Texas Register January 23, 2025 Volume: 50 Number: 4


Texas Register Table of Contents

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §§355.502, 355.505, 355.513, to clarify the types of services included under the umbrella of professional services under §1915(c) waiver programs and correct formatting, references, and punctuation.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER E. COMMUNITY CARE FOR AGED AND DISABLED
1 TAC §§355.502, 355.505, 355.513

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.502, concerning Reimbursement Methodology for Common Services in Home and Community-Based Services Waivers; §355.505, concerning Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program; §355.513, concerning Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver Program; §355.723, concerning Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs; and §355.725, concerning Reimbursement Methodology for Common Waiver Services in Home and Community-based Services (HCS) and Texas Home Living (TxHmL).

BACKGROUND AND PURPOSE

The purpose of the proposal is to add in-home and out-of-home settings for home health care services (including nursing, occupational therapy, and physical therapy) to the reimbursement methodologies for Community Living Assistance and Support Services Waiver Program (CLASS), the Deaf-blind Multiple Disabilities (DBMD), Home and Community-based Services (HCS), and Texas Home Living (TxHmL) waiver programs. These amendments ensure compliance with the 21st Century Cures Act, which requires all states to implement the use of electronic visit verification (EVV).

The proposal also establishes the reimbursement methodology for employment readiness services in the DBMD, HCS, and TxHmL waiver programs in accordance with House Bill 4169, 88th Legislature, Regular Session, 2023.

SECTION-BY-SECTION SUMMARY

Edits to correct formatting, references, and punctuation are made throughout all the rules. Also, “speech/language therapy” is revised to “speech and language pathology” throughout the rules.

The proposed amendments to §355.502(b) and (d) clarify that nursing services, occupational therapy, and physical therapy are offered in both in-home and out-of-home settings under the umbrella of professional services.

The proposed amendments to §355.505(c)(4)(A) and subsection (c)(4)(A)(vii) clarify that nursing services, occupational therapy, and physical therapy are offered in both in-home and out-of-home settings under §1915(c) waiver programs.

The proposed amendment to §355.513(c)(5) clarifies that nursing services, occupational therapy, and physical therapy are offered in both in-home and out-of-home settings under the DBMD waiver program. Additionally, the proposed amendment adds the reimbursement methodology for employment readiness services. New paragraph (12) is added to describe the employment readiness payment rates. The remaining section is renumbered to account for the addition of a paragraph.


Amending 1 TAC §355.723, §355.725, to clarify that certain services are offered in both in-home and out-of-home settings under the HCS and TxHmL programs, as well as common waiver services.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER F. REIMBURSEMENT METHODOLOGY FOR PROGRAMS SERVING PERSONS WITH MENTAL ILLNESS OR INTELLECTUAL OR DEVELOPMENTAL DISABILITY
1 TAC §355.723, §355.725

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.502, concerning Reimbursement Methodology for Common Services in Home and Community-Based Services Waivers; §355.505, concerning Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program; §355.513, concerning Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver Program; §355.723, concerning Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs; and §355.725, concerning Reimbursement Methodology for Common Waiver Services in Home and Community-based Services (HCS) and Texas Home Living (TxHmL).

BACKGROUND AND PURPOSE

The purpose of the proposal is to add in-home and out-of-home settings for home health care services (including nursing, occupational therapy, and physical therapy) to the reimbursement methodologies for Community Living Assistance and Support Services Waiver Program (CLASS), the Deaf-blind Multiple Disabilities (DBMD), Home and Community-based Services (HCS), and Texas Home Living (TxHmL) waiver programs. These amendments ensure compliance with the 21st Century Cures Act, which requires all states to implement the use of electronic visit verification (EVV).

The proposal also establishes the reimbursement methodology for employment readiness services in the DBMD, HCS, and TxHmL waiver programs in accordance with House Bill 4169, 88th Legislature, Regular Session, 2023.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.723 clarifies that nursing services, occupational therapy, and physical therapy are offered in both in-home and out-of-home settings under the HCS and TxHmL programs. Additionally, the proposed amendment adds the reimbursement methodology for employment readiness services. The paragraphs under subsection (d) are renumbered to account for the addition of a paragraph.

The proposed amendment to §355.725 clarifies that nursing services, occupational therapy, and physical therapy are offered in both in-home and out-of-home settings under common waiver services.


Amending 1 TAC §355.8301, to implement a Nurse Residency Program (NRP) to increase retention of nurses through post-graduation and post-licensure residencies at Health-Related Institutions (HRIs).

SUBCHAPTER J. PURCHASED HEALTH SERVICES
DIVISION 16. MEDICAID PROFESSIONAL SERVICES
1 TAC §355.8301

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §355.8301, concerning the Nurse Residency Program, in new Division 16, Medicaid Professional Services.

BACKGROUND AND PURPOSE

The purpose of the proposed new rule is to implement a Nurse Residency Program (NRP) to support increased retention of nurses through post-graduation and post-licensure residencies at Health-Related Institutions (HRIs). The proposed new rule describes the participation requirements and structure of the NRP.

Payments will be based on the number of registered nurses and licensed vocational nurses in formal nursing residencies using separate weighting factors as a fraction of the upper payment limit (UPL) for related fee-for-service (FFS) claims. The proposed new rule also describes the methodology used by HHSC to determine the amounts of the payments. HHSC will submit this program to the Centers for Medicare & Medicaid Services (CMS) for approval under the Texas state plan. The program is expected to be funded by intergovernmental transfers.

