Texas Register July 29, 2022 Volume: 47 Number: 30

Texas Register Table of Contents

1 Texas Department of Insurance
- - 1.0.1 Adopted Rules Re:
  - 1.0.2 In Addition Re:
    - 1.0.2.1 Company Licensing
2 Texas Health and Human Services Commission
- - 2.0.1 In Addition Re:
    - 2.0.1.1 Public Notice – Texas State Plan for Medical Assistance Amendment

Texas Department of Insurance

Adopted Rules Re:

Amending 28 TAC §§10.1 – 10.3 to clarify statutory definitions and update contact information for the Division of Workers’ Compensation and the Office of Managed Care Quality Assurance.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER A. GENERAL PROVISIONS AND DEFINITIONS
28 TAC §§10.1 – 10.3

OVERVIEW

The Commissioner of Insurance adopts the repeal of 28 TAC §10.102 and §10.103; new §10.3; and amendments to §§10.1, 10.2, 10.20 – 10.27, 10.40 – 10.42, 10.60 – 10.63, 10.80 – 10.86, 10.100, 10.101, 10.104, 10.120 – 10.122, and 10.200, concerning workers’ compensation health care networks.

The Commissioner adopts the repeal of §10.102 and §10.103, new §10.3, and amended §§10.1, 10.21, 10.23 – 10.25, 10.27, 10.40, 10.42, 10.62, 10.63, 10.80, 10.84 – 10.86, 10.100, 10.101, 10.104, 10.122, and 10.200 without changes to the proposed text published in the February 4, 2022, issue of the Texas Register (47 TexReg 457). The rules will not be republished.

The Commissioner adopts amendments to the following sections with changes to the proposed text published in the February 4, 2022, issue of the Texas Register: §§10.2, 10.20, 10.22, 10.26, 10.41, 10.60, 10.61, 10.81 – 10.83, 10.120, and 10.121. Changes to the proposed rule text include changes made in response to comment, and additional minor changes to wording and punctuation for clarification, consistency within rule text, and consistency with department language preferences and drafting practices. These rules will be republished.

In the April 1, 2022, issue of the Texas Register (47 TexReg 1740), the Secretary of State’s Office corrected an error it made to the proposed amendments to 28 TAC §10.60(j)(4). The text for proposed paragraph (4) of subsection (j) was incorrectly identified as new language. Only the paragraph number should have been listed as new language. In the same issue, the department posted a Notice of Hearing for the proposal.

BACKGROUND AND JUSTIFICATION

The repeals, new section, and amendments in Chapter 10 are necessary to implement legislative amendments to the Insurance Code. Some of the amendments implement changes to Insurance Code Chapter 1305, as added by House Bill 7, 79th Legislature, 2005, and as amended by HB 4290, 81st Legislature, 2009; Title 5 of the Labor Code, as amended by HB 7 and HB 4290; and Occupations Code Chapter 111, as amended by Senate Bill 1107, 85th Legislature, 2019, and HB 2056, 87th Legislature, 2021. This adoption also removes unnecessary data requirements, reducing the burden on workers’ compensation health care networks (certified networks) and carriers.

In addition, the amendments and repeals harmonize certified network requirements with rules for other networks and utilization review requirements to comply with Insurance Code Chapter 4201, which was recodified and amended after the Chapter 10 rules were adopted. Recent updates to the Utilization Review Agent rules in 28 TAC Chapter 19 also generally apply to certified networks, so conforming edits are made to Chapter 10 to decrease rule redundancy. The amendments update current rules to correct obsolete statutory citations and physical address references, shorten some rules with simpler citations to statutes or references to other rules, and comply with current department language preferences and drafting practices.

SECTION-BY-SECTION SUMMARY

Section 10.1. The amendments to §10.1 update and add more complete statutory citations, reflect the addition of Insurance Code §1305.008 by HB 472, remove a 2006 applicability date, and make changes to conform to current department language preferences and drafting practices.

