Subchapter A. TRAVEL MANAGEMENT SERVICES

The Texas Department of Health and Human Services (HHSC) proposes the repeal of §355.8401 and §355.8481 and new §355.8401 concerning reimbursement methodology for Case Management for Children and Pregnant Women (CPW). Specifically, new §355.8401 covers general information and basis for rate analysis regarding reimbursement to CPW providers who provide billable contacts to eligible recipients. New §355.8401 includes language from proposed repealed §355.8401 and proposed repealed §355.8481.

The repeals and the new section are proposed in order to ensure all affected providers receive equal reimbursement for provision of case management services. The CPW program is the result of the proposed combination of two previously separate programs, Medicaid Case Management for High Risk Pregnant Women and High Risk Infants (PWI) and the Texas Health Steps Medical Case Management (THSteps MCM). The combination of these two programs into a single entity ensures, through a larger provider base, more continuity of service for all consumers who are eligible for these services. As reimbursement will now be paid through the new CPW Program, accompanying rules must be formulated which support the rate process. Because the separate PWI and THSteps MCM programs are proposed for merging into a single program, these programs will no longer be required to retain individual reimbursement rules.

HHSC further proposes the repeal of §355.8401. Specifically, this section covers general information on reimbursement to qualified providers for case management services provided to Medicaid-eligible individuals who are high-risk pregnant women or high-risk infants. Reimbursement under this section is cost-related, sets a basis for rate analysis and covered uniform rates throughout the geographic area(s) providing the service. These rates are modeled on other case management and cost information provided by HHSC.

HHSC further proposes the repeal of §355.8481. Specifically, this section covers the reimbursement of qualified THSteps medical case management providers for billable contacts with eligible recipients. It further covers provider reimbursement rates set for other Medicaid case management services administered by HHSC and the Texas Department of Health.

Section 355.8401 and §355.8481 are being proposed for repeal as a result of the proposed combination of the Medicaid Case Management for High Risk Pregnant Women and High Risk Infants (PWI) and the Texas Health Steps Medical Case Management (THSteps MCM) programs into one new program, Case Management for Children and Pregnant Women (CPW), proposed 25 TAC Chapter 27, published in the October 27, 2000, issue of the Texas Register (25 TexReg 10624) and the proposed repeals of Case Management for High-Risk Pregnant Women and High-Risk Infants, 25 TAC §§32.301-32.305 and 32.307, published in the October 27, 2000, issue of the Texas Register (25 TexReg 10628), Texas Health Steps Medical Case Management, §§33.501-33.506, published in the October 27, 2000, issue of the Texas Register (25 TexReg 10629) and Medicaid Case Management Services for High Risk Pregnant Women and High Risk Infants, §§37.81-37.86, published in the October 27, 2000, issue of the Texas Register (25 TexReg 10631).

Mr. Don Green, Chief Financial Officer for HHSC, has determined for the first five years this proposed section is in effect, there will be fiscal implications to the state government as a result of administering or enforcing the sections as proposed. The effect on state government will mean increased costs to the state of $1,016,704, $1,866,565, $2,405,812, $2,973,934, and $3,513,064 in state fiscal years 2001, 2002, 2003, 2004, and 2005 respectfully, for a total of $11,776,079 over these five years. The increased funds will enable all providers of the proposed new case management service, CPW, to receive the same amount of reimbursement for providing intakes and comprehensive services. In addition, public and private agencies will be reimbursed equally for provision of the same services-intake, comprehensive case management assessment and follow-up. There will be no effect on local government.

Mr. Stephen Lorenzen, HHSC Director of Medicaid Rate Setting, has determined that for the first five years the sections and repeals are in effect, the public benefits anticipated as a result of enforcing or administering the new section include better access to primary care providers, preventive health services, other health services and community resources for those children and pregnant women accessing the services. There will be no adverse impact on micro-businesses and small businesses. This was determined after concluding that the only small businesses and micro-businesses affected by the new rule will potentially experience an increase in cost reimbursement as a result of the reimbursement structure in the proposed new rules. There are no anticipated economic costs to persons who receive the services. There is no anticipated impact on local employment.

Comments on the proposal may be submitted to Veda White, ACSW, LMSW-ACP, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3199, (512) 458-7111, extension 2111. Comments will be accepted for 30 days following publication of the proposal in the Texas Register .

A public hearing concerning the proposed sections will be held on Monday, March 19, 2001, from 9:30 a.m. to 12:00 p.m., in the Texas Department of Health Board Room M739, 1100 West 49th Street, Austin, Texas.