TITLE 1.ADMINISTRATION

Part 5. GENERAL SERVICES COMMISSION

Chapter 117. SUPPORT SERVICES DIVISION

Subchapter D. PRINTING

1 TAC §117.61

The General Services Commission proposes new rule §117.61, regarding Printing. The new rule will implement §2172.003 of the Texas Government Code, Title 10, Subtitle D, which provides for the General Services Commission to assist state agencies with their printing activities and to assess and evaluate those printing activities.

Mr. Paul Adkins, Staff Services Program Director, has determined that for the first five-year period the new rule is in effect there will be no fiscal implications for state or local government as a result of implementing and enforcing this rule.

Mr. Adkins also has determined that for each year of the first five years the new rule is in effect, the public will benefit from the assessment and coordination of printing activities between state agency printing shops. There is no anticipated economic cost to persons required to comply with the rule as proposed. There will be no effect on small or large businesses and/or persons.

Comments on the proposal for the new rule may be submitted to Ann Dillon, General Counsel, General Services Commission, P.O. Box 13047, Austin, Texas 78711-3047. Comments must be received no later than 30 days from the date of publication of the proposal in the Texas Register .

The new rule is proposed under the authority of Texas Government Code, Title 10, Subtitle D, §§2152.003 and 2172.003 which provides the General Services Commission with the authority to promulgate rules necessary to implement the section.

The following statute is affected by these rules: Texas Government Code, Title 10, Subtitle D, §2172.003.

§117.61.Printing.

(a)

Pursuant to Texas Government Code, Title 10, Subtitle D, §2172.003, the commission may provide assistance to any state agency regarding their printing activities. Assistance can be provided by telephone, fax, letter, e-mail or in person.

(b)

The commission assesses and evaluates printing activities to ensure the best interests of the State of Texas are met. The commission may make recommendations to state agencies that will increase the productivity and cost-effectiveness of their printing operations. The assessment may include but is not limited to an appraisal of equipment, customer base, sales, printing volume, costs, and personnel.

(c)

The commission adopted the Council on Competitive Government's (CCG) Cost Methodology as a baseline for evaluating and comparing cost of state agency printing operations. All state agency printing shops in Travis County (except higher education) operate under a Franchise Agreement ("Agreement") with the commission, which allows state agencies currently operating a printing shop to maintain direct control with general oversight provided by the commission through Franchise Agreements. Failure to sign the Agreement will eliminate the authority for an agency to operate a printing shop. The Agreement requires each printing shop to utilize the CCG Cost Methodology in determining the cost of printing. The commission requires that each printing shop provide quarterly data to the commission. The commission summarizes this information in quarterly and annual reports.

(d)

The commission reviews state agency requisitions for new printing shop equipment, including copiers/duplicators and other printing devices used in quick copy operations. To complete the review, the state agency must provide written documentation to the commission. This documentation may include but is not limited to:

(1)

A summary narrative justifying the proposed purchase, rent or lease of equipment;

(2)

A description of the method of finance;

(3)

A detailing of the model(s) of printing equipment the agency currently has that it plans to replace (if applicable);

(4)

A detailing of the model(s) of printing equipment the agency plans to acquire;

(5)

A detailing of current annual costs for equipment to be replaced (if applicable);

(6)

A detailing of the estimated annual cost for the proposed equipment;

(7)

The cost benefit of proposed equipment;

(8)

The estimated volume of work which may be processed through the proposed equipment;

(9)

A summary of the equipment(s) enhanced features;

(10)

The number of hours per day the proposed equipment will run;

(11)

The number of shifts the proposed equipment will be operated on a daily basis; and

(12)

Miscellaneous information that may be pertinent as a consequence of other information supplied by the agency.

(e)

The commission shall assist state agencies with expediting the production of printing and graphic arts by serving as a source of information, facilitating disputes, hosting meetings or performing other services.

(f)

A roster of franchised printing shops is maintained by the commission. This roster includes printing shop equipment, facilities, special capabilities and staffing. The roster will be provided to requesting entities.

(g)

The commission will work with state agencies to ensure that printing services and supplies are purchased in the most economical manner possible. A vendor listing by commodity and services is maintained to maximize information regarding private sector suppliers. A summary vendor listing will be provided to requesting entities.

(h)

The commission will work with state agencies to coordinate the consolidation of printing shops when the agencies involved determine a consolidation is appropriate.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on June 8, 2000.

TRD-200004037

Ann Dillon

General Counsel

General Services Commission

Earliest possible date of adoption: July 23, 2000

For further information, please call: (512) 463-3960


Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 355. MEDICAID REIMBURSEMENT RATES

Subchapter G. OTHER COMMUNITY-BASED SERVICES AND TELEMEDICINE SERVICES

1 TAC §355.7001

The Health and Human Services Commission submits a proposed amendment to §355.7001 concerning the reimbursement for telemedicine services for the Medicaid Program. House Bill 1398, 76th Legislature, amended the statute that addresses telemedicine services in the Medicaid program. To be consistent with the new law, the Health and Human Services Commission is amending the rule, particularly to amend the definition of "rural," to include a definition of "rural health facility," and to allow rural health facilities to serve as hub site providers.

