Texas Register Table of Contents
- 1 Texas Health and Human Services Commission
- 1.0.1 Proposed Rules Re:
- 1.0.2 Adopted Rules Re:
- 1.0.2.1 Amending 1 TAC §354.2301, §354.2302, to update headings and add new definitions concerning Medicaid third party recovery.
- 1.0.2.2 Amending 1 TAC §§354.2311, 354.2313, 354.2315, to modify language in the current sections concerning Medicaid third party recovery.
- 1.0.2.3 Amending 1 TAC §354.2321, §354.2322, to delete phrases and replace current phrases in the sections regarding Provider Billing and Recovery from Other Third Parties.
- 1.0.2.4 Amending 1 TAC §§354.2331 – 354.2334, to update existing phrases and delete phrases in the sections.
- 1.0.2.5 Amending 1 TAC §§354.2341, 354.2343, 354.2344, to describe what is required by HHSC of a third party resource concerning payment for a Medicaid health care item or service provided by the Medicaid program.
- 1.0.2.6 Amending 1 TAC §§354.2354 – 354.2356, to describe when a health care service provider must first seek reimbursement from a third-party resource before billing Medicaid and to prohibit health care service providers from billing Medicaid recipients for copayments, deductibles, or coinsurance for Medicaid-covered services.
- 1.0.2.7 Amending 1 TAC §355.102, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the cost determination process.
- 1.0.2.8 Amending 1 TAC §355.458, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the reimbursement methodology for ICF/IID.
- 1.0.2.9 Amending 1 TAC §§355.722, to use the phrases “Provider Finance,” “Provider Finance Department,” and “PFD” as they relate to the reimbursement methodology for programs serving persons with mental illness or intellectual or developmental disability.
- 1.0.2.10 Amending 1 TAC §355.8210, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to purchased health services.
- 1.0.2.11 Amending 1 TAC §355.8422, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD” as they relate to the reimbursement methodology for the Early Childhood Intervention Program.
- 1.0.2.12 Amending 1 TAC §355.9040, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD” when referring to miscellaneous programs.
- 1.0.2.13 Amending 1 TAC §355.7201, to specify that legislatively-required reports are to be collected from hospitals and nursing facilities and to require that these reports be collected on a semi-annual basis instead of a monthly basis.
- 1.0.3 Proposed Rule Reviews Re:
- 1.0.3.1 Reviewing Title 1, Part 15, to consider for readoption, revision, or repeal the chapter concerning Texas Health Steps Comprehensive Care Program.
- 1.0.3.2 Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal the chapter regarding Consumer Managed Personal Attendant Services (CMPAS) Program.
- 1.0.4 Adopted Rule Reviews Re:
- 1.0.5 In Addition Re:
- 1.0.5.1 Public Notice: Texas State Plan Amendment to Make Changes to Requirements for Prescribed Pediatric Extended Care Centers (PPECCs)
- 1.0.5.2 Public Notice – Youth Empowerment Services (YES) Program
- 1.0.5.3 Revised Public Notice – Community Living Assistance and Support Services (CLASS) Waiver Program
- 2 Texas Board of Physical Therapy Examiners
- 3 Texas Department of State Health Services
- 3.0.1 Adopted Rules Re:
- 3.0.1.1 Amending 25 TAC §448.801, §448.803, to require a provider who is screening or assessing an individual through electronic means to do so using synchronous audio-visual technology unless there is a declared state of disaster, at which time the provider may use audio-only technology.
- 3.0.1.2 Amending 25 TAC §448.911, to clarify requirements for outpatient CDTF programs providing services through electronic means.
- 3.0.2 Proposed Rules Re:
- 3.0.2.1 Proposed review of Title 25, Part 1, to consider for readoption, revision, or repeal the chapter regarding Emergency Preparedness.
- 3.0.2.2 Proposed review of Title 25, Part 1, to consider for readoption, revision, or repeal the chapter pertaining to Case Management for Children and Pregnant Women.
- 3.0.2.3 Proposed review of Title 25, Part 1, to consider for readoption, revision, or repeal the chapter concerning Texas HIV Medication Program.
- 3.0.2.4 Certification Limited Liability Report
- 3.0.1 Adopted Rules Re:
- 4 Department of Aging and Disability Services
- 4.0.1 Proposed Rule Reviews Re:
- 4.0.1.1 Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter regarding Contracting to Provide Assisted Living and Residential Care Services.
- 4.0.1.2 Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter concerning Contracting to Provide Special Services to Persons with Disabilities.
- 4.0.1 Proposed Rule Reviews Re:
Texas Health and Human Services Commission
Proposed Rules Re:
New 1 TAC §371.1723, to explain the types and procedures for retrospective payment reviews.
CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER G. ADMINISTRATIVE ACTIONS AND SANCTIONS
1 TAC §371.1723
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Office of Inspector General (OIG), proposes in the Texas Administrative Code, Title 1, Part 15, Chapter 371, Subchapter G, Division 3, new §371.1723, concerning Recoupment of Overpayments Identified by Retrospective Payment Review.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to describe OIG’s retrospective payment review procedures related to records requests, review processes, notices, and due process.
Texas Government Code §531.102 authorizes OIG to conduct reviews related to the provision and delivery of all health and human services in Texas to identify fraud, waste, or abuse.
SECTION-BY-SECTION SUMMARY
- The proposed new §371.1723(a) identifies the types of retrospective payment reviews – data reviews and record reviews – performed by OIG and states that OIG may recoup an overpayment identified in a retrospective payment review.
- The proposed new §371.1723(b) describes the procedures related to a retrospective payment review records request, including the time deadline required to submit records in response to a records request. The proposed new §371.1723(b) also states that failure to timely produce requested records may result in an OIG enforcement action.
- The proposed new §371.1723(c) describes the review procedures related to a retrospective payment review, including the dollar limit of overpayment recoveries resulting from retrospective payment reviews and the ability of a person to produce records to address a review finding.
- The proposed new §371.1723(d) specifies the notices OIG sends during a retrospective payment review, which includes any finding of an overpayment amount and instructions for filing an appeal.
- The proposed new §371.1723(e) outlines the first and second level appeal options available to a person subject to a retrospective payment review.
- The proposed new §371.1723(f) specifies the timing and circumstances under which results of a retrospective payment review become final.
New 26 TAC §§307.251, 307.253, 307.255, 307.257, 307.259, 307.261, 307.263, 307.265, 307.267, to describe a BHPP liaison and establish which LMHA or LBHA employs a BHPP liaison.
CHAPTER 307. BEHAVIORAL HEALTH PROGRAMS
SUBCHAPTER F. BEHAVIORAL HEALTH PARTNERSHIP PROGRAM
26 TAC §§307.251, 307.253, 307.255, 307.257, 307.259, 307.261, 307.263, 307.265, 307.267
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new Subchapter F, Behavioral Health Partnership Program in Texas Administrative Code, Chapter 307. New Subchapter F comprises §307.251, concerning Purpose; §307.253, concerning Application; §307.255, concerning Definitions; §307.257, concerning Behavioral Health Partnership Program Liaison Qualifications; §307.259, concerning Local Mental Health Authority or Local Behavioral Health Authority Responsibilities; §307.261, concerning Determining which Local Mental Health Authority or Local Behavioral Health Authority Employs a Behavioral Health Partnership Program Liaison; §307.263, concerning Responsibilities of a Behavioral Health Partnership Program Liaison; §307.265, concerning Texas Health and Human Services Commission Waiver Process; §307.267, concerning Texas Health and Human Services Commission Notification.
BACKGROUND AND JUSTIFICATION
The purpose of the proposal is to implement Senate Bill 26, 88th Legislature, Regular Session, 2023, which amends Texas Education Code §8.151 and §8.152 to establish a process for local mental health authorities (LMHAs) or local behavioral health authorities (LBHAs) to submit a waiver request to HHSC to hire a licensed master social worker or licensed professional counselor (LPC) associate in lieu of a non-physician mental health professional (NPMHP) if the LMHA is unable to hire a NPMHP in its designated regional education service center (ESC). The proposal establishes the behavioral health partnership program (BHPP) as the program name and “behavioral health partnership program liaison” as the position title that includes an NPMHP or a person hired under the waiver process.
SECTION-BY-SECTION SUMMARY
- Proposed new §307.251 describes the purpose of the subchapter, which is to implement the BHPP.
- Proposed new §307.253 establishes new Subchapter F’s applicability to LMHAs and LBHAs.
- Proposed new §307.255 provides definitions for terminology used in the subchapter. Additionally, for purposes of this subchapter, a “non-physician mental health professional” as referenced under Texas Education Code §8.152 is included in the term “behavioral health partnership program liaison.”
- Proposed new §307.257 describes the BHPP liaison as a person who either meets the qualifications of an NPMHP or for whom the LMHA or LBHA submits a waiver request to HHSC.
- Proposed new §307.259 describes LMHA and LBHA responsibilities to enter into a memorandum of understanding with the ESC addressing employment of a BHPP liaison; provide payment for costs for space and administrative costs; provide supervision of the BHPP liaison; provide reports to HHSC; and comply with parameters concerning how long an NPMHP waiver is effective.
- Proposed new §307.261 establishes which LMHA or LBHA employs a BHPP liaison based on the LMHA or LBHA serving the majority of counties in which the ESC is located and requires the LMHA or LBHA to consult with the other LMHA or LBHA in the same region before making the final hiring decision.
- Proposed new §307.263 establishes responsibilities of a BHPP liaison for carrying out the functions and duties required of an NPMHP in accordance with Texas Education Code §8.155.
