Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 14.
COUNTY INDIGENT HEALTH CARE PROGRAM
The Texas Department of Health (department) adopts the amendments
to §§14.1, 14.2, 14.104, and 14.203 concerning the County Indigent
Health Care Program. Section 14.1 is adopted with changes to the proposed
text as published in the December 1, 2000, issue of the
Texas Register
(25 TexReg 11861). Sections 14.2, 14.104, and 14.203
are adopted without changes, and therefore the sections will not be republished.
The amendments comply with Health and Safety Code Chapter 61, which requires
that the standards and procedures used to determine eligibility must be consistent
with the Temporary Assistance to Needy Families (TANF) and Medicaid standards
and procedures.
The proposed amendment to §14.1 allows the department to prevent payments
for services that were not paid by the county within 95 calendar days from
the county's receipt of the bill, to withhold state assistance funds to counties
if serious deficiencies that cannot be corrected are identified, and to routinely
audit a county receiving state assistance funds. The appeals conducted by
the Office of General Counsel for audit disputes are deleted so that the program
and the deputyship can handle these disputes. The signature of the county
judge and the additional wording on the State of Texas purchase voucher that
the payee agrees to repay any funds paid in error are proposed for counties
receiving state assistance funds.
The proposed amendments to §14.2 delete the appeals conducted by the
Office of General Counsel on eligibility dispute resolutions to leave the
responsibility for program policy within the deputyship.
Section 14.104 proposes amendments to increase the maximum income limit
deduction for the sponsor's family to be consistent with the Temporary Assistance
to Needy Families (TANF) program as required by the Health and Safety Code,
Chapter 61.
Section 14.203 allows counties to choose how to pay inpatient hospital
services at the beginning of the calendar year rather than the state fiscal
year to simplify county administration.
No public comments were received regarding the proposal. A public hearing
on the amendments was held at 10:00 a.m. on December 15, 2000, in the Public
Hearing Room, Texas Department of Health, 12555 Riata Vista Circle, Austin,
Texas, to accept comments on the proposed repeals and amendments; but no persons
who wished to comment were present.
Due to a staff comment, a change was made to §14.1(i)(2)(B). In the
second sentence, a period was added and a comma was deleted to state "...acknowledges
the state's authority to collect any funds paid in error."..." instead of
"...acknowledges the state's authority to collect any funds paid in error,"...".
Subchapter A. COUNTY PROGRAM ADMINISTRATION
25 TAC §14.1, §14.2
The amendments are adopted under Health and Safety Code Chapter
61 and Human Resources Code Chapters 22 and 32. The department has rule making
authority for the County Indigent Health Care Program under Health and Safety
Code Chapter 61.
§14.1.County Program Administration.
(a)
Definitions. The following words and terms, when used in
this section, shall have the following meanings, unless the context clearly
indicates otherwise:
(1)
A county refers to:
(A)
a county not fully served by a public hospital or a hospital
district; or
(B)
a county that provides indigent health care services to
its eligible residents through a hospital established by a board of managers
jointly appointed by a county and a municipality.
(2)
Day on which county expends funds--The county expends funds
on the day the county writes a check paying for a bill.
(3)
Days--Calendar days.
(4)
Eligibility staff--Individuals who determine program eligibility.
These individuals may be county officials, county personnel, or persons determining
program eligibility under contract with the county. If the term "staff" is
used alone, it has the same meaning.
(5)
General revenue tax levy (GRTL)--The county's annual general
revenue tax levy. The GRTL includes all county property taxes and sales and
use tax revenue that the county expects to receive in the calendar year in
which the state fiscal year begins. Sales and use tax revenue is collected
under the County Sales and Use Tax Act in compliance with the Tax Code, §26.042(c).
The GRTL excludes the $.30 county tax for farm-to-market roads or flood control
(lateral road fund) and the $.15 county tax for maintenance of public roads
(special road and bridge fund). The GRTL used to establish the county's 8.0%
limit for the County Indigent Health Care Program in the coming state fiscal
year is the county's adjusted GRTL as of July 31 of the current year minus
the amount of revenue dedicated for program services in the previous year.