Mr. Don Green, Chief Financial Officer, has determined that for the first five-year period the amended rule is in effect, there will be no net fiscal implications as a result of administering §355.7001. The use of telemedicine will result in an increase in expenditures due to the reimbursement for attending providers but will also result in a decrease in expenditures for medical transportation costs. Savings may also result because of earlier interventions that telemedicine may effectively provide by allowing clients in rural and medically underserved areas to access services more quickly and conveniently. The use of telemedicine to date has been minimal; telemedicine networks are only beginning to be developed in the state. Providers must also cover hardware, software, and transmission costs. There will be no fiscal impact for local governments.

Mr. Green has also determined that for the first five-year period the section is in effect, the public benefit anticipated as a result of enforcing the section will be improved access to health care services for eligible recipients. There will be no costs to small businesses or persons complying with the section as proposed. There will be no impact on local employment.

Comments may be submitted to Kay Ghahremani, Texas Health and Human Services Commission, P.O. Box 13247, Austin, Texas 78751, (512) 424-6518. Comments will be accepted for 30 days following publication of this proposal in theTexas Register .

The amended rule is proposed under the Texas Government Code, Chapter 531, §531.033, which authorizes the Commissioner of Health and Human Services to adopt rules necessary to carry out the Health and Human Services Commissioner's duties under Chapter 531; and under Texas Government Code, §531.021, which provides the commission with the authority to administer federal medical assistance funds.

The amended rule implements Government Code, §531.021 and Human Resources Code, §§32.001-32.047.

§355.7001.Telemedicine Services.

(a)

Definitions. The following words and terms, when used in this chapter, will have the following meanings, unless the context clearly indicates otherwise.

(1)

Telemedicine - a method of health care service delivery used to facilitate medical consultations by physicians to health care providers in rural or underserved areas for purposes of patient diagnosis or treatment that requires advanced telecommunications technologies, including interactive video consultation, teleradiology, and telepathology.

(2)

Rural - area defined as a county with a population of [ less than ] 50,000 or less or a county that was not designated as a metropolitan area by the United States Bureau of the Census according to the 1990 federal census and does not have within the boundaries of the county a hospital, licensed under chapter 241, Health and Safety Code, with more than 100 beds.

(3)

Underserved - area that meets the definition of Medically Underserved Area (MUA) or Medically Underserved Population (MUP) by the U.S. Department of Health and Human Services.

(4)

Rural Health Facility - a health facility that is located in a rural county and is at least 30 miles from any accredited medical school or any teaching hospital affiliated through a written contract or agreement with an accredited medical school and that is:

(A)

a licensed, non-profit hospital;

(B)

a health clinic that is affiliated through a written contract or agreement with an accredited medical school;

(C)

a health clinic that is affiliated through a written contract or agreement with a teaching hospital that is affiliated through a written contract or agreement with an accredited medical school;

(D)

a health clinic that is affiliated through a written contract or agreement with a federally qualified health center;

(E)

a hospital that is licensed under chapter 241, Health and Safety Code, and is owned or operated by a municipality, county, hospital district, or hospital authority, and provides inpatient or outpatient services; or

(F)

a health clinic that is affiliated through a written contract or agreement with a hospital that is licensed under chapter 241, Health and Safety Code, and is owned or operated by a municipality, county, hospital district, or hospital authority, and provides inpatient or outpatient services.

(5)

[ (4) ] Hub Site Provider - a physician at a rural health facility or an accredited medical or osteopathic school located in Texas, or a physician at one of the following entities affiliated through a written contract or agreement with an accredited medical or osteopathic school located in Texas: hospitals, teaching hospitals, tertiary centers, or health clinics. The hub site physician will provide consultation and diagnosis, and may develop the patient's plan of care and treatment.

(6)

[ (5) ] Remote Site Provider - a health professional, such as a physician or advanced practice nurse, that is able to independently bill the Medicaid Program for a visit, or a Federally Qualified Health Center or Rural Health Clinic. Remote site providers must be located in rural or underserved areas. The remote site provider is responsible for carrying out or coordinating the plan of care and treatment after consulting with the hub site provider.

(b)

Reimbursement for Services Performed Using Telemedicine.

(1)

Using telemedicine, hub site providers can bill only for the following services:

(A)

consultation using interactive video;

(B)

consultation or interpretation using telemedicine as defined by Medicaid telemedicine medical policy and as currently reimbursed under the Medicaid program; and

(C)

teleradiology and telepathology as they are currently reimbursed under the Medicaid program pursuant to medical policy.

(2)

Using telemedicine, remote site providers can bill only for a visit or encounter using interactive video as described in Medicaid telemedicine medical policy.

(3)

Telemedicine services are reimbursed in accordance with the existing Medicaid reimbursement methodology.

(4)

Providers seeking reimbursement for telemedicine services must provide and bill for the service in the manner prescribed by the Texas Department of Health.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on June 12, 2000.

TRD-200004122

Marina S. Henderson

Executive Deputy Commissioner

Texas Health and Human Services Commission

Earliest possible date of adoption: July 23, 2000

For further information, please call: (512) 424-6576