- Proposed new §307.265 describes the HHSC waiver process for an LMHA or LBHA to employ an LMSW or LPC associate to serve as the BHPP liaison.
- Proposed new §307.267 describes HHSC’s written notification regarding if an LMHA’s or LBHA’s waiver request is approved or the opportunity to remedy and resubmit the waiver request if it was denied.
Adopted Rules Re:
Amending 1 TAC §354.2301, §354.2302, to update headings and add new definitions concerning Medicaid third party recovery.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER J. MEDICAID THIRD PARTY RECOVERY
1 TAC §354.2301, §354.2302
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter J, to §354.2301, concerning Basis and Purpose; §354.2302, concerning Definitions; §354.2311, concerning Applicant and Recipient Assignment of Rights; §354.2313, concerning Duty of Applicant or Recipient to Inform and Cooperate; §354.2315, concerning Duty of Attorney or Representative of a Recipient; §354.2321, concerning Provider Billing and Recovery from Third Party Resources; §354.2322, concerning Provider Billing and Recovery from Other Liable Third Parties; §354.2331, concerning Requests for Information; §354.2332, concerning Distribution of Recoveries; §354.2333, concerning Waiver Authority of the Executive Commissioner; §354.2334, concerning Notices and Payments; §354.2341, concerning Third Party Health Insurer Payment and Information Requirements; §354.2343, concerning Administrative Penalties for Failure to Provide Information; §354.2344, concerning Notice and Appeal of Administrative Penalty; §354.2354, concerning Billing Medicare Intermediaries; §354.2355, concerning Long Term Care Providers; and §354.2356, concerning Provider Requirements to Bill Third Party Health Coverage.
The amendments to §§354.2301, 354.2302, 354.2311, 354.2313, 354.2315, 354.2321, 354.2322, 354.2331 – 354.2334, 354.2341, 354.2343, 354.2344 and 354.2354 – 354.2356 are adopted without changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6696). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The federal Consolidated Appropriations Act of 2022 (H.R. 2471) amended §1902(a)(25)(I) of the Social Security Act to require a state plan for medical assistance to make certain assurances to the Secretary of Health and Human Services that state law imposes certain requirements on responsible third party health insurers.
Senate Bill (SB) 1342, 88th Legislature, Regular Session, 2023, implemented H.R. 2471 by amending Texas Human Resources Code §32.0424. SB 1342 also repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (i) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (ii) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (iii) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Further, Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual.
One purpose of the amendments is to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the amendments implement other changes made to §1902(a)(25)(I) of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The amendments also add and update definitions; clarify the sections of the amendments that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care; and update certain outdated terms and phrases throughout TAC Chapter 354, Subchapter J.
Amending 1 TAC §§354.2311, 354.2313, 354.2315, to modify language in the current sections concerning Medicaid third party recovery.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER J. MEDICAID THIRD PARTY RECOVERY
1 TAC §§354.2311, 354.2313, 354.2315
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter J, to §354.2301, concerning Basis and Purpose; §354.2302, concerning Definitions; §354.2311, concerning Applicant and Recipient Assignment of Rights; §354.2313, concerning Duty of Applicant or Recipient to Inform and Cooperate; §354.2315, concerning Duty of Attorney or Representative of a Recipient; §354.2321, concerning Provider Billing and Recovery from Third Party Resources; §354.2322, concerning Provider Billing and Recovery from Other Liable Third Parties; §354.2331, concerning Requests for Information; §354.2332, concerning Distribution of Recoveries; §354.2333, concerning Waiver Authority of the Executive Commissioner; §354.2334, concerning Notices and Payments; §354.2341, concerning Third Party Health Insurer Payment and Information Requirements; §354.2343, concerning Administrative Penalties for Failure to Provide Information; §354.2344, concerning Notice and Appeal of Administrative Penalty; §354.2354, concerning Billing Medicare Intermediaries; §354.2355, concerning Long Term Care Providers; and §354.2356, concerning Provider Requirements to Bill Third Party Health Coverage.
The amendments to §§354.2301, 354.2302, 354.2311, 354.2313, 354.2315, 354.2321, 354.2322, 354.2331 – 354.2334, 354.2341, 354.2343, 354.2344 and 354.2354 – 354.2356 are adopted without changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6696). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The federal Consolidated Appropriations Act of 2022 (H.R. 2471) amended §1902(a)(25)(I) of the Social Security Act to require a state plan for medical assistance to make certain assurances to the Secretary of Health and Human Services that state law imposes certain requirements on responsible third party health insurers.
Senate Bill (SB) 1342, 88th Legislature, Regular Session, 2023, implemented H.R. 2471 by amending Texas Human Resources Code §32.0424. SB 1342 also repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (i) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (ii) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (iii) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Further, Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual.