In counties partially served by a hospital district, the counties' 8.0% limit
is based on the GRTL for the property outside the area served by the hospital
district.
(6)
Public facility--A public hospital or a hospital district
owned, operated, or leased by a hospital district.
(7)
Public hospital--A hospital owned, operated, or leased
by a county, city, town, hospital authority, or other political subdivision
of the state, excluding a hospital district and hospital authority. A hospital
is not considered to be a public hospital for the purposes of providing indigent
care if the hospital:
(A)
is owned, operated, or leased by a city with a population
of less than 5,500, according to the most recent federal decennial census;
(B)
was leased before January 1, 1981, by a city that at the
time of the lease did not have a legal obligation to provide indigent care;
(C)
was established under Texas Civil Statutes, Article 4494i-1;
or
(D)
was leased to a nongovernmental person or entity at the
time of sale and was sold on or after January 1, 1988, to a nongovernmental
purchaser.
(8)
State fiscal year--The 12-month period beginning September
1 of each calendar year and ending August 31 of the following calendar year.
(b)
County responsibility for an indigent health care program.
Each county without a public facility legally obligated to serve the entire
county must administer a county indigent health care program that serves all
or that portion of the county not served by a public facility. The county's
program must provide basic health care services to eligible county residents
who do not live in a county area served by a public facility. A county that
adopts a property tax rate exceeding 8.0% (as calculated under the Tax Code, §26.04)
and designates a portion of that tax rate for basic health care services must
spend the revenues produced by that portion of the designated rate for basic
health care services only. If a county owns a public hospital, and the county
sells or leases the hospital to another party, the terms of the sale or lease
agreement determine the type and level of county responsibility. If the sale
or lease represents the county's attempt to totally divest itself of the public
hospital or reduce the level of services provided by the hospital, the Indigent
Health Care and Treatment Act, Subtitles D and E, apply.
(c)
General administrative requirements. Each county required
to administer a program must:
(1)
provide public notice and make a reasonable effort to notify
the public, at the beginning of the state's fiscal year, of the county's eligibility
standards, and the county's application, documentation, and verification procedures
and the verification and documentation procedures that applicants must comply
with to establish eligibility;
(2)
establish an application procedure;
(3)
furnish each applicant with a written application form;
(4)
assist applicants in completing the application form and
the application process, and inform applicants that this assistance is available;
(5)
require applicants to sign a written statement swearing
to the truth of the information they supply;
(6)
determine eligibility within 14 days after the date a completed
application is received;
(7)
provide applicants with a written notice of the eligibility
decision. Each county must include on its notice to denied applicants the
reason for denial and an explanation of the county's appeal process;
(8)
inform approved households that they must report any changes
in income and resources within 14 days after the date the change occurs;
(9)
review the eligibility of each household at least once
every six months;
(10)
develop a process for reviewing denied cases and for hearing
appeals requested by households that are denied assistance;
(11)
maintain a case record for each eligible and denied applicant.
Case records for denied applicants must be maintained for a minimum of three
state fiscal years after the relevant state fiscal year;
(12)
allow denied applicants to resubmit an application whenever
circumstances justify an eligibility redetermination.
(13)
All counties required to provide indigent health care
shall submit annual financial reports to the department. A county satisfies
the annual reporting requirements if the county submits information to the
department as required by law to obtain an annual distribution under the Agreement
Regarding Disposition of Settlement Proceeds filed on July 24, 1998, in the
United States District Court, Eastern District of Texas, in the case styled
The State of Texas v. The American Tobacco Co., et al., No. 5-96CV-91.
(d)
County administrative option.
(1)
Counties may administer or may contract with others to
administer a program that uses:
(A)
the eligibility policies; the application, documentation,
and verification procedures; and the service definitions contained in this
chapter; or
(B)
county-developed standards and procedures that are less
restrictive than those contained in this chapter.
