Part 5.
TEXAS BUILDING AND PROCUREMENT COMMISSION
Chapter 111.
EXECUTIVE ADMINISTRATION DIVISION
Subchapter B. HISTORICALLY UNDERUTILIZED BUSINESS PROGRAM
1 TAC §111.14
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Building and Procurement Commission or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Building and Procurement Commission proposes
the repeal of 1 TAC, Chapter 111, Subchapter B, §111.14, concerning subcontracting
for Historically Underutilized Business Program (HUB). The section outlines
the steps to be followed in determining whether subcontracting opportunities
are probable under a contract, the good faith required in developing a HUB
subcontracting plan, submission and review during contract performance, and
contract compliance.
The repeal is necessary because this section is being replaced with a new §111.14
approved by the commissioners and published contemporaneously in this issue
of the
Texas Register
. Repealing the rule
allows for a new rule which will function more effectively because it more
correctly reflects the statutes, will meet the objectives of the program,
and addresses concerns raised by interested parties.
Cindy Reed, Deputy Executive Director, has determined for the first five
year period the repeal is in effect, there will be no fiscal implication for
the state or local governments as a result of the repeal of the rule.
Ms. Reed has also determined that for each year of the first five year
period the repeal is in effect, the public benefit anticipated as a result
of repealing the rule will be negligible. There will be no effect on large,
small or micro-businesses. There is no anticipated economic cost to persons
as a result of the repeal and there is no impact on local employment.
Comments on the proposal may be submitted to Cynthia de Roch, General Counsel,
Texas Building and Procurement Commission, P.O. Box 13047, Austin, Texas 78711-3047.
Comments may also be sent via e-mail to travis.langdon@tbpc.state.tx.us. Comments
must be received no later than 15 days from the date of publication of the
proposal in the
Texas Register
.
The repeal of §111.14 is proposed under the authority of
the Texas Government Code, Title 10, Subtitle D, §§152.003, 2161.002,
and 2161.253.
The following statute is affected by the repeal: Texas Government Code,
Chapters 2161.
§111.14.Subcontracts.
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 January 22, 2004.
TRD-200400440
Cynthia de Roch
General Counsel
Texas Building and Procurement Commission
Earliest possible date of adoption: March 7, 2004
For further information, please call: (512) 463-4257
1 TAC §111.14
The Texas Building and Procurement Commission proposes new
rules to Title 1, Texas Administrative Code, Chapter 111, Subchapter B, §111.14
concerning subcontracting for Historically Underutilized Business (HUB). The
new rules will revise the current (HUB) program rules to bring the rules into
alignment with statutory requirements, meet the objectives of the program
without creating costly administrative requirements for the vendors and agencies
which must comply with the rules, and address concerns raised by interested
parties.
Ms. Cindy Reed, Deputy Executive Director, has determined for the first
five year period the new rules are in effect there will be a decrease in the
administrative costs required to respond to state contracting opportunities,
as well as award state contracts when the expected value is $100,000 or more
and the contracting agency has determined that subcontracting opportunities
are probable.
Ms. Reed further determines that for each year of the first five year period
the new rules are in effect, the public benefit anticipated as a result of
enforcing the rules is compliance with the current statutory requirements
of Texas Government Code, Chapter 2161, as they apply to HUB. Respondents
to state contracting opportunities will experience moderate decreases in administrative
costs with regard to responding to state contracting opportunities where the
expected contract value is $100,000.00 or more and the contracting agency
has determined that subcontracting opportunities are probable. There will
be no adverse impact on large, small or micro-businesses. Ms. Reed has also
determined that for each year of the first five year period after the new
rules are in effect, there will be no effect on employment.
Comments on the proposals may be submitted to Cynthia de Roch, General
Counsel, Texas Building and Procurement Commission, P.O. Box 13047, Austin,
TX 78711-3047. Comments may also be sent via email to travis.langdon@tbpc.state.tx.us.
All comments must be received no later than thirty (30) days from the date
of publication of the proposal to the
Texas Register
.
The new rules in §111.14 are proposed under the authority
of the Texas Government Code, Title 10, Subtitle D, §§2152.003,
2161.002, and 2161.253.
The following codes are affected by these rules: Texas Government Code,
Chapters 2161.
§111.14.Subcontracting.
(a)
General Provisions
(1)
In accordance with Texas Government Code, Chapter 2161,
Subchapter F, each state agency that considers entering into a contract with
an expected value of $100,000 or more shall, before the agency solicits bids,
proposals, offers, or other applicable expressions of interest, determine
whether subcontracting opportunities are probable under the contract.