One purpose of the amendments is to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the amendments implement other changes made to §1902(a)(25)(I) of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The amendments also add and update definitions; clarify the sections of the amendments that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care; and update certain outdated terms and phrases throughout TAC Chapter 354, Subchapter J.
Amending 1 TAC §354.2321, §354.2322, to delete phrases and replace current phrases in the sections regarding Provider Billing and Recovery from Other Third Parties.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER J. MEDICAID THIRD PARTY RECOVERY
1 TAC §354.2321, §354.2322
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter J, to §354.2301, concerning Basis and Purpose; §354.2302, concerning Definitions; §354.2311, concerning Applicant and Recipient Assignment of Rights; §354.2313, concerning Duty of Applicant or Recipient to Inform and Cooperate; §354.2315, concerning Duty of Attorney or Representative of a Recipient; §354.2321, concerning Provider Billing and Recovery from Third Party Resources; §354.2322, concerning Provider Billing and Recovery from Other Liable Third Parties; §354.2331, concerning Requests for Information; §354.2332, concerning Distribution of Recoveries; §354.2333, concerning Waiver Authority of the Executive Commissioner; §354.2334, concerning Notices and Payments; §354.2341, concerning Third Party Health Insurer Payment and Information Requirements; §354.2343, concerning Administrative Penalties for Failure to Provide Information; §354.2344, concerning Notice and Appeal of Administrative Penalty; §354.2354, concerning Billing Medicare Intermediaries; §354.2355, concerning Long Term Care Providers; and §354.2356, concerning Provider Requirements to Bill Third Party Health Coverage.
The amendments to §§354.2301, 354.2302, 354.2311, 354.2313, 354.2315, 354.2321, 354.2322, 354.2331 – 354.2334, 354.2341, 354.2343, 354.2344 and 354.2354 – 354.2356 are adopted without changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6696). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The federal Consolidated Appropriations Act of 2022 (H.R. 2471) amended §1902(a)(25)(I) of the Social Security Act to require a state plan for medical assistance to make certain assurances to the Secretary of Health and Human Services that state law imposes certain requirements on responsible third party health insurers.
Senate Bill (SB) 1342, 88th Legislature, Regular Session, 2023, implemented H.R. 2471 by amending Texas Human Resources Code §32.0424. SB 1342 also repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (i) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (ii) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (iii) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Further, Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual.
One purpose of the amendments is to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the amendments implement other changes made to §1902(a)(25)(I) of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The amendments also add and update definitions; clarify the sections of the amendments that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care; and update certain outdated terms and phrases throughout TAC Chapter 354, Subchapter J.
Amending 1 TAC §§354.2331 – 354.2334, to update existing phrases and delete phrases in the sections.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER J. MEDICAID THIRD PARTY RECOVERY
1 TAC §§354.2331 – 354.2334
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter J, to §354.2301, concerning Basis and Purpose; §354.2302, concerning Definitions; §354.2311, concerning Applicant and Recipient Assignment of Rights; §354.2313, concerning Duty of Applicant or Recipient to Inform and Cooperate; §354.2315, concerning Duty of Attorney or Representative of a Recipient; §354.2321, concerning Provider Billing and Recovery from Third Party Resources; §354.2322, concerning Provider Billing and Recovery from Other Liable Third Parties; §354.2331, concerning Requests for Information; §354.2332, concerning Distribution of Recoveries; §354.2333, concerning Waiver Authority of the Executive Commissioner; §354.2334, concerning Notices and Payments; §354.2341, concerning Third Party Health Insurer Payment and Information Requirements; §354.2343, concerning Administrative Penalties for Failure to Provide Information; §354.2344, concerning Notice and Appeal of Administrative Penalty; §354.2354, concerning Billing Medicare Intermediaries; §354.2355, concerning Long Term Care Providers; and §354.2356, concerning Provider Requirements to Bill Third Party Health Coverage.
The amendments to §§354.2301, 354.2302, 354.2311, 354.2313, 354.2315, 354.2321, 354.2322, 354.2331 – 354.2334, 354.2341, 354.2343, 354.2344 and 354.2354 – 354.2356 are adopted without changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6696). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The federal Consolidated Appropriations Act of 2022 (H.R. 2471) amended §1902(a)(25)(I) of the Social Security Act to require a state plan for medical assistance to make certain assurances to the Secretary of Health and Human Services that state law imposes certain requirements on responsible third party health insurers.
Senate Bill (SB) 1342, 88th Legislature, Regular Session, 2023, implemented H.R. 2471 by amending Texas Human Resources Code §32.0424. SB 1342 also repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (i) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (ii) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (iii) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Further, Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual.
One purpose of the amendments is to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the amendments implement other changes made to §1902(a)(25)(I) of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The amendments also add and update definitions; clarify the sections of the amendments that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care; and update certain outdated terms and phrases throughout TAC Chapter 354, Subchapter J.
