Texas Register Table of Contents
Governor
Appointments Re:
The Governor appointed two individuals to the Texas Board of Occupational Therapy Examiners on April 25, 2023.
Appointed to the Texas Board of Occupational Therapy Examiners for a term to expire February 1, 2029:
- Estrella Barrera of Austin, Texas.
- Blanca E. Cardenas of Mission, Texas.
Texas Health and Human Services Commission
In Addition Re:
Updated Public Notice – Texas State Plan for Medical Assistance Amendment, concerning updated reimbursement methodology for outpatient hospital services.
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 will be effective beginning on the date that the modernized Medicaid Management Information System (MMIS) becomes operational.
BACKGROUND AND JUSTIFICATION
The purpose of the amendment is to update the reimbursement methodology for the outpatient hospital services to an outpatient prospective payment system (OPPS) in the current state plan by updating a number of items to comply with Texas Government Code Section 536.005. The OPPS that HHSC is proposing to implement is the EAPG grouper methodology. EAPGs are a visit-based classification system intended to reflect the utilization and type of resources of outpatient encounters for patients with similar clinical characteristics. EAPGs are used in OPPS for a variety of outpatient settings, including but not limited to: hospital emergency rooms, outpatient clinics, renal dialysis facilities, and same day surgery. EAPGs are proprietary to 3M™ Health Information Systems and 3M™ initially developed Ambulatory Patient Groups (APGs) prior to 2000. In 2007, 3M™ made significant changes to its earlier variant of the grouper to reflect current clinical practice including coding and billing practices and to describe a broader, non-Medicare population which resulted in what we now call EAPGs. EAPGs group procedures and medical visits that share similar clinical characteristics, resource utilization patterns and cost so that payment is based on the relative intensity of the entire visit. The EAPG grouping system is designed to recognize clinical and resource variations in severity, which results in higher payments for higher intensity services and lower payments for less intensive services. While each claim may receive multiple EAPGs, each procedure is assigned to only one EAPG.