(2)
Counties may change eligibility standards to make them
more or less restrictive than their preceding standards. However, the new
standards can be no more restrictive than those contained in Subchapter B
of this chapter (relating to Determining Eligibility).
(3)
If a city in the county with a population below 15,000
according to the last federal census owns, operates, or leases a public hospital,
the city and county may enter into an agreement transferring part of the public
hospital's indigent health care responsibility to the county. The transfer
agreement is irrevocable and cannot be amended unless a hospital district
is created after the effective date of the agreement and the boundaries of
the district cover all or part of the county. It must:
(A)
specify that the county is assuming the hospital's responsibility
for paying other providers for services delivered to eligible city residents
on an emergency basis or because the service is unavailable at the hospital;
(B)
require that the city public hospital continues to otherwise
provide health care services to eligible city residents as required by law;
(C)
occur by August 31, 1989, by adoption of an ordinance,
resolution, or order by the commissioners' court and city governing body;
and
(D)
take effect on a September 1, within two years after the
date of the agreement.
(4)
The county and city must establish coordinated application
and eligibility verification procedures that comply with subsection (c) of
this section and the Indigent Health Care and Treatment Act, §10.03.
These procedures must ensure the efficient and timely referral of the eligible
city residents to the proper city or county entity. County expenditures for
services made under the terms of the agreement are creditable towards the
county's 8.0% limit if the city resident otherwise meets the eligibility standards
contained in Chapter 4 of this title (relating to Determining Eligibility).
County expenditures for coordinating application and verification procedures
cannot be credited towards the county's 8.0% limit. Within 30 days after the
agreement is made, the city and county must notify the department of the agreement
and its effective date and send the department a copy of all ordinances, resolutions,
or other orders pertaining to the County Indigent Health Care Program agreement.
(5)
Upon county request, the Texas Medicaid or Vendor Drug
Program will reimburse the counties for basic services provided to otherwise
eligible county residents appealing a social security disability determination
denial and who are later determined to be retroactively SSI/Medicaid-eligible.
County eligibility for reimbursement is subject to §14.204(h) and (i)
of this title (relating to Services and Payment Liability, Limitations, and
Options). Reimbursement is available only for services covered by the Texas
Medicaid or Vendor Drug Program.
(e)
State assistance fund.
(1)
The Texas Department of Health (department) is responsible
for distributing state assistance to eligible counties to the extent appropriated
state funds are available.
(2)
A county is eligible for the state assistance fund only
if the county:
(A)
complied with the eligibility policies and the application,
documentation, and verification procedures contained in this chapter; and
(B)
expended 8.0% of the applicable GRTL in the state fiscal
year for the provision of basic and department approved optional health care
services to eligible county residents;
(C)
the department may waive the requirement that the county
meet the minimum expenditure level and provide state assistance at a lower
level determined by the department. The county must submit the waiver request
to the department prior to the beginning of the state fiscal year for which
the waiver is being requested. The department must make a determination on
the request not later than 90 days after the department's receipt of the request
and shall notify the county of their determination. The county must demonstrate
on their waiver request, through an appropriate actuarial analysis, that the
county is unable to satisfy the 8.0% GRTL level based on the following:
(i)
although the county's GRTL has increased significantly,
expenditures for health care services have not increased by the same percentage;
or
(ii)
the county is at the maximum allowable ad valorem tax
rate, has a small population, or has insufficient taxable property.
(3)
Counties may not credit expenditures towards eligibility
for state assistance if the expenditures are for a resident eligible under
less restrictive eligibility standards but ineligible under the department
eligibility standards, except for net income standards up to 50% of the Federal
Poverty Income Limits (FPIL). A county that provides indigent health care
services to its eligible residents through a hospital established by a board
of managers jointly appointed by a county and a municipality may use less
restrictive eligibility and resource standards and may credit expenditures
towards eligibility for state assistance. If a county has a contract with
a state agency to provide basic services to eligible county residents in a
hospital maintained or operated by the state agency, the county may credit
all expenditures for a county resident eligible under the department or less
restrictive county standards.