Amending 1 TAC §§354.2341, 354.2343, 354.2344, to describe what is required by HHSC of a third party resource concerning payment for a Medicaid health care item or service provided by the Medicaid program.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER J. MEDICAID THIRD PARTY RECOVERY
1 TAC §§354.2341, 354.2343, 354.2344
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter J, to §354.2301, concerning Basis and Purpose; §354.2302, concerning Definitions; §354.2311, concerning Applicant and Recipient Assignment of Rights; §354.2313, concerning Duty of Applicant or Recipient to Inform and Cooperate; §354.2315, concerning Duty of Attorney or Representative of a Recipient; §354.2321, concerning Provider Billing and Recovery from Third Party Resources; §354.2322, concerning Provider Billing and Recovery from Other Liable Third Parties; §354.2331, concerning Requests for Information; §354.2332, concerning Distribution of Recoveries; §354.2333, concerning Waiver Authority of the Executive Commissioner; §354.2334, concerning Notices and Payments; §354.2341, concerning Third Party Health Insurer Payment and Information Requirements; §354.2343, concerning Administrative Penalties for Failure to Provide Information; §354.2344, concerning Notice and Appeal of Administrative Penalty; §354.2354, concerning Billing Medicare Intermediaries; §354.2355, concerning Long Term Care Providers; and §354.2356, concerning Provider Requirements to Bill Third Party Health Coverage.
The amendments to §§354.2301, 354.2302, 354.2311, 354.2313, 354.2315, 354.2321, 354.2322, 354.2331 – 354.2334, 354.2341, 354.2343, 354.2344 and 354.2354 – 354.2356 are adopted without changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6696). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The federal Consolidated Appropriations Act of 2022 (H.R. 2471) amended §1902(a)(25)(I) of the Social Security Act to require a state plan for medical assistance to make certain assurances to the Secretary of Health and Human Services that state law imposes certain requirements on responsible third party health insurers.
Senate Bill (SB) 1342, 88th Legislature, Regular Session, 2023, implemented H.R. 2471 by amending Texas Human Resources Code §32.0424. SB 1342 also repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (i) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (ii) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (iii) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Further, Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual.
One purpose of the amendments is to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the amendments implement other changes made to §1902(a)(25)(I) of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The amendments also add and update definitions; clarify the sections of the amendments that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care; and update certain outdated terms and phrases throughout TAC Chapter 354, Subchapter J.
Amending 1 TAC §§354.2354 – 354.2356, to describe when a health care service provider must first seek reimbursement from a third-party resource before billing Medicaid and to prohibit health care service providers from billing Medicaid recipients for copayments, deductibles, or coinsurance for Medicaid-covered services.
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER J. MEDICAID THIRD PARTY RECOVERY
1 TAC §§354.2354 – 354.2356
OVERVIEW
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments in Texas Administrative Code (TAC), Title 1, Part 15, Chapter 354, Subchapter J, to §354.2301, concerning Basis and Purpose; §354.2302, concerning Definitions; §354.2311, concerning Applicant and Recipient Assignment of Rights; §354.2313, concerning Duty of Applicant or Recipient to Inform and Cooperate; §354.2315, concerning Duty of Attorney or Representative of a Recipient; §354.2321, concerning Provider Billing and Recovery from Third Party Resources; §354.2322, concerning Provider Billing and Recovery from Other Liable Third Parties; §354.2331, concerning Requests for Information; §354.2332, concerning Distribution of Recoveries; §354.2333, concerning Waiver Authority of the Executive Commissioner; §354.2334, concerning Notices and Payments; §354.2341, concerning Third Party Health Insurer Payment and Information Requirements; §354.2343, concerning Administrative Penalties for Failure to Provide Information; §354.2344, concerning Notice and Appeal of Administrative Penalty; §354.2354, concerning Billing Medicare Intermediaries; §354.2355, concerning Long Term Care Providers; and §354.2356, concerning Provider Requirements to Bill Third Party Health Coverage.
The amendments to §§354.2301, 354.2302, 354.2311, 354.2313, 354.2315, 354.2321, 354.2322, 354.2331 – 354.2334, 354.2341, 354.2343, 354.2344 and 354.2354 – 354.2356 are adopted without changes to the proposed text as published in the November 17, 2023, issue of the Texas Register (48 TexReg 6696). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The federal Consolidated Appropriations Act of 2022 (H.R. 2471) amended §1902(a)(25)(I) of the Social Security Act to require a state plan for medical assistance to make certain assurances to the Secretary of Health and Human Services that state law imposes certain requirements on responsible third party health insurers.
Senate Bill (SB) 1342, 88th Legislature, Regular Session, 2023, implemented H.R. 2471 by amending Texas Human Resources Code §32.0424. SB 1342 also repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (i) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (ii) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (iii) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Further, Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual.
