25 TAC §34.3
Subject to the approval of the State Medicaid director, the
Texas Department of Health (department) proposes an amendment to §34.3,
concerning the deinstitutionalization of children from nursing facilities
into the Medically Dependent Children Program (MDCP). The purpose of the proposed
amendment will redefine the population that may access existing MDCP services.
The proposed amendment will allow the department to move eligible children
from institutions to home and community settings, if the parents choose this
option. The proposed amendment to §34.3 refers to an agreement between
the Texas Department of Human Services and the department to support the placement
of current or prior resident children from Texas nursing facilities into permanent
placement in their homes or community settings. The children targeted under
this provision will have been in placement for continuous institutional long-term
care purposes. The provision excludes institutional placements that are for
respite purposes or the treatment of an acute condition.
The proposed amendment to §34.3(c) resulted from the recognition that
current MDCP deinstitutionalization rules are constraining, due to the four-month
residency requirement.
David Cook, Director of Programs, Administration and Management, Texas
Department of Human Services (TDHS), has determined for the first five years
this proposed section is in effect, there will be potential fiscal implications
to the state government as a result of administering the sections as proposed.
The effect on state government will mean projected costs to the state of $46,338,
$47,848, $49,283, $50,762, and $52,285 in state fiscal years 2002, 2003, 2004,
2005, and 2006 respectively, for a total of $246,516 over these five years
for approximately thirty children. This fiscal note was calculated and submitted
by TDHS since the deinstitutionalization funding for the potential 30 slots
will be provided by TDHS per the agreement between agencies.
Lee Johnson, Acting Director, Division of Financial Management, Associateship
for Family Health, Texas Department of Health, has determined that for fiscal
years 2002 through 2006, for each child who is deinstitutionalized, there
may be a fiscal impact each year ranging from a cost of up to $17,155 in state
general revenue per child per year to a savings of up to $8,846 per child
per year. Mr. Johnson has determined that for the first five-year period the
amended section is in effect, there will be no fiscal implications to local
government as a result of administering the section as proposed.
Mr. Johnson has also determined that for each of the first five years the
section is in effect, the public benefits as a result of enforcing this section
will be that more families in Texas will be able to keep their children in
their own home or community setting. There may be a positive economic effect
on microbusinesses or small businesses in that nurses, home and community
support agencies, and other qualifying providers of community-based care will
gain revenue once a child is deinstitutionalized, up to an estimated $104,549
per child in a 12-month period. There may however be an adverse economic effect
on microbusinesses or small businesses in that any nursing facility that qualifies
as a small or microbusiness will lose revenue once a child is removed from
the facility to a home or community setting. The adverse economic impact could
reach an estimated $88,120 per child in a 12-month period. There are no economic
costs to persons other than the families of the children who participate.
There is no anticipated impact on local employment.
Comments on the proposal may be submitted in writing to Susan Penfield,
M.D., Bureau of Children's Health, Texas Department of Health, 1100 West 49th
Street, Austin, Texas 78756, by FAX at (512) 458-7238, or by telephone at
1-800-252-8023 or (512) 458-7111, extension 3104. Comments will be accepted
for 30 days following publication of this proposal in the
Texas Register
.
The amendment is proposed under the Social Security Act, §1915(c)
relating to Medicaid waiver programs for home or community based services;
Chapter 15, §1.07, Acts of the 72nd Legislature, First Called Session
(1991), as amended by Chapter 747, Actions of the 73rd Legislature (1993)
which authorizes the Texas Board of Health (board) to adopt rules necessary
to administer the MDCP; and the Health and Safety Code §12.001, which
provides the board with authority to adopt rules to implement every duty imposed
by law on the board, the department, and the commissioner of health.
This proposed amendment affects Chapter 32 of the Human Resources Code.
§34.3.Participant Eligibility Criteria.
(a) - (b)
(No change.)
(c)
Deinstitutionalization.
(1)
For purposes of this section, "deinstitutionalization"
refers to an interagency agreement between the Texas Department of Human Services
and the Texas Department of Health to support the permanent placement of current
and previous resident children of Texas nursing facilities into their homes
and community settings. The children targeted under this provision will have
been in placement for continuous institutional long-term care purposes.
(2)
"Placement for continuous institutional
long term care purposes," refers to placement and subsequent residence in
an institution for the purpose of meeting a registrant's ongoing needs when
the child's needs cannot be met in the home on an ongoing basis. This excludes
respite placements and placements for treatment of acute episodes.
(3)
An MDCP interest/waiting list registrant
may be considered for deinstitutionalization into MDCP at any time since September
1, 1995 if the registrant:
(A)
has resided in a Texas nursing facility for continuous
institutional long term care purposes; or
(B)
has resided in another Texas institution, (i.e., an ICF-MR,
hospital, long-term acute care setting), for continuous institutional long
term care purposes, followed by residence in a Texas nursing facility.
[
(1)
Any MDCP registrant who has resided in
a Texas nursing facility for at least four months since September 1, 1995,
may be considered for deinstitutionalization into MDCP under §34.3; however,
if, prior to residency in a Texas nursing facility, the child resided in another
institution in Texas for long term care purposes, that time in the other institution
may count towards the four months of residency in a Texas nursing facility
for purposes of this section; and further, preference for access to these
slots may be given to those children who were residing in a Texas nursing
facility prior to the effective date of the rules, if:
]
(C)
[
(A)
] has been determined to be
Medicaid eligible; and
(D)
[
(B)
] has met all of the criteria
in subsection (b) of this section.
(4)
[
(2)
] The names of qualified individuals
applying for nursing facility deinstitutionalization shall be maintained on
a waiting list separate from that for other MDCP registrants.
(5)
[
(3)
]An individual applying for nursing
facility deinstitutionalization under MDCP shall become eligible for waiver
services under this subsection if:
(A)
a vacancy designated for qualified individuals under this
subsection exists within the waiver; and
(B)
the individual's Texas Index for Level of Effort (TILE)
funding is available to be allocated for home and community-base services.
(d) - (i)
(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 29, 2001.
TRD-200103723
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: August 12, 2001
For further information, please call: (512) 458-7236