(4)
The department distributes funds to eligible counties based
on a maximum annual allocation for each county potentially eligible for state
assistance, subject to funding. The maximum annual allocation for each county
will be based on such factors as spending history, population, and the number
of residents living below the Federal Poverty Income Limit. The maximum annual
allocation will be recomputed at least every six months. The minimum annual
allocation, subject to funding, will be no less than the average of what a
county would have received in state fiscal years 1997, 1998, and 1999 at the
8.0% GRTL threshold with a 90% state match. At the end of the state fiscal
year the department may reallocate the distribution of money to eligible counties.
(f)
Eligibility requirements for counties applying for state
assistance.
(1)
Each county that plans to credit expenditures towards eligibility
for the state assistance fund must:
(A)
comply with the eligibility standards and the application,
documentation, and verification procedures contained in this chapter. County
use of the department application for assistance form, the eligibility worksheet,
and the monthly financial/activity report is also required. County use of
other department forms is not required if the county substitutes a similar
form with the same content as the department form;
(B)
notify the department by telephone as soon as possible
before the dates on which the county anticipates it will expend both 6.0%
and 8.0% of its GRTL. The telephone calls reporting these expenditure levels
must occur no later than the date on which the county reaches these expenditure
levels;
(C)
notify the department in writing within seven days after
the county telephones the department to report that the county has reached
the 6.0% expenditure level. The county must also notify the department and
the county's mandated providers in writing within seven days after the county
telephones the department to report that the county has reached the 8.0% expenditure
level;
(D)
use adequate, auditable accounting records and procedures
that establish a clear, accurate audit trail for each expenditure;
(E)
complete and submit reports prescribed by the department
to the department within 10 days after the end of each month. All counties
that are eligible to receive state assistance must submit monthly financial
reports covering the 12-month period preceding the date on which state assistance
is sought.
(F)
complete and submit a State of Texas purchase voucher to
the department to claim state matching funds;
(G)
maintain a case record for each eligible and denied resident;
(H)
cooperate fully with the department by providing any and
all information requested by the department in an audit of county records
or a review of county eligibility for state assistance;
(I)
maintain all records and vouchers for three state fiscal
years after the relevant state fiscal year; and
(J)
report the county's GRTL, as shown in county records on
July 31 of each year, to the State Property Tax Board no later than October
1 of the same year. If part of the county is served by a hospital district,
request the county appraisal district to determine the GRTL of county propertylocated
outside the area served by a hospital district.
(2)
Counties may not credit payments for the following towards
eligibility for state assistance:
(A)
ineligible individuals;
(B)
non-basic or department non-approved optional services;
(C)
amounts for basic or department approved optional services
that exceed the payment rates established by the department;
(D)
basic or department approved optional services if:
(i)
a physician provides the service and does not certify in
writing that the service was medically necessary; or
(ii)
a nonphysician provides the service and does not certify
in writing that the service was ordered by a physician;
(E)
county program administrative expenses;
(F)
services that were not paid by the county within 95 calendar
days from the county's receipt of the bill. For SSI applicants, the date of
receipt is the day the applicant is determined CIHCP eligible because their
SSI application has been denied by the Social Security Administration.
(3)
Counties may also credit toward eligibility for state assistance
the value of health care services credited or paid in a state fiscal year
and provided to county residents eligible under the eligibility and payment
standards established by the department in Subchapters B, C, and D of this
chapter (relating to Determining Eligibility, Providing Services, and Care
Management) under the following types of contracts:
(A)
a health care provider and a county entered into a contract,
on or before January 1, 1985, require that the provider furnish a certain
level of mandatory health care services to eligible county residents; or
(B)
the terms of a sales contract between a county and a purchaser
of the county's hospital require the purchaser to provide inpatient and outpatient
hospital services. The sale must have occurred on or after January 1, 1988,
and the hospital must have been:
(i)
leased to a nongovernmental person or entity at the time
of sale; and
(ii)
purchased by a nongovernmental person or entity.