Currently, Texas has no Medicaid programs covering additional payments for post-graduation and post-licensure nursing residencies, and there are no similar national programs. HHSC is proposing this new rule based on the success of a CMS pilot program for advanced practice nurses that indicated nursing residencies beyond the minimum training for licensure improved nurse retention.


Adopted Rules Re:

Adopting 1 TAC §354.1832, to create a new process through which the Vendor Drug Program (VDP) will add drugs to the formulary on a provisional basis and elaborate on an existing process concerning Preferred Drug List (PDL) exceptions.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER F. PHARMACY SERVICES
DIVISION 2. ADMINISTRATION
1 TAC §354.1832

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1832 and §354.1921, concerning Vendor Drug Program.

Section 354.1832 and §354.1921 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7146). These rules will not be republished.

BACKGROUND AND PURPOSE

The adopted rules implement House Bill (H.B.) 3286 and Senate Bill (S.B.) 241, 88th Legislature, Regular Session, 2023.

H.B. 3286 amended the Texas Government Code to add §531.0691, creating a new process for the Medicaid pharmacy benefit in which the Vendor Drug Program (VDP) will add drugs to the formulary on a provisional basis. H.B. 3286 also amended Texas Government Code Chapter 533 to add §533.071 which elaborates on an existing process in the Medicaid managed care program regarding Preferred Drug List (PDL) exceptions and when a non-preferred drug can be used by listing these exceptions. Section 533.071 also added new PDL exceptions.

S.B. 241 amended Texas Health and Safety Code Chapter 439 to add new Subchapter D, §439.102. Texas Health and Safety Code §439.102(a) requires a manufacturer of a brand name insulin prescription drug for which a generic or biosimilar prescription drug is not available and is included in the Medicaid VDP formulary, to submit to HHSC a written verification stating whether or not the unavailability of the generic or biosimilar prescription drug is the result, wholly or partly, (1) of a scheme by the manufacturer to pay a generic or biosimilar prescription drug manufacturer to delay manufacturing or marketing the generic or biosimilar drug; (2) a legal or business strategy to extend the life of a patent on the brand name prescription drug; (3) the manufacturer directly manipulating a patent on the brand name prescription drug; or (4) the manufacturer directly manipulating an action described in reasons (1)-(3) of this sentence on behalf of another entity.


Adopting 1 TAC §354.1921, to require brand-name insulin prescription drug manufacturers to submit notification of unavailability of generic or biosimilar insulin drugs to HHSC and set forth the reporting requirements.

CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER F. PHARMACY SERVICES
DIVISION 7. TEXAS DRUG CODE INDEX–ADDITIONS, RETENTIONS, AND DELETIONS
1 TAC §354.1921

OVERVIEW

The Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1832 and §354.1921, concerning Vendor Drug Program.

Section 354.1832 and §354.1921 are adopted without changes to the proposed text as published in the September 13, 2024, issue of the Texas Register (49 TexReg 7146). These rules will not be republished.

BACKGROUND AND PURPOSE

The adopted rules implement House Bill (H.B.) 3286 and Senate Bill (S.B.) 241, 88th Legislature, Regular Session, 2023.

H.B. 3286 amended the Texas Government Code to add §531.0691, creating a new process for the Medicaid pharmacy benefit in which the Vendor Drug Program (VDP) will add drugs to the formulary on a provisional basis. H.B. 3286 also amended Texas Government Code Chapter 533 to add §533.071 which elaborates on an existing process in the Medicaid managed care program regarding Preferred Drug List (PDL) exceptions and when a non-preferred drug can be used by listing these exceptions. Section 533.071 also added new PDL exceptions.

S.B. 241 amended Texas Health and Safety Code Chapter 439 to add new Subchapter D, §439.102. Texas Health and Safety Code §439.102(a) requires a manufacturer of a brand name insulin prescription drug for which a generic or biosimilar prescription drug is not available and is included in the Medicaid VDP formulary, to submit to HHSC a written verification stating whether or not the unavailability of the generic or biosimilar prescription drug is the result, wholly or partly, (1) of a scheme by the manufacturer to pay a generic or biosimilar prescription drug manufacturer to delay manufacturing or marketing the generic or biosimilar drug; (2) a legal or business strategy to extend the life of a patent on the brand name prescription drug; (3) the manufacturer directly manipulating a patent on the brand name prescription drug; or (4) the manufacturer directly manipulating an action described in reasons (1)-(3) of this sentence on behalf of another entity.


In Addition Re:

Criminal History Requirements for Child Care Operations – Proposed

OVERVIEW

26 Texas Administrative Code §745.661 (relating to What types of criminal convictions may affect a subject’s ability to be present at an operation?) states that HHSC will review the three charts listed in subsection (a) of the section annually and publish any changes for public comment in the Texas Register as an “In Addition” document. Questions or comments about the content of the proposed changes may be directed to Child Care Regulation at (512) 438-3269.


Public Notice: Texas State Plan for Medical Assistance – Home and Community-Based Services Adult Mental Health (HCBS-AMH) §1915(i) State Plan Benefit Renewal

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit transmittal number (TN) 25-0008 to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act. The Centers for Medicare and Medicaid Services approved the Home and Community-Based Services Adult Mental Health (HCBS-AMH) §1915(i) State Plan benefit through August 31, 2025. The purpose of this amendment is to request a renewal of the §1915(i) Home and Community-Based Services-Adult Mental Health (HCBS-AMH) program serving adults with a diagnosis of serious mental illness (SMI). The requested effective date for this proposed renewal is September 1, 2025.


Texas Department of Insurance

In Addition Re:

Application to do business in the state of Texas for Sidecar Health Insurance Company, a foreign life, accident and/or health company. The home office is in Columbus, Ohio.