.See the Texas Register for details.

    Adopted Rules

  • HHSC adopted an amendment to §353.4, concerning Managed Care Organization Requirements Concerning Out-of-Network Providers, which will require Medicaid MCOs to reimburse out-of-network providers at the Medicaid fee-for-service rate minus five percent, unless the parties agree to a different amount. For details, see the relevant section of the Texas Register.
  • HHSC also adopted amendments to §354.1015, concerning Benefits and Limitations, and §354.1017, concerning Specifications for Eyewear, relating to the Medicaid Vision Care Program, to mirror the Medicaid state plan for certain vision services provided to the under 21 population and to align with current standard of care practices. See the Texas Register for more information.
  • The Texas Board of Nursing adopted amendments to §213.33, concerning Factors Considered for Imposition of Penalties/Sanctions with changes to subsections (k) and (l) of the proposed text published in the December 4, 2009, issue of the Texas Register (34 TexReg 8628). The amendments are necessary to adopt the Disciplinary Matrix, used in the resolution of eligibility and disciplinary matters before the Board, in rule. For more information, see the relevant section of the Texas Register.