Section 10.2. The amendments to §10.2 update and add more complete statutory citations, clarify existing and add new definitions, and make changes to conform to current department language preferences and drafting practices. Specifically, the amendments:

update the definition of “adverse determination” to clarify that the term does not include a denial of health care services because of a failure to request prospective or concurrent utilization review, and to provide consistency with the requirements in Labor Code §408.021(a) and §413.014(c)(6) and the definition in 28 TAC §19.2003(b)(1) and §134.600(a)(1);
add the defined terms “administrator,” “concurrent utilization review,” “Division of Workers’ Compensation,” “MCQA,” “physician,” and “telehealth service, telemedicine medical service, and teledentistry dental service;”
amend the definitions of “affiliate,” “capitation,” “complainant,” “complaint,” “credentialing,” “emergency,” “fee dispute,” “independent review,” “independent review organization,” “medical emergency,” “medical records,” “mental health emergency,” “network or workers’ compensation health care network,” “person,” “quality improvement program,” “rural area,” “screening criteria,” and “transfer of risk” to cite Insurance Code §1305.004 rather than repeat its provisions;
amend the definition of “life-threatening” to cite Insurance Code Chapter 4201;
remove the defined term “nurse” because the term is no longer used in 28 TAC Chapter 10;
amend the definition of “preauthorization” because the definition of “utilization review” in Insurance Code §1305.004 refers to the definition in Insurance Code Chapter 4201, which includes retrospective review, and the 2009 amendments to Insurance Code Chapter 1305 by HB 4290 removed separate references to retrospective review in sections referring to utilization review;
amend the definition of “retrospective review” to exclude the review of services for which prospective or concurrent utilization reviews were previously conducted or should have been previously conducted because preauthorization no longer includes retrospective review and retrospective review does not include preauthorization or concurrent review; and
update the list of terms that have the meanings assigned by Labor Code §401.011 to include “impairment rating” and “maximum medical improvement.”

The department revised proposed §10.2(a)(9) to clarify that the “Division of Workers’ Compensation” has the meaning assigned to the “Division” by Labor Code §401.011.

In response to a comment, the department revised proposed §10.2(a)(33) to clarify that “service area” has the meaning assigned by Insurance Code §1305.004(a)(24).

Section 10.3. New §10.3 indicates that any contact information needed for the Division of Workers’ Compensation or the Office of Managed Care Quality Assurance can be found on the department’s website and notes that this contact information should be used when an email address, mailing address, or telephone number is referenced in Chapter 10.

Amending 28 TAC §§10.20 – 10.27 to implement legislative amendments to the Insurance Code.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER B. CERTIFICATION
28 TAC §§10.20 – 10.27

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.20. The amendments to §10.20 add more complete statutory citations and remove a reference to “contracting with more than one person” from the description of a person who must be certified as a workers’ compensation health care network, because this language is not contained in Insurance Code Chapter 1305. The department revised the text of §10.20 as proposed to replace a comma with a semicolon after the word “chapter” in §10.20(1)(A).

Section 10.21. The amendments to §10.21 remove a specific web address and a specific mailing address contained in the section to avoid providing incorrect information should that information change.

Section 10.22. The amendments to §10.22 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. In addition, the amendments:

specify submission of the National Association of Insurance Commissioners Uniform Certificate of Authority Application (NAIC UCAA) Form 11 biographical affidavit for providing biographic data;
clarify that a description and map of the applicant’s proposed service area is required and require a map with information for each specialty providing services to injured employees, to simplify applications and shorten processing times by eliminating delays when the department requests these materials;
require information about providers that provide telehealth service, telemedicine medical service, or teledentistry dental service so the department can know who is providing services by telecommunications or other information technology and how that affects certified networks, as well as what services are available by telecommunications or other information technology and whether those services can actually be provided in that manner;
clarify that an access plan is required for any service area in which the certified network does not meet accessibility and availability requirements, to simplify applications and shorten processing times by eliminating delays when the department must request the necessary access plans; and
clarify that applicants must verify that certified network doctors have completed both training and testing as required by the Labor Code and rules adopted by the Commissioner of Workers’ Compensation.

The department revised the proposed text of §10.22(20) to add the words “and be designed to reduce inappropriate or unnecessary health care while safeguarding necessary care” as stated in Insurance Code §1305.304 and 28 TAC §10.83(a).

Section 10.23. The amendments to §10.23 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices.