(g)
Determining county eligibility for state assistance.
(1)
Within 30 days from the date the department receives written
notification that the county expended 6.0% of its GRTL for basic and department
approved optional services for eligible residents, the department must:
(A)
complete a review of the county's eligibility system;
(B)
provide the county with a report of the findings of the
review; and
(C)
provide information relevant to a department audit of the
country's financial accounting system.
(2)
If the eligibility systems review does not identify any
deficiencies in the county's eligibility system, the county is eligible for
state assistance when it reaches the 8.0% expenditure level. If deficiencies
are identified, the county must correct the deficiencies within five workdays
of written notice before claiming state assistance funds. If serious deficiencies
that cannot be corrected are identified, the county is not eligible for state
assistance funds. Serious deficiencies are consistent misapplication of policy
as stated in these rules and the County Indigent Health Care Handbook.
(h)
The department state-assistance-fund audits.
(1)
The department may routinely audit a county that receives
state assistance funds.
(2)
A county may request an administrative review of the department
audit report if the county disagrees with the report findings. The county
requests an administrative review by sending written notice, an explanation
of the county's reason for disagreement, and all relevant information to the
department Indigent Health Care Policy Section. The county's written request
must be postmarked within 30 days from the date of the county's audit exit
conference.
(3)
If the policy section does not receive a written request
for administrative review as stipulated in paragraph (2) of this subsection,
the findings of the department audit report are final.
(4)
The policy section must determine the accuracy of the department
audit report and notify the county of its decision by letter postmarked within
30 days from the date the department received the county's audit.
(i)
The department administration of state assistance funds.
The following procedures are established to assist the department in its administration
of state assistance funds and to assist counties in the management of their
programs.
(1)
After a county reaches the 6.0% GRTL expenditure level,
the county must contact the department by telephone immediately before any
commissioners court meets to authorize program expenditures; the county must
report the amount of expenditures the court will be asked to authorize and
the amount of any other unpaid bills for services.
(2)
After a county reaches the 8.0% expenditure level, the
county must contact the department by telephone to encumber available state
assistance funds to match expenditures that the commissioners court will be
asked to authorize.
(A)
The department provides the county with an approval code
number for the state-assistance-encumbered funds.
(B)
The county must complete the State of Texas purchase voucher
form, enter "For reimbursement from the state assistance fund provided under
the County Indigent Health Care Program (the Health and Safety Code, Chapter
61). The payee agrees to repay any funds paid in error and acknowledges the
state's authority to collect any funds paid in error." and the approval code
number for the encumbered funds on the voucher, and submit the voucher to
the department within 30 days after the commissioner's court authorizes the
expenditures. The county judge must sign and date the purchase voucher and
enter his or her telephone number. If the county does not submit the purchase
voucher within the 30-day period, the encumbered state assistance funds become
unencumbered.
(3)
The department prepares a weekly report on the status of
the state assistance fund after 50% of the fund is expended, and the department
sends the report to counties that reported reaching the 6.0% expenditure level.
(4)
The department cannot ensure that a county will expend
only the amount it is legally obligated to spend on its program unless the
county complies with the requirements contained in this section.
(5)
If a county underclaims state assistance funds for a state
fiscal year, and state assistance funds for that fiscal year are expended,
the department cannot match the underclaimed county expenditures.
This agency hereby certifies that the adoption has been
reviewed by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of
the Secretary of State on February 23, 2001.
TRD-200101124
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 15, 2001
Proposal publication date: December 1, 2000
For further information, please call: (512) 458-7236
25 TAC §14.104
The amendment is adopted under Health and Safety Code Chapter
61 and Human Resources Code Chapters 22 and 32. The department has rule making
authority for the County Indigent Health Care Program under Health and Safety
Code Chapter 61.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on February 23, 2001.
