The following information was obtained from the January 21 issue of the Texas Register:
Public Hearing and Notice
HHSC will hold a public hearing on February 15, 2011, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for Clinical Laboratory Services. The hearing will be held in the Lone Star Conference Room of HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin, Texas.
HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance, which would modify the reimbursement methodology in the State Plan for Hospice Care to indicate that DADS pays a Medicaid hospice room and board per diem amount that’s 96.96 percent of the appropriate rate for each Medicaid hospice recipient living in an NF or ICM/MR.
For more information about each announcement, see the Texas Register.
Proposed Rules
HHSC proposes new §371.216, concerning waiver of extrapolation, in Chapter 371, Medicaid and Other Health and Human Services Fraud and Abuse Program Integrity, to clarify procedural questions arising out of the conversion from the TILE classification system and provider payment methodology to the federal RUG classification system and provider payment methodology.
HHSC proposed to amend §372.501, concerning disqualifications due to criminal activity, in Chapter 372, governing TANF and SNAP, to correct an error in the section. An excerpt (emphasis added):
“The rule currently states that a person is disqualified from both TANF and SNAP benefits if the person is convicted of a felony drug offense committed on or after April 1, 2002. However, in accordance with federal law (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)), HHSC disqualifies a person from SNAP benefits if the person is convicted of a felony drug offense committed after August 22, 1996.”
HHSC proposes new Chapter 395, Civil Rights, Subchapter A, General Provisions, consisting of §395.1, concerning purpose, and §395.2, concerning definitions; Subchapter B, Responsibilities of Health and Human Services Agencies, consisting of §395.11, concerning health and human services (HHS) agency responsibilities, and §395.12, concerning role of the HHSC Civil Rights Office (CRO); Subchapter C, Complaints, consisting of §395.21, concerning complaints and complaint procedures, and §395.22, concerning complaint records; Subchapter D, Compliance Monitoring, consisting of §395.31, concerning HHS agency compliance, and §395.32, concerning contractor compliance; and Subchapter E, Employment Practices, consisting of §395.41, concerning employment practices.
The new sections would establish civil rights rules that will apply to all HHSC agencies. See the Texas Register for details about each proposed rule.
On DADS’ behalf, HHSC proposed to repeal Chapter 73, Civil Rights, including all subchapters and sections. HHSC has proposed civil rights rules that will apply to all health and human services agencies; therefore, DADS proposes to repeal its civil rights rules. See the Texas Register for more information.
Adopted Rules
HHSC adopts amendments to §353.601, General Provisions; §353.603, Member Participation; §353.605, Participating Providers; and new §353.607, STAR+PLUS Handbook. The new rules will reflect the current program description and member participation guidelines and update the geographic locations where the program is available, as well as specify that the STAR+PLUS Handbook includes policies and procedures to be used by all health and human services agencies and their contractors and providers in the delivery of 1915(b) and/or 1915(c) STAR+PLUS waiver services to eligible members.
HHSC adopted new §354.1440, Medical Care or Services Provided to Medicaid Recipients Outside of Texas, and §354.1442, concerning Out-of-State Provider Eligibility, to strengthen the Medicaid rules regarding out-of-state providers.
HHSC adopted amendments to §355.501, Reimbursement Methodology for PACE, to allow higher levels of managed care savings and add language allowing for appropriate actuarial adjustments to be made for statistical outliers, and other changes.
HHSC adopted amendments to §355.8043, concerning Supplemental Payments for Physician Services, to add Texas A&M Health Science Center to the list of approved state entities that are eligible to receive Medicaid physician supplemental payments.
HHSC adopts the repeal of §355.8083 and moves the program policy information related to out-of-state providers to new §354.1440 and §354.1442 in Chapter 354, Medicaid Health Services. HHSC is adopting the rules in Chapter 354 concurrently with this repeal. These changes are designed to strengthen the Medicaid rules regarding out-of-state providers.
HHSC adopted amended §355.8261, Federally Qualified Health Center Services Reimbursement, which updates the Medicaid reimbursement methodology for Federally Qualified Health Centers.
HHSC adopted amendments to §355.8551, Reimbursement Methodology for Pharmacy Health Services, related to the Medicaid pharmacy dispensing fee, to reduce the fee by one percent.
See the Texas Register for more information.
On DADS’ behalf, HHSC adopted the repeal of Chapter 1, Subchapter D, consisting of §1.151, concerning purpose; §1.152, concerning applicability and scope of rules; §1.153, concerning definitions; §1.154, concerning administrative law judge; §1.155, concerning hearing guidelines; §1.156, concerning conduct of hearings–general requirements; §1.157, concerning prehearing procedure; §1.158, concerning evidence and depositions; §1.159, concerning deliberation; §1.160, concerning decisions; §1.162, concerning references; and §1.163, concerning distribution.
The repeal deletes rules no longer required in the DADS rule base.
On DADS’ behalf, HHSC adopted new Chapter 91, consisting of §§91.1 – 91.8, concerning hearings under the Administrative Procedure Act (APA), to provide rules for governing certain issues related to hearings under the APA, Texas Government Code, Chapter 2001.
See the Texas Register for more information.