Section 10.24. The amendments to §10.24 add more complete statutory citations, remove a specific mailing address contained in the section and reference an email address instead, to avoid providing incorrect information should that mailing address change, and make changes to conform to current department language preferences and drafting practices.

Section 10.25. The amendments to §10.25 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. The amendments also:

refer to §10.27 in regard to material modifications;
clarify that a certified network must file an expansion, elimination, or reduction of an existing service area, or addition of a new service area with the department for approval before implementation and in accordance with the prior approval requirement in §10.26; and
add a requirement that a certified network notify the department of the merger of the certified network with another entity and any other organizational change at least 30 days before implementing the merger or organizational change.

Section 10.26. The amendments to §10.26 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. In addition, the amendments:

remove a 30-day advance filing requirement for modification requests as duplicative of the requirement for prior approval;
add statutory citations and references to rules with which a corrected notice of certified network requirements and employee information and acknowledgment form must comply; and
remove a specific mailing address contained in the section to avoid providing incorrect information should that address change.

The department made a change from the proposal to replace a comma with a semicolon after the word “Requirements” in the text added to §10.26(f).

The department made a change from the proposal to replace a comma with a semicolon after the words “chapter” and “Networks.”

Section 10.27. The amendments to §10.27 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. Also, the amendments:

remove specific email and mailing addresses contained in the section to avoid providing incorrect information should the addresses change;
add a requirement that a request for a modification to network configuration that adds or modifies telehealth service, telemedicine medical service, or teledentistry dental service must include an explanation about updating its provider directory and any statements or restrictions on those services in the request; and
in response to continued questions from regulated entities, clarify that a material modification includes a change to the network configuration that alters the ability of the certified network to comply with the availability and accessibility requirements described in §10.80.

Amending 28 TAC §§10.40 – 10.42, concerning mandatory compliance with the Insurance Code for persons serving as both a management contractor or a third party and as an agent of the health care providers.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER C. CONTRACTING
28 TAC §§10.40 – 10.42

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.40. The amendments to §10.40 add more complete statutory citations and make a change to conform to current department language preferences and drafting practices. Amendments also clarify that a person serving as both a management contractor or a third party and as an agent of the health care provider must comply with Insurance Code §1305.153.

Section 10.41. The amendments to §10.41 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. The amendments also:

refer to both the carrier’s and the certified network’s responsibility for delegated functions, to conform to Insurance Code §1305.154(b);
require reporting of claim numbers, which are already available and being reported, so that the department will know how many claims are affected;
remove a separate reference to retrospective review because retrospective review is included in utilization review;
correct a typographical error; and
require certified network consent to subdelegation of network functions to avoid situations where networks are unaware of subdelegations or where there is no monitoring of subdelegations.

In response to a comment that the language in proposed §10.41(a) did not include statutory language about confidentiality, the department declined to adopt proposed §10.41(a) because it is not necessary to repeat statutory language. The department redesignated proposed §10.41(b) – (d) as §10.41(a) – (c).

Section 10.42. The amendments to §10.42 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. The amendments also require provider contracts to provide that:

the provider agrees to follow the pharmacy closed formulary adopted by the Division of Workers’ Compensation under 28 TAC §134.540 so the department can be assured that contracted providers are aware of and compliant with this existing requirement;
billing and payment will be made in accordance with rules governing the billing and payment for certifications of maximum medical improvement and impairment rating examinations so the department can ensure that providers and certified networks are aware of and compliant with these existing requirements;
the provider will receive written notice from the carrier if the carrier contests compensability of an injury the provider is treating, to conform to Insurance Code §1305.153(e); and
the carrier may not deny payment for services provided before the issuance of the notice on the grounds that the injury was not compensable, to conform to Insurance Code §1305.153(e).

