1 TAC §355.8021
The Health and Human Services Commission (HHSC) proposes
an amendment to §355.8021 concerning reimbursement methodology for home
health services. Section 355.8021 is being amended to continue the current
reimbursement methodology for skilled nursing visits, home health aide visits,
physical therapy, and occupational therapy services provided by enrolled home
health agencies. Enrolled home health agencies will be reimbursed the reasonable
cost of supplying the service, applying the same standards, cost reporting
period, and cost reimbursement principles used in computing reimbursement
for comparable services under Title XVIII Medicare prior to October 1, 2000.
Effective October 1, 2000, the Medicare program is scheduled to begin reimbursing
home health services utilizing a prospective payment system (PPS).
Don Green, Chief Financial Officer, has determined that for each year of
the first five years the section is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
section. This amendment does not have any foreseeable implications relating
to cost or revenues of local governments.
Mr. Stephen Lorenzen, Director of Medicaid rate setting, has determined
that for each year of the first five years the section is in effect, the public
benefit anticipated as a result of enforcing the section will be a clearer
understanding of the reimbursement methodology used for covered 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.
Comments on the proposal may be submitted to Jeff Phelps, Program Administrator,
Medicaid Reimbursement Division, Texas Health and Human Services Commission,
P.O. Box 13247, Austin, Texas 78711-3247 or at (512) 424-6657, within 30 days
of publication of this proposal in the
Texas Register
. To comply with federal regulations, a copy of the proposal is being
sent to each Texas Department of Human Services (DHS) office where it will
be available for public review upon request.
A public hearing will be held at 1:30 p.m., Central Daylight Savings Time,
on January 22, 2001, in the Public Hearing Room, Building 3, first floor of
the Riata Crossing Facility, 12555 Riata Vista Circle, Austin, Texas 78727-6404,
to accept comments on the proposal.
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.
The proposed amendment affects Chapter 32 of the Human Resources Code and
Chapter 531 of the Government Code.
§355.8021.Reimbursement Methodology for Home Health Services.
(a)
Reimbursement methodology for services provided by a home
health agency.
(1)
Except for expendable medical supplies and DME, authorized
home health services provided for eligible Medicaid recipients are reimbursed
the reasonable cost of supplying the service, applying the same standards,
cost reporting period, and cost reimbursement principles [
currently
]
used in computing reimbursement for comparable services under Title XVIII
Medicare
prior to October 1, 2000
.
(2)
(No change).
(b)
Reimbursement methodology for expendable medical supplies
provided by enrolled home health agencies and DME providers/suppliers. Participating
providers are reimbursed the maximum allowable fee for expendable medical
supplies established by the department. The maximum allowable fee is based
upon the lesser of the following:
(1)
(No change).
(2)
the Medicare fee schedule
in place prior to October
1, 2000,
as defined in
Title 25,
§29.301
,
[
of this title
] (relating to General); or
(3)
the expendable medical supply acquisition fee as defined
in
Title 25
§29.301 [
of this title
].
(c)
Reimbursement methodology for durable medical equipment
provided by enrolled home health agencies and DME providers/suppliers. Participating
providers are reimbursed the maximum allowable fee for durable medical equipment
established by the department. The maximum allowable fee for durable medical
equipment is based on the lesser of the following:
(1)-(2)
(No change).
(3)
the Medicare fee schedule as defined in
Title 25
§29.301
[
of this title
]; or
(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 December 21, 2000.
TRD-200008892
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: February 4, 2001
For further information, please call: (512) 458-7236