Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 29.
PURCHASED HEALTH SERVICES
Subchapter J. AMBULANCE SERVICES
25 TAC §29.903
Subject to the approval of the State Medicaid Director, the
Texas Department of Health (department) proposes an amendment to §29.903
concerning authorized ambulance services for nonemergency transport.
The department has determined the need to amend the rule to comply with
Human Resource Code ?§32.024 as amended by Senate Bill 374, 76th Legislative
Session, 1999, which will allow non-emergency ambulance services to be immediately
granted upon receipt of a Texas Department of Health approved request for
authorization signed by a physician.
Joe Moritz, Health Care Financing Budget Director, has determined that
for each year of the first five years the section is in effect, there will
be fiscal implications as a result of enforcing or administering the section
as proposed. The impact on state government is a projected additional state
cost of $2,078,423 for Fiscal Year 2001, and $2,081,899 for Fiscal Year 2002,
$2,081,899 for Fiscal Year 2003, $2,081,899 for Fiscal Year 2004, and $2,081,899
for Fiscal Year 2005, with an associated increase in the federal Medicaid
matching funds received by the state. The amendment does have foreseeable
implications relating to cost or revenues of local governments. It is anticipated
that the amendment will result in increased expenditures paid to ambulance
companies.
Mr. Moritz has also determined that for each of the first five years the
section is in effect, the public benefit anticipated as a result of enforcing
the section will be to provide increased access for Texas Medical Assistance
Program recipients to nonemergency ambulance transportation services. There
will be no effect on small business or micro-businesses to comply with this
section as proposed. This was determined by interpretation of the rule that
small businesses and micro-businesses will not be required to alter their
business practices in order to comply with the rule as proposed. There are
no anticipated economic costs to persons who are required to comply with the
section as proposed. There will be no impact on local employment.
A public hearing on the proposed amendments will be held at 9:00 a.m. on
July 10, 2000, in the Public Hearing Room, Texas Department of Health, 12555
Riata Vista Circle, Austin, Texas, to accept comments on the proposal.
Comments on the proposed amendments may be submitted to Kathy Will, Program
Specialist, Policy Initiatives, Texas Department of Health, Mail Code Y-927,
1100 West 49th Street, Austin, Texas, 78756-3199, within 30 days of publication
in the
Texas Register
. In order to comply
with federal regulations, a copy of this proposal is being sent to each field
office of the Texas Department of Human Services where it will be available
for public review upon request for a period of 30 days.
The amendment is proposed under the Human Resources Code, §32.021
and the Texas Government Code, §531.021, which provide the Health and
Human Services Commission with the authority to adopt rules to administer
the state's medical assistance program. Rules are submitted by the Texas Department
of Health under its agreement with the Health and Human Services Commission
to operate the purchased health services program as authorized by Acts of
the 72nd Legislature, First Called Session, Chapter 15, §1.07, (1991).
The proposed amendment affects Chapter 32 of the Human Resources Code and
Chapter 531 of the Government Code.
§29.903.Authorized Ambulance Services.
These requirements are in addition to the requirements as stated in §29.1
of this title (relating to Claim Information Requirements), and §29.902
of this title (relating to Additional Claim Information Requirements).
(1)
(No change.)
(2)
Nonemergency Ambulance Transportation. The department or
its designee reimburses a Medicaid-enrolled provider for the nonemergency
transportation of a Medicaid recipient under the following conditions:
(A)
(No change.)
(B)
the severely disabled recipient can not be transported
by any means other than an ambulance without endangering the health or safety
of the recipient;
and
(C)
the nonemergency ambulance transportation of the severely
disabled Medicaid recipient is to or from a scheduled medical appointment
and authorization has been received from the department or its designee.
(i)
The
[
(I)
the recipient's medical needs and disability; and
(II)
duration of time if regular transportation will be required
as a result of the recipient's medical needs and disability.
(ii)
The
[
(iii)
A request for authorization must be
immediately granted and must be effective for a period of 180 days from the
date of issuance if the request includes a written statement from a physician
that:
(I)
states that alternative means of transporting
the recipient are contraindicated;
(II)
is dated not earlier than the 60th day
before the date on which the request for authorization is made; and
(III)
is submitted on the Texas Department
of Health approved Physician Certification Form.
(3) - (4)
(No change.)