Amending 28 TAC §§10.60 – 10.63 to describe processes and procedures for health care services networks.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER D. NETWORK REQUIREMENTS
28 TAC §§10.60 – 10.63

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.60. The amendments to §10.60 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. In addition, the amendments:

provide that, upon notification that health care services are being provided through the network, an employee living within the service area of a network and who is being treated by a non-network provider for an injury that occurred before the employer’s insurance carrier established or contracted with that network, may select a network treating doctor from a list of contracted doctors or request a doctor who the employee selected before the injury as the employee’s primary care physician or provider under Insurance Code Chapter 843;
remove the Health Maintenance Organization Division mailing address from the list of places from which a sample acknowledgment form may be obtained because there is no longer a program area named “Health Maintenance Organization Division;”
revise language regarding retaliation to reflect the language of Insurance Code §1305.404;
require the clear identification of providers who provide telehealth service, telemedicine medical service, or teledentistry dental service in lists of certified network providers, so it will be clear to injured employees, providers, certified networks, and the department who is providing these services;
clarify that the failure of an employer or carrier, as applicable, to establish a standardized process for complying with the delivery of notice of network requirements in this section creates a rebuttable presumption that the employee has not received the notice and is not subject to network requirements; and
provide that a dispute regarding whether an employer or carrier properly provided the information required by §10.60 to an employee may be resolved by requesting a benefit review conference as provided under Insurance Code §1305.103(c) and §1305.451(e).

The department revised the proposed amendments to §10.60(b) by placing the word “may” at the end of §10.60(b), rather than the beginning of §10.60(b)(1). The department also revised the proposed text by adding a comma after the word “section” in proposed §10.60(e). In addition, the department changed proposed §10.60(f)(2)(A)(i) by replacing a comma with a semicolon after the word “network,” and the department made a change from the proposal to add a comma after the word “name” in §10.60(f)(3).

In response to comments, the department declined to adopt proposed new §10.60(g), which would have provided for an employer and carrier to determine which party would be responsible for obtaining a signed acknowledgment form. As part of this change from the proposed text, the department declined to establish a new §10.60(h), and it retained text that would have been deleted as part of the proposed change. For consistency with these changes, the department redesignated the subsections that follow §10.60(g) to reflect that new §10.60(g) is not adopted, and the department made additional changes to the proposal to delete references to “responsible party” in §10.60(b), (c), (e), (i), (j), and (k), as adopted.

The department made changes to §10.60(g) as adopted to add “concerning Treating Doctor; Referrals” following the citation to Insurance Code §1305.103(c) and to replace the word “shall” with “must” to conform to current department language preferences and drafting practices. The department revised proposed §10.60(h)(14)(A) to change “telehealth services, telemedicine medical services, or teledentistry dental services” to “a telehealth service, telemedicine medical service, or teledentistry dental service” for consistency in terminology within the rule text.

In response to a comment, the department declined to adopt proposed §10.60(k). The subsections that followed proposed §10.60(k) have been redesignated as appropriate to reflect this change from the proposed text.

Section 10.61. The amendments to §10.61 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. The amendments also add a reference to the rules of the Division of Workers’ Compensation to provide guidance regarding treatment for compensable injuries to non-network providers.

In response to a comment that deleting §10.61(d) would remove the ability of an employee and network to agree that the employee may participate in a network even though the employee does not live within the network service area, the department retained §10.61(d). For consistency with this change, the department redesignated proposed §10.61(e) and (f) as §10.61(f) and (g) in the adopted text.

Section 10.62. The amendments to §10.62 make changes to conform to current department language preferences and drafting practices.

Section 10.63. The amendments to §10.63 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices.

Amending 28 TAC §§10.80 – 10.86 to update network requirements for providers.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER E. NETWORK OPERATIONS
28 TAC §§10.80 – 10.86

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.80. The amendments to §10.80 make changes to conform to current department language preferences and drafting practices. The amendments also:

clarify that providers must be licensed to practice in this state, unless exempt from licensing requirements;
clarify that network adequacy is measured by the number of contracting doctors and specialists, not noncontracted ones;
replace a requirement to give the reason or reasons that health care services or providers cannot be made available for each geographic area identified as not having adequate health care services or providers available with requirements to list the providers or physicians a certified network attempted to contract with, how and when the certified network contacted each provider, and a description of a reason each provider gave for declining to contract with the certified network to more closely track 28 TAC §3.3707, because these descriptions have resulted in better reporting by carriers and better oversight by the department;
remove duplicative requirements in current §10.80(g)(4)(B) and (C), which are already included in §10.80(f) and new subsection (g)(6); and
provide specific reporting requirements in §10.80(g)(5) when a general hospital is not available in an approved nonrural county, or a general acute hospital is available in an approved nonrural area but refuses to contract with the certified network.