One purpose of the amendments is to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the amendments implement other changes made to §1902(a)(25)(I) of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The amendments also add and update definitions; clarify the sections of the amendments that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care; and update certain outdated terms and phrases throughout TAC Chapter 354, Subchapter J.
Amending 1 TAC §355.102, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the cost determination process.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER A. COST DETERMINATION PROCESS
1 TAC §355.102
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.
Sections 355.306, 355.314, 355.743, 355.746, 355.781, and 355.8421 were also published as proposed in this rulemaking. These sections were withdrawn in the November 24, 2023, issue of the Texas Register (48 TexReg 6881) due to conflicts with other agency rulemakings.
The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted without changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6065). The rules will not be republished.
BACKGROUND AND JUSTIFICATION
In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted to reflect the current department name.
Amending 1 TAC §355.458, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to the reimbursement methodology for ICF/IID.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER D. REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID)
1 TAC §355.458
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.
Sections 355.306, 355.314, 355.743, 355.746, 355.781, and 355.8421 were also published as proposed in this rulemaking. These sections were withdrawn in the November 24, 2023, issue of the Texas Register (48 TexReg 6881) due to conflicts with other agency rulemakings.
The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted without changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6065). The rules will not be republished.
BACKGROUND AND JUSTIFICATION
In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted to reflect the current department name.
Amending 1 TAC §§355.722, to use the phrases “Provider Finance,” “Provider Finance Department,” and “PFD” as they relate to the reimbursement methodology for programs serving persons with mental illness or intellectual or developmental disability.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH MENTAL ILLNESS OR INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §355.722
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.
Sections 355.306, 355.314, 355.743, 355.746, 355.781, and 355.8421 were also published as proposed in this rulemaking. These sections were withdrawn in the November 24, 2023, issue of the Texas Register (48 TexReg 6881) due to conflicts with other agency rulemakings.
The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted without changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6065). The rules will not be republished.
BACKGROUND AND JUSTIFICATION
In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted to reflect the current department name.
Amending 1 TAC §355.8210, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD,” respectively, as they relate to purchased health services.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8210
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.
Sections 355.306, 355.314, 355.743, 355.746, 355.781, and 355.8421 were also published as proposed in this rulemaking. These sections were withdrawn in the November 24, 2023, issue of the Texas Register (48 TexReg 6881) due to conflicts with other agency rulemakings.
The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted without changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6065). The rules will not be republished.
BACKGROUND AND JUSTIFICATION
In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted to reflect the current department name.
Amending 1 TAC §355.8422, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD” as they relate to the reimbursement methodology for the Early Childhood Intervention Program.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8422
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.
Sections 355.306, 355.314, 355.743, 355.746, 355.781, and 355.8421 were also published as proposed in this rulemaking. These sections were withdrawn in the November 24, 2023, issue of the Texas Register (48 TexReg 6881) due to conflicts with other agency rulemakings.
The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted without changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6065). The rules will not be republished.
BACKGROUND AND JUSTIFICATION
In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted to reflect the current department name.
Amending 1 TAC §355.9040, to replace the phrases “Rate Analysis,” “Rate Analysis Department,” or “RAD” with “Provider Finance,” “Provider Finance Department,” and “PFD” when referring to miscellaneous programs.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER M. MISCELLANEOUS PROGRAMS
1 TAC §355.9040
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.102, concerning General Principles of Allowable and Unallowable Costs; §355.458, concerning Supplemental Payments to Non-State Government-Owned Facilities; §355.722, concerning Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers; §355.8210, concerning Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care; §355.8422, concerning Reimbursement for Specialized Rehabilitation Services for Infants and Toddlers with Developmental Disabilities; and §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program.
Sections 355.306, 355.314, 355.743, 355.746, 355.781, and 355.8421 were also published as proposed in this rulemaking. These sections were withdrawn in the November 24, 2023, issue of the Texas Register (48 TexReg 6881) due to conflicts with other agency rulemakings.
The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted without changes to the proposed text as published in the October 20, 2023, issue of the Texas Register (48 TexReg 6065). The rules will not be republished.
BACKGROUND AND JUSTIFICATION
In 2020, the Rate Analysis Department of HHSC underwent a rebranding to change the department’s name to “Provider Finance Department.” The amendments to §355.102, §355.458, §355.722, §355.8210, §355.8422, and §355.9040 are adopted to reflect the current department name.
Amending 1 TAC §355.7201, to specify that legislatively-required reports are to be collected from hospitals and nursing facilities and to require that these reports be collected on a semi-annual basis instead of a monthly basis.