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-200004098
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: July 23, 2000
For further information, please call: (512) 458-7236
Subject to the approval of the State Medicaid Director, the Texas
Department of Health (department) proposes amendments to §§33.134,
33.301 and 33.316 concerning the accompaniment by a parent, guardian or authorized
adult at THSteps/EPSDT medical and dental checkups for children who are younger
than age 15. The EPSDT program is also known as Texas Health Steps. Specifically
the sections cover the primary responsibilities of EPSDT medical and dental
screening providers and standards of care.
The amendment to §33.134(a)(2) corrects grammar concerning conjunctions.
The amendment to §33.134(a)(3) clarifies to whom medical screening
providers can interpret medical screening results.
The other amendments to §§33.134, 33.301 and 33.316 implement
Acts 1999, 76th Legislature, Chapter 766 (House Bill 1285), which amends the
Human Resources Code, §32.024(s). The amendments add as a condition for
eligibility for provider reimbursement the accompaniment of a parent, guardian,
or other authorized adult at EPSDT well-child (medical) and dental checkups
of children who are younger than age 15.
The amendments to §§33.134(a)(5), 33.301 and 33.316 do not apply
to services provided by a school health clinic, Head Start program, or child-care
facility if these facilities or programs (1) obtain written consent to the
services from the child's parent or guardian within the one-year period preceding
the date on which the services are provided, and that consent has not been
revoked; and (2) encourage parental involvement in and management of the health
care of children receiving services from the clinic, program, or facility.
These rules do not conflict with or supersede the Family Code, Chapters
151, 153, and 32 relating to who may consent for medical and dental services
for a child.
Roy Middleton, Director, Division of Financial Management, Associateship
for Community Health and Resources Development, has determined that, for the
first five years the amended sections are in effect, there will no fiscal
implications to state or local governments as a result of enforcing or administering
the proposed amendments.
Margaret Drummond-Borg, M.D. , Director, Genetic Screening and Case Management
Division, has determined that for the first five years the amended sections
are in effect, the anticipated benefit is an increase of parental involvement
in and management of the health care of EPSDT children. There will be no adverse
economic effect on small businesses or micro businesses. This was determined
by assessing any new demand for additional services that were not previously
required and for which no additional reimbursement was provided. It was determined
that no additional services are being required and there is no economic impact
of this policy change. There are no anticipated economic costs to persons
who are required to comply with the amendments as proposed. There is no anticipated
impact on local employment.
Comments on the proposed rules may be sent to Rosemary G. Morris, MSW,
Bureau of Children's Health, Texas Department of Health, 1100 West 49th Street,
Austin, Texas 78756, 512/458-7745. Comments will be accepted for 30 days following
publication of this proposal in the
Texas Register
.
Subchapter E. MEDICAL PHASE
25 TAC §33.134
The amendment is proposed under the Human Resources Code, §32.024(s)
which allows the department to establish rules governing the EPSDT program;
the Human Resources Code, §32.021 and the Government Code, §531.021,
which provides the Health and Human Services Commission with the authority
to administer the state's medical assistance program and are submitted by
the department under its agreement with the Health and Human Services Commission
to operate the purchased health services program as authorized under Acts
1991, 72nd Legislature, First Called Session, Chapter 15, §1.07.
The amendment affects the Human Resources Code, Chapter 32.
§33.134.Primary Responsibilities of Medical Screening Providers.
(a)
The primary responsibilities of medical screening
providers are:
(1)
to conduct medical screening according to policies and
procedures established by the Texas Department of Health;
(2)
to provide clinic surroundings which will establish a good
relationship between clinic personnel
,
[
(3)
to interpret medical screening results to the
recipient
or the recipient's
parent, conservator,
or
responsible adult,
and/or recipient during the exit interview;
(4)
to make referrals for needed follow-up diagnosis and treatment
services
; and
(5)
to ensure a parent, guardian
or authorized adult presents a recipient under age 15 at an EPSDT medical
checkup and continues to wait for the child while the checkup takes place
unless:
(A)
the services are provided by a school health
clinic, Head Start program, or child-care facility (as defined in the Human
Resources Code, §42.002(3));
(B)
written consent to the services, which has not
been revoked, was provided by the child's parent or guardian within the one-year
period prior to the date the services are provided; and
(C)
the provider encourages parental involvement
in and management of the health care of the children receiving services from
the clinic, program, or facility.
(b)
The term "authorized adult"
means a person, including an adult related to the child, who is authorized
by a child's parent or guardian to accompany a child to a Texas Health Steps
medical checkup.