Section 10.81. The amendments to §10.81 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices. In addition, the amendments:

remove a separate reference to retrospective review because a statutory change since the creation of the rule added retrospective review to the definition of utilization review;
require certified networks to maintain documentation demonstrating that doctors who provide certifications of maximum medical improvement or assign impairment ratings to injured employees are authorized to do so under 28 TAC §130.1; and
remove a now-obsolete subsection (g), dealing with actions permitted until January 1, 2007.

The department made a change to §10.81(c)(1) as proposed to change “the Joint Commission on Accreditation of Healthcare Organizations” to “The Joint Commission.”

Section 10.82. The amendments to §10.82 make changes to conform to current department language preferences and drafting practices. The amendments also:

substantially shorten the section, simplify the process for selection and retention of preferred providers, and make the process more cost effective by replacing lengthy and detailed credentialing requirements with nationally promulgated processes;
reduce certified network effort and inquiries by including a reminder that requirements of §10.41 apply to delegation of credentialing; and
allow time for compliance with the amendments by permitting entities subject to §10.82 to comply with the section as it currently exists until January 1, 2023; entities will have until January 1, 2023, to make a filing attesting to compliance with the rule amendments.

The department revised §10.82(a) as proposed to capitalize the word “the” before “Joint Commission.”

In response to comments to change the September 23, 2022, compliance date in proposed §10.82(d) for credentialing standards, the department changed the date to January 1, 2023.

Section 10.83. The amendments to §10.83 make changes to conform to current department language preferences and drafting practices.

The department revised §10.83(a) as proposed to add “be” before “designed,” for consistency with Insurance Code §1305.304 and 28 TAC §10.22(20).

Section 10.84. The amendments to §10.84 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices.

Section 10.85. The amendments to §10.85 add more complete statutory citations and make changes to conform to current department language preferences and drafting practices.

Section 10.86. The amendment to §10.86 makes a change to conform to current department language preferences and drafting practices.

Amending 28 TAC §§10.100, 10.101, 10.104 to update obsolete statutory definitions and remove “and Retrospective Review” as it is now included in utilization review.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER F. UTILIZATION REVIEW
28 TAC §§10.100, 10.101, 10.104

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The amendments delete “and Retrospective Review” from the title of the subchapter because a statutory change since the creation of the subchapter added retrospective review to the definition of utilization review.

Section 10.100. The amendments to §10.100 correct obsolete citations and add more complete statutory citations.

Section 10.101. The amendments to §10.101 make changes to conform to current department language preferences and drafting practices. The amendments also:

remove separate references to retrospective review because retrospective review is a part of utilization review;
add new subsections (c) and (d) to address Labor Code §§408.0043 – 408.0045 requirements relating to qualifications for utilization review reviewers and track the language currently used in the utilization review agent rules;
add new subsection (e) to clarify the requirements that apply to health care providers through a certified network, as authorized by Labor Code §413.014;
add new subsection (f) to shorten and simplify the rule by referring to the requirements of Insurance Code Chapter 1305 and 28 TAC Chapter 19, Subchapter U, rather than repeating the requirements of these statutes and rules in §10.102 and §10.103; and
add new subsection (g) to include a requirement that reconsideration procedures must include a method for expedited reconsideration under Insurance Code §1305.354(b) and (c).

Section 10.102 and §10.103. Section 10.102 and §10.103 are repealed. The general standards for utilization review addressed in those sections are replaced with new subsections in §10.101.

Section 10.104. The amendments to §10.104 update obsolete statutory citations, add more complete statutory citations, and make changes to conform to current department language preferences and drafting practices. In addition, the amendments:

insert references to Insurance Code Chapter 1305, Subchapter H, and department and Division of Workers’ Compensation rules to clarify applicable requirements for compliance;
reformat and redesignate some subsections of the rule;
remove separate references to retrospective review because retrospective review is now included in the definition of utilization review;
update a reference to conform to the redesignation of subsections;
shorten and simplify the rule by citing Insurance Code §1305.354(a)(4) and 28 TAC §133.308(k) rather than listing requirements previously contained in §10.104(b)(2)(A) – (E);
add new subsection (g) to conform to Labor Code §413.0311; and
note, for the convenience of participants, that the department and the Division of Workers’ Compensation are not considered to be parties to a medical dispute.