TRD-200101125
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 15, 2001
Proposal publication date: December 1, 2000
For further information, please call: (512) 458-7236
25 TAC §14.203
The amendment is adopted under Health and Safety Code Chapter
61 and Human Resources Code Chapters 22 and 32. The department has rule making
authority for the County Indigent Health Care Program under Health and Safety
Code Chapter 61.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed
with the Office of the Secretary of State on February 23, 2001.
TRD-200101126
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 15, 2001
Proposal publication date: December 1, 2000
For further information, please call: (512) 458-7236
Subchapter I. SANITATION IN PECAN SHELLING PLANTS
25 TAC §§229.131 - 229.134
The Texas Department of Health (department) adopts the repeal
of §§229.131-229.134, concerning sanitation in pecan shelling plants.
The repealed sections are adopted without changes to the proposed repeal as
published in the December 1, 2000 issue of the
Texas
Register
(25 TexReg 11871) and therefore will not be republished.
The repeal of these rules is necessary because the rules contain language
that is obsolete. Also, language in the repeal of §229.134(b) and (c)
was added as an amendment to the Current Good Manufacturing Practice and Good
Warehousing Practice in the Manufacturing, Packing, or Holding Human Food,
Chapter 229, Food and Drug, §229.219 of this title.
Pursuant to the Government Code, §2001.039, each state agency is required
to review and consider for readoption each rule adopted by that agency. The
sections have been reviewed and the department has determined that reasons
for adopting the sections no longer exist.
The department published a Notice of Intention to Review for §§229.131-229.134
as required by Government Code, §2001.039 in the
Texas Register
on April 7, 2000 (25 TexReg 3062). No comments were
received as a result of this publication.
No comments were received on the proposed repeal during the comment period.
The repeals are adopted under Health and Safety Code, §431.241,
which provides the department with the authority to adopt necessary regulations
pursuant to the enforcement of Chapter 431; and §12.001, which provides
the Texas Board of Health (board) with the authority to adopt rules for the
performance of every duty imposed by law on the board, the department, and
the commissioner of health.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on February 23, 2001.
TRD-200101143
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 15, 2001
Proposal publication date: December 1, 2000
For further information, please call: (512) 458-7236
The Texas Department of Health (department) adopts the repeal of existing §§229.301
- 229.304 and new §§229.301 - 229.306, concerning the issuance of
certificates of free sale and sanitation and/or certificates of origin. The
repealed sections and new §§229.301 - 229.306 are adopted without
changes to the proposed text as published in the December 1, 2000 issue of
the
Texas Register
(25 TexReg 11873), and
therefore will not be republished.
New §§229.301 - 229.306 cover the purpose, definitions, minimum
requirements, application for certificate, time frames and fees. Certificates
are issued to manufacturers and distributors for the purpose of importing
products from the United States into other countries. These rules set forth
the process for obtaining a certificate and clarify the products that the
department can certify.
Government Code §2001.039 requires each state agency to review and
consider for readoption each rule adopted by that agency pursuant to the Government
Code, Chapter 2001 (Administrative Procedure Act). Sections 229.301 - 229.304
have been reviewed and the department has determined that reasons for adopting
the sections continue to exist in that rules are needed on this subject; however,
the rules need revision as described in this preamble.
The department published a Notice of Intention to Review these sections
in the December 31, 1999, issue of the
Texas Register
(24 TexReg 12082). No comments were received as a result of the publication
of the notice.
The department received no comments on the proposed repeal and new rules
during the public comment period.
Subchapter R. ISSUANCE OF CERTIFICATES OF FREE SALE AND CERTIFICATES OF ORIGIN
Subchapter B. DETERMINING ELIGIBILITY
Subchapter C. PROVIDING SERVICES
Chapter 229.
FOOD AND DRUG
Chapter 229.
FOOD AND DRUG