(c)
The term "parental involvement"
means encouraging the accompaniment by a parent or guardian of a child at
an EPSDT medical checkup by notifying the parent of the appointment date in
writing at least one week in advance of the scheduled appointment and providing
the parent the option to attend the appointment.
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-200004060
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: July 23, 2000
For further information, please call: (512) 458-7236
25 TAC §33.301, §33.316
The amendments are proposed under the Human Resources Code, §32.024(s)
which allows the department to establish rules governing the EPSDT program;
the Human Resources Code, §32.021 and the Government Code, §531.021,
which provides the Health and Human Services Commission with the authority
to administer the state's medical assistance program and are submitted by
the department under its agreement with the Health and Human Services Commission
to operate the purchased health services program as authorized under Acts
1991, 72nd Legislature, First Called Session, Chapter 15, §1.07.
The amendments affect the Human Resources Code, Chapter 32.
§33.301.Definitions
The following words and terms when used in Subchapters F, G and H of
this chapter, shall have the following meanings, unless the context clearly
indicates otherwise.
(1)
Accompanied - A parent, guardian
or authorized adult presents a recipient under age 15 at an EPSDT dental checkup
and continues to wait for the child while the checkup takes place.
(2)
Authorized adult - A person,
including an adult related to the child, who is authorized by a child's parent
or guardian to accompany a child to a Texas Health Steps dental checkup.
(3)
[
(4)
[
(5)
[
(6)
[
(7)
[
(8)
[
(9)
Parental involvement - Encourages
the accompaniment by a parent or guardian of a child at an EPSDT dental checkup
by notifying the parent of the appointment date in writing and at least one
week in advance of the scheduled appointment and providing the parent the
option to attend the appointment.
(10)
[
(11)
[
§33.316.Standards of Care.
(a)
Texas Health Steps recipients or their parents or guardians
who can give informed consent shall:
(1)
receive information following an oral evaluation regarding:
(A)
the dental diagnosis;
(B)
scope of proposed treatment, including alternatives and
risks;
(C)
anticipated results;
(D)
need for administration of sedation or anesthesia, including
risks; and
(2)
receive a full explanation of the treatment plan and give
informed consent prior to its implementation.
(b)
Texas Health Steps recipients shall:
(1)
receive dental services specified in the treatment plan
which meet the standards of care established by the laws relating to the practice
of dentistry and the rules and regulations of the SBDE;
(2)
receive dental services free from abuse or harm from the
provider or the provider's staff; and
(3)
receive only that treatment required to address documented
medical necessity and which meets professionally recognized standards of health
care as recognized by the SBDE.
(c)
A Texas Health Steps dental
provider shall require that a recipient be accompanied by a parent, guardian,
or authorized adult at a Texas Health Steps dental appointment if the recipient
is younger than 15 years of age unless:
(1)
the services are provided by a school health
clinic, Head Start program, or child care facility (as defined in the Human
Resources Code, §42.002(3));
(2)
written consent to the services, which has not
been revoked, was provided by the child's parent or guardian within the one-year
period prior to the date the services are provided; and
(3)
the provider encourages parental involvement
in and management of the oral health care of the children receiving services
from the clinic, program, or facility.
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-200004061
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: July 23, 2000
For further information, please call: (512) 458-7236
Subchapter A. CONTROL OF COMMUNICABLE DISEASES
the
] prior authorization for
nonemergency ambulance transportation will be based upon the following:
the
] prior authorization request
must be approved or denied by the department or its designee not later than
48 hours after receipt of a request
unless clause (iii) of this subparagraph
applies
.
Chapter 33.
EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT
and
] the recipient
,
and
the
[
his
]
recipient's
family;
Subchapter G. DENTAL SERVICES
(1)
] Department--The Texas Department
of Health.
(2)
] Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT)-A component of the Medicaid program, also
known as Texas Health Steps (THSteps), which provides medical check-up and
dental services to Medicaid and Texas Health Steps clients under age 21 years.
(3)
] HHSC--Health and Human Services
Commission.
(4)
] Manual--The Texas Medicaid
Provider Procedures Manual, including all updates published in the Texas Medicaid
Bulletin.
(5)
] Medicaid--A medical and dental
program provided under Title XIX of the federal Social Security Act and the
Human Resources Code, Chapter 32.
(6)
] OIE--The Office of Investigations
and Enforcement at the Health and Human Services Commission.
(7)
] Recipient--A Medicaid-enrolled
client.
(8)
] SBDE--State Board of Dental
Examiners.
Chapter 97.
COMMUNICABLE DISEASES