Amending 28 TAC §10.102, §10.103 to clarify complaints related to fee disputes for providers and certified networks.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER F. UTILIZATION REVIEW
28 TAC §10.102, §10.103

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.120. The amendments to §10.120 make changes to the section to conform to current department language preferences and drafting practices and provide clarity to providers and certified networks by clarifying that a complaint relating to a fee dispute is a complaint from a provider regarding the failure to pay a claim in accordance with the contract between the certified network and provider.

In response to a comment to change the language concerning “a network’s failure to pay,” the department deleted “the network” in proposed §10.120(b) because a health care network is not always the payor.

Section 10.121. The amendments to §10.121 make changes to conform to current department language preferences and drafting practices. The amendments also:

require resolution letters to explain the certified network’s procedures and deadlines for filing an appeal of the complaint;
require the maintenance of a complaint-and-appeal log because a record of complaints is more useful if a record of appeals is included; and
remove a reference to retrospective review.

The department changed proposed §10.121(e) in response to a comment for clarification on the meaning of the term “complaint appeal” by removing the term. The language now states that each network must maintain the required complaint-and-appeal log and documentation on each complaint, appeal, complaint proceeding, and action taken on the complaint until the third anniversary after the date the complaint was received.

Section 10.122. The amendments to §10.122 remove specific email addresses contained in the section to avoid providing incorrect information if the addresses change. The amendments also add a provision stating that the complaint form may be obtained from the department’s website.

Amending 28 TAC §§10.120 – 10.122 to clarify complaints related to fee disputes for providers and certified networks.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER G. COMPLAINTS
28 TAC §§10.120 – 10.122

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.121. The amendments to §10.121 make changes to conform to current department language preferences and drafting practices. The amendments also:

require resolution letters to explain the certified network’s procedures and deadlines for filing an appeal of the complaint;
require the maintenance of a complaint-and-appeal log because a record of complaints is more useful if a record of appeals is included; and
remove a reference to retrospective review.

Amending 28 TAC §10.200 to clarify payment practices for examination fees.

CHAPTER 10. WORKERS’ COMPENSATION HEALTH CARE NETWORKS
SUBCHAPTER H. EXAMINATIONS
28 TAC §10.200

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

Section 10.200. The amendments to §10.200 add more complete statutory citations, make changes to conform to current department language preferences and drafting practices, and make revisions to eliminate confusion among regulated entities by clarifying that examination fees are payable to the department at the address shown on the invoice.

In Addition Re:

Company Licensing

OVERVIEW

Application for First Professionals Insurance Company, Inc., a domestic fire and/or casualty company, to change its name to Verde Insurance Company. The home office is in Dallas, Texas.

Texas Health and Human Services Commission

In Addition Re:

Public Notice – Texas State Plan for Medical Assistance Amendment

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit an amendment to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendment is effective September 1, 2022.

BACKGROUND AND JUSTIFICATION

The purpose of the amendment is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for the following services:

Physicians, Vaccine Administration under the Pediatric Immunization Program, Birthing Centers, Durable Medical Equipment Prosthetics Orthotics (DMEPOS), Outpatient Hospital Services, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Vision Services, Medication Assistance Treatment (MAT) and Ambulatory Surgical Center (ASC).

The proposed amendment is estimated to result in an annual aggregate expenditure of $4,448,357 for federal fiscal year (FFY) 2022, consisting of $ $2,663,231 in federal funds and $1,785,126 in state general revenue. For FFY 2023, the estimated annual aggregate expenditure is $6,138,697 consisting of $3,675,238 in federal funds and $2,463,459 in state general revenue. For FFY 2024, the estimated annual aggregate expenditure is $5,824,663 consisting of $3,487,226 in federal funds and $2,337,437 in state general revenue.

Further detail on specific reimbursement rates and percentage changes is available on the HHSC Provider Finance website under the proposed effective date at: https://pfd.hhs.texas.gov/rate-packets