25 TAC §§419.453, 419.455-419.459, 419.462, 419.464, 419.465
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) proposes amendments to §§419.453, 419.455-419.459, 419.462,
419.464, and 419.465 of Chapter 419, Subchapter L, governing Medicaid rehabilitative
services.
The amendments would modify the definition of "on site" because it did
not accurately describe the type of location at which community support services
and day programs could be provided. The amendments would also state that a
Medicaid provider cannot provide more than one rehabilitative service to an
individual at the same time and on the same day; describe the residential
and non-residential locations at which community support services and day
programs can be provided; clarify that services provided to patients of hospitals
licensed under Chapter 577 or 241 of the Texas Health and Safety Code are
not reimbursed by Medicaid as rehabilitative services; reference the rules
governing Medicaid fair hearings; and update the reference section.
Bill Campbell, Chief Financial Officer, has determined that for each year
of the first five years the proposed amendments are in effect enforcing or
administering the rules does not have foreseeable implications relating to
cost or revenues of the state or local governments.
Dave Wanser, Director, Behavioral Health Services, has determined that
for each year of the first five years the proposed amendments are in effect
the public benefits expected as a result of the adoption of the rules are
clear and concise requirements related to the locations at which community
support services and day programs can be provided. It is anticipated that
there would be no additional economic cost to persons required to comply with
the proposed rules because the requirements included with the amendments have
no costs associated with them.
It is not anticipated that the proposed amendments will affect a local
economy because the amendments do not include requirements that relate to
a local economy.
It is not anticipated that the proposed amendments will have an adverse
economic effect on small businesses or micro-businesses because the amendments
do not include requirements that would economically affect small businesses
or micro-businesses.
Written comments on the proposal may be sent to Linda Logan, Director,
Policy Development, Texas Department of Mental Health and Mental Retardation,
P.O. Box 12668, Austin, Texas, 78711-2668, within 30 days of publication.
The new sections are proposed under the Texas Health and Safety
Code, §532.015(a), which provides the Texas Board of Mental Health and
Mental Retardation with broad rulemaking authority; the Texas Government Code, §531.021(a),
and the Texas Human Resources Code, §32.021(a), which provide HHSC with
the authority to administer the federal medical assistance (Medicaid) program
in Texas; Acts 1995, 74th Legislature, Chapter 6, §1, (Senate Bill 509),
which clarifies the authority of HHSC to delegate the operation of all or
part of a Medicaid program to a health and human services agency; and the
Human Resources Code, §32.021(c), which provides an agency operating
part of the Medicaid program with the authority to adopt necessary rules for
the proper and efficient operation of the program. HHSC has delegated to TDMHMR
the authority to operate the Medicaid program for rehabilitative services.
§419.453.Definitions.
The following words and terms, when used in this subchapter, have the
following meanings, unless the context clearly indicates otherwise:
(1)-(15)
(No change.)
(16)
On site--
A non-residential location operated
by the Medicaid provider or a person or entity under arrangement with the
Medicaid provider at which rehabilitative services are provided, such as a
clinic, clubhouse, or office.
[
A location operated by the Medicaid
provider, or a location operated by a person or entity under arrangement with
the Medicaid provider, at which services are provided, such as a clinic, clubhouse,
or day treatment setting, but not a residential treatment facility or assisted
living facility with 16 or fewer beds, or a facility with more than 16 beds
that is a hospital licensed under Chapter 577 or Chapter 241 of the Texas
Health and Safety Code.
] The term [
also
] includes a school
when services are provided to children or adolescents.
(17)-(24)
(No change.)
§419.455.Rehabilitative Services: General Requirements.
(a)-(f)
(No change.)
(g)
The following concerns the provision of more than
one rehabilitative service at the same time and on the same day.
(1)
A
Medicaid provider is not prohibited from
providing a
community support service [
may be provided
] to
an individual's LAR or to a child's or adolescent's primary caregiver at the
same time
and on the same day
the individual, child, or adolescent
is attending a day program or receiving a separate community support service.
(2)
A Medicaid provider is prohibited
from providing more than one rehabilitative service to an individual at the
same time and on the same day.
(h)
(No change.)
§419.456.Community Support Services.
(a)
Description. Community support services are services that
are provided in person one-on-one or in a small group[
, either on site
or in the community (including in the individual's home), but not as part
of a day program
]. Community support services include:
(1)-(3)
(No change.)