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER I. REPORTING
1 TAC §355.7201
OVERVIEW
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.7201, concerning Novel Coronavirus (COVID-19) Fund Reporting. The amendment to §355.7201 is adopted without changes to the proposed text as published in the November 24, 2023, issue of the Texas Register (48 TexReg 6813). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment is necessary to comply with the 2024-25 General Appropriations Act, House Bill (H.B.) 1, 88th Legislature, Regular Session, 2023 (Article II, HHSC, Rider 150), which requires that HHSC develop a report detailing the total value and uses of COVID-19-related Federal Funds, including Provider Relief Funds, provided directly to nursing facilities and hospitals contracting with HHSC since the beginning of the public health emergency.
Proposed Rule Reviews Re:
Reviewing Title 1, Part 15, to consider for readoption, revision, or repeal the chapter concerning Texas Health Steps Comprehensive Care Program.
The Texas Health and Human Services Commission (HHSC) proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 1, Part 15, of the Texas Administrative Code:
Chapter 363, Texas Health Steps Comprehensive Care Program
Reviewing Title 26, Part 1, to consider for readoption, revision, or repeal the chapter regarding Consumer Managed Personal Attendant Services (CMPAS) Program.
The Texas Health and Human Services Commission (HHSC) proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 26, Part 1, of the Texas Administrative Code:
Chapter 275, Consumer Managed Personal Attendant Services (CMPAS) Program
Adopted Rule Reviews Re:
Adopting the review of Title 26, Part 1, concerning IDD-BH Training.
The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code (TAC):
Chapter 302, IDD-BH Training
Adopting the review of Title 26, Part 1, regarding Substance Use Services.
The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code (TAC):
Chapter 321, Substance Use Services
Adopting the review of Title 26, Part 1, covering Anatomical Gift.
The Texas Health and Human Services Commission (HHSC) adopts the review of the chapter below in Title 26, Part 1, of the Texas Administrative Code (TAC):
Chapter 990, Anatomical Gift
In Addition Re:
Public Notice: Texas State Plan Amendment to Make Changes to Requirements for Prescribed Pediatric Extended Care Centers (PPECCs)
OVERVIEW
The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number 24-0005 to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act.
The purpose of this amendment is to make requirements for PPECCs consistent with changes made to state licensing rules for PPECCs as required by House Bill (H.B.) 3550, 88th Texas Legislature, Regular Session, 2023. The proposed amendment requires a PPECC to provide transportation to a recipient when the recipient’s physician determines the recipient is stable to receive transportation services and the parent or legal guardian wants the recipient to receive transportation services. The proposed amendment also requires that a recipient be accompanied by a PPECC nurse or direct care staff member, as identified by the physician in the plan of care, during transport to and from the PPECC. Apart from H.B. 3550, the proposed amendment revises the qualifications for a PPECC’s nursing director and alternate nursing director to be consistent with state licensing rules for PPECCs and makes minor editorial changes for clarity. The proposed amendment is effective 9/1/2024.
The proposed amendment is estimated to have no fiscal impact, as it is not expected to have an effect on Medicaid utilization or cost.
Public Notice – Youth Empowerment Services (YES) Program
OVERVIEW
The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to amend the waiver application for the Youth Empowerment Services (YES) Program. HHSC administers the YES Program under the authority of Section 1915(c) of the Social Security Act. CMS has approved the YES waiver application through March 31, 2028. The proposed effective date for the amendment is July 1, 2024, and does not affect the cost neutrality of the waiver.
The YES Program is designed to provide home and community-based services to children and youth with serious emotional disturbances and their families, with a goal of reducing or preventing children’s inpatient psychiatric treatment and the consequent removal from their families. The program currently serves eligible children who are at least three years of age and under 19 years of age.
Revised Public Notice – Community Living Assistance and Support Services (CLASS) Waiver Program
OVERVIEW
The original notice regarding the Community Living Assistance and Support Services (CLASS) waiver program renewal request was posted in the Texas Register on February 9, 2024. This revised notice reflects an additional change to the renewal request to remove the word “unauthorized” from performance measure G.c.1.
The Texas Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) to renew the CLASS waiver program. HHSC administers the CLASS Program under the authority of §1915(c) of the Social Security Act. CMS has approved the CLASS waiver application through August 31, 2024. The proposed effective date for the renewal is September 1, 2024.
Texas Board of Physical Therapy Examiners
Adopted Rules Re:
Amending 22 TAC §341.3, to clarify which activities qualify for continuing competence units (CCUs).
CHAPTER 341. LICENSE RENEWAL
22 TAC §341.3
OVERVIEW
The Texas Board of Physical Therapy Examiners adopts the amendment to §341.3, Qualifying Continuing Competence Activities with changes to the proposed text as published in the December 1, 2023, issue of the Texas Register (48 TexReg 6996). The rule will be republished. The amendments are adopted in order to clarify certain activities that qualify for continuing competence units (CCUs).
