The following information was obtained from the July 15 issue of the Texas Register:
Proposed Rules
HHSC proposes to amend §355.457 and §355.722, Cost Finding Methodology, which would establish the cost finding methodology for the ICF/MR, HCS, and TxHmL programs and describe limitations for reporting wage rates, benefits, and hours for related-party direct service workers, etc. See the Texas Register for details about the proposed changes.
HHSC proposes to amend §355.8065, Disproportionate Share Hospital (DSH) reimbursement Methodology, to update language in the rule related to the federal DSH audit rule and clarify current administrative processes. For more information, see the Texas Register.
Finally, HHSC proposes to amend §355.8441, Reimbursement Methodologies for Early and Periodic Screening, Diagnosis and Treatment Services, to allow publicly owned mobile dental units and clinics to receive additional federal funding through supplemental payments for Medicaid fee-for-service dental claims. See the Texas Register for details.
Adopted Rules
HHSC adopted amendments to §354.1415, Vendor Requirements and Conditions for Participation; §354.1416, Eligibility Criteria; and §354.1417, Definitions for Texas Medicaid Wellness Program Services, to align HHSC’s administrative rules with its revised approach to health management.
HHSC adopted amendments to §354.1430, Definitions, which increases access to telemedicine pediatric specialty and subspecialty services for Medicaid recipients under 21.
For more information, see the Texas Register.
HHSC adopted amendments to §355.8043, Supplemental Payments for Physician Services, which allows HHSC to make Medicaid supplemental payments to physicians “employed by or under contract with a physician group practice organized by, under the control of, or under contract with a non-profit, tax-exempt hospital where both the hospital and the physician group practice provide medical education under contract with a state-owned medical school.”
HHSC adopted the repeal of §355.8640, Reimbursement for the Disease Management Program. An excerpt:
The repealed rule describes the payment structure for the Medicaid disease management program, as well as the percentage of the disease management vendor’s fees that are placed at risk if the vendor does not meet targeted savings and performance measures. The payment structure and at-risk fee components are specific to the former disease management program, which HHSC is replacing with the successor Texas Medicaid Health Management program, also known as the Texas Medicaid Wellness Program. HHSC and the selected program vendor will negotiate a new payment structure, including new at-risk components and performance measures. The repeal is adopted to avoid potential confusion regarding the application of the rule to the successor program.
Finally, HHSC adopted amendments to §371.1685, Use of Criminal History Record Information, which makes a conviction of an offense under §22.021, Texas Penal Code, aggravated sexual assault, a conviction that renders an applicant or provider ineligible to participate in the Texas Medicaid program. For details, see the Texas Register.