(b)
(No change.)
(c)
Location. With the exception of an inpatient
hospital setting or an institution for mental diseases, community support
services may be provided in any setting in which the individual's needs can
be addressed (e.g., the individual's home, a restaurant, a grocery store,
on site, or a residential treatment setting with 16 or fewer beds).
§419.457.Day Programs for Acute Needs.
(a)-(c)
(No change.)
(d)
Location of services.
Day programs for acute needs
may be provided only:
[
Day programs for acute needs must be provided
on site.
]
(1)
on site; or
(2)
in a short-term, crisis-resolution
oriented residential treatment setting with 16 or fewer beds.
(e)-(f)
(No change.)
§419.458.Day Programs for Skills Training.
(a)-(b)
(No change.)
(c)
Location of services. Day programs for skills training
may
[
must
] be provided
only
:
(1)
on site; or
(2)
in
[
within
] a residential
treatment setting
[
treatment/training facility
] with 16 or
fewer beds.
(d)-(e)
(No change.)
§419.459.Day Programs for Skills Maintenance.
(a)-(b)
(No change.)
(c)
Location of services.
Day programs for skill maintenance
may be provided only:
[
Day programs for skill maintenance must
be provided:
]
(1)
on site;
(2)
in a residential treatment setting
with 16 or fewer beds;
(3)
in an assisted living setting with
16 or fewer beds; or
(4)
in a setting with more than 16 beds
if:
(A)
the eligible individual receiving the services is 65 years
of age or older;
(B)
the setting is not a hospital licensed under the Texas
Health and Safety Code, Chapter 577 or 241, or a state hospital operated by
TDMHMR; and
(C)
the services are not otherwise reimbursed by Medicaid.
[(1)
on site;]
[(2)
within a assisted living facility
with 16 or fewer beds; or]
[(3)
within a facility with more than
16 beds if:]
[(A)
the eligible individual receiving the services is 65 years
of age or older;]
[(B)
the facility is not a hospital licensed under Chapter
577 or Chapter 241 of the Texas Health and Safety Code or a state hospital
operated by TDMHMR; and]
[(C)
the services are not otherwise reimbursed by Medicaid.]
(d)-(e)
(No change.)
§419.462.Medicaid Reimbursement.
(a)-(e)
(No change.)
(f)
Services and activities not reimbursed by Medicaid as rehabilitative
services include:
(1)-(10)
(No change.)
(11)
services provided to:
(A)
inmates of a public institution (e.g., penal institutions)
as defined in 42 CFR, §435.1009; [
or
]
(B)
residents of an Intermediate Care Facility for Mental Retardation
(ICF/MR);
or
[
and
]
(C)
patients of a hospital licensed under
the Texas Health and Safety Code, Chapter 577 or 241; and
(12)
(No change.)
§419.464.Fair Hearings.
(a)
Any Medicaid eligible individual whose request for eligibility
for rehabilitative services is denied or is not acted upon with reasonable
promptness, or whose rehabilitative services have been terminated, suspended,
or reduced by TDMHMR is entitled to a fair hearing
in accordance with
Chapter 419, Subchapter G of this title (relating to Medicaid Fair Hearings).
[
, conducted by the Texas Department of Human Services. A request
for a fair hearing must be submitted to the TDMHMR Office of Medicaid Administration
and received within 90 days from the date the notice of denial of eligibility
for rehabilitative services or notice of termination, suspension, or reduction
of rehabilitative services was mailed.
]
(b)
(No change.)
§419.465.References.
The following laws and rules are referenced in this subchapter:
(1)-(5)
(No change.)
(6)
Chapter 412,
Subchapter
[
subchapter
] G of this title (relating to Mental Health Community Services Standards);
[
and
]
(7)
Section 414.504(g) of this title (relating to Pre-employment
Criminal History Clearance) of Chapter 414,
Subchapter
[
subchapter
] K of this title (relating to Criminal History Clearances)
; and
[
.
]
(8)
Chapter 419, Subchapter G of this
title (relating to Medicaid Fair Hearings).
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 April 28, 2000.
TRD-200003034
Charles Cooper
Chairman, Texas MHMR Board
Texas Department of Mental Health and Mental Retardation
Earliest possible date of adoption: June 11, 2000
For further information, please call: (512) 206-4581