BACKGROUND AND JUSTIFICATION
The amendments broaden the category of residencies and fellowships by allowing completion of a residency or fellowship accredited by an entity other than the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) and mentorship of a resident or fellow in an approved program to qualify for CCUs, and requires the Board to maintain a list of approved residencies and fellowships. Additionally, the amendments eliminate oPTion as a qualifying activity as the Federation of State Boards of Physical Therapy (FSBPT) has discontinued the self-assessment tool.
Texas Department of State Health Services
Adopted Rules Re:
Amending 25 TAC §448.801, §448.803, to require a provider who is screening or assessing an individual through electronic means to do so using synchronous audio-visual technology unless there is a declared state of disaster, at which time the provider may use audio-only technology.
CHAPTER 448. STANDARD OF CARE
SUBCHAPTER H. SCREENING AND ASSESSMENT
25 TAC §448.801, §448.803
OVERVIEW
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §448.801, concerning Screening; §448.803, concerning Assessment; and §448.911, concerning Treatment Services Provided Through Electronic Means.
The amendments to §§448.801, 448.803, and 448.911 are adopted with changes to the proposed text as published in the November 10, 2023, issue of the Texas Register (48 TexReg 6562). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to comply with and implement House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021. H.B. 4, Section 2, amended Texas Government Code Chapter 531 to require HHSC to determine which services are cost-effective and clinically effective and adopt rules to develop and implement a system to allow providers to provide certain behavioral health services using audio-only means to an individual receiving those services. The amendments allow a chemical dependency treatment facility (CDTF) to deliver certain audio-only substance use disorder treatment services that HHSC determined are clinically effective and safe.
The amendments are also necessary to update the requirements for providing services through electronic means to increase clarity and readability.
Amending 25 TAC §448.911, to clarify requirements for outpatient CDTF programs providing services through electronic means.
CHAPTER 448. STANDARD OF CARE
SUBCHAPTER I. TREATMENT PROGRAM SERVICES
25 TAC §448.911
OVERVIEW
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §448.801, concerning Screening; §448.803, concerning Assessment; and §448.911, concerning Treatment Services Provided Through Electronic Means.
The amendments to §§448.801, 448.803, and 448.911 are adopted with changes to the proposed text as published in the November 10, 2023, issue of the Texas Register (48 TexReg 6562). These rules will be republished.
BACKGROUND AND JUSTIFICATION
The amendments are necessary to comply with and implement House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021. H.B. 4, Section 2, amended Texas Government Code Chapter 531 to require HHSC to determine which services are cost-effective and clinically effective and adopt rules to develop and implement a system to allow providers to provide certain behavioral health services using audio-only means to an individual receiving those services. The amendments allow a chemical dependency treatment facility (CDTF) to deliver certain audio-only substance use disorder treatment services that HHSC determined are clinically effective and safe.
The amendments are also necessary to update the requirements for providing services through electronic means to increase clarity and readability.
Proposed Rules Re:
Proposed review of Title 25, Part 1, to consider for readoption, revision, or repeal the chapter regarding Emergency Preparedness.
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 25, Part 1, of the Texas Administrative Code:
Chapter 2, Emergency Preparedness
Proposed review of Title 25, Part 1, to consider for readoption, revision, or repeal the chapter pertaining to Case Management for Children and Pregnant Women.
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 25, Part 1, of the Texas Administrative Code:
Chapter 27, Case Management for Children and Pregnant Women
Proposed review of Title 25, Part 1, to consider for readoption, revision, or repeal the chapter concerning Texas HIV Medication Program.
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 25, Part 1, of the Texas Administrative Code:
Chapter 98, Texas HIV Medication Program
Certification Limited Liability Report
OVERVIEW
The Hospital Survey Program in the Center for Health Statistics, Texas Department of State Health Services, has completed its analysis of hospital data for the purpose of certifying nonprofit hospitals or hospital systems for limited liability under Texas Health and Safety Code, §311.0456. Thirty-one (31) hospitals requested certification. Each of the requesting hospitals will be notified, by mail, on the determination of whether the statutory certification requirements were met. The certification issued under Texas Health and Safety Code §311.0456 to a nonprofit hospital or hospital system takes effect on December 31, 2023, and expires on the anniversary of that date.
Department of Aging and Disability Services
Proposed Rule Reviews Re:
Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter regarding Contracting to Provide Assisted Living and Residential Care Services.
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of Aging and Disability Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 40, Part 1, of the Texas Administrative Code:
Chapter 46, Contracting to Provide Assisted Living and Residential Care Services
Reviewing Title 40, Part 1, to consider for readoption, revision, or repeal the chapter concerning Contracting to Provide Special Services to Persons with Disabilities.
The Texas Health and Human Services Commission (HHSC), on behalf of the Department of Aging and Disability Services, proposes to review and consider for readoption, revision, or repeal the chapter listed below, in its entirety, contained in Title 40, Part 1, of the Texas Administrative Code:
Chapter 58, Contracting to Provide Special Services to Persons with Disabilities