(A)
State agencies shall use the following steps to determine
if subcontracting opportunities are probable under the contract:
(i)
Use the HUB participation goals in §111.13 of this
title (relating to Annual Procurement Utilization Goals); and
(ii)
Research the Centralized Master Bidders List, the HUB
Directory, the Internet, and other directories, identified by the commission,
for HUBs that may be available to perform the contract work.
(B)
In addition determination of subcontracting opportunities
may include, but is not limited to, the following:
(i)
contacting other state and local agencies and institutions
of higher education to obtain information regarding similar contracting and
subcontracting opportunities; and
(ii)
reviewing the history of similar agency purchasing transactions.
(2)
If subcontracting opportunities are probable, each agency's
invitation for bids, requests for proposals or other purchase solicitation
documents for construction, professional services, other services, and commodities
with an expected value of $100,000 or more shall state that probability and
require a HUB subcontracting plan.
(A)
The HUB subcontracting plan shall be submitted at the same
time as the response (bid, proposal, offer, or other applicable expression
of interest), except for construction contracts involving alternative delivery
methods. For construction contracts involving alternative delivery methods,
the HUB subcontracting plan may be submitted up to 24 hours following the
date/time that responses are due provided that responses are not opened until
the HUB subcontracting plan is received.
(B)
Responses that do not include a completed HUB subcontracting
plan in accordance with paragraph (3) of this section, shall be rejected due
to material failure to comply with advertised specifications in accordance
with §113.6 (a) of this title (relating to Bid Evaluation and Award).
(3)
A state agency shall require a respondent to state whether
it is a certified HUB. A state agency shall also require a respondent to state
overall subcontracting and overall certified HUB subcontracting to be provided
in the contract. Respondents shall follow procedures in subsection (a)(3)(A)(i),
(a)(3)(A)(ii), and (a)(3)(A)(iii) of this section when developing the HUB
subcontracting plan.
(A)
The HUB subcontracting plan shall consist of completed
forms prescribed by the Texas Building and Procurement Commission and shall
include the following:
(i)
certification that respondent has made a good faith effort
to meet the requirements of this section,
(ii)
identification of the subcontractors that will be used
during the course of the contract,
(iii)
the expected percentage of work to be subcontracted
(iv)
and the approximate dollar value of that percentage of
work. The plan shall include goals established pursuant to §111.13 of
this title (relating to Annual Procurement Utilization Goals).
(B)
The successful respondent shall provide all additional
documentation required by the agency to demonstrate compliance with good faith
effort requirements prior to contract award. If the successful respondent
is unable to provide supporting documentation (phone logs, fax transmittals,
electronic mail, etc.) within the timeframe specified by the agency to demonstrate
compliance with this subsection prior to contract award, that respondent’s
bid/proposal shall be rejected for material failure to comply with advertised
specifications.
(b)
Construction Contracts
(1)
Evidence of good faith effort in developing a HUB subcontracting
plan for construction contracts, including heavy construction, building construction,
and special trade construction includes, but is not limited to, the following
procedures:
(A)
Divide the contract work into reasonable lots or portions
to the extent consistent with prudent industry practices.
(B)
Provide written justification of the selection process
if a non HUB subcontractor is selected.
(C)
Provide notice to minority or women trade organizations
or development centers to assist in identifying HUBs by disseminating subcontracting
opportunities to their membership/participants. The notice shall, in all instances,
include the scope of work, information regarding location to review plans
and specifications, information about bonding and insurance requirements,
and identify a contact person. Respondent must provide notice to organizations
or development centers no less than five (5) working days for construction
contracts prior to submission of the response (bid, proposal, offer, or other
applicable expression of interest).
(D)
Notify HUBs of the subcontracting opportunities that the
respondent intends to subcontract. The preferable method of notification shall
be in writing. The notice shall, in all instances, include the scope of the
work, information regarding the location to review plans and specifications,
information about bonding and insurance requirements, and identify a contact
person. The notice shall be provided to potential HUB subcontractors prior
to submission of the respondent's response.
(2)
The respondent shall provide potential HUB subcontractors
reasonable time to respond to the respondent's notice. "Reasonable time to
respond" in this context is no less than five (5) working days for construction
contracts, including heavy construction, building construction, and special
trade construction, from receipt of notice, unless circumstances require a
different time period, which is determined by the agency and documented in
the contract file.
(3)
The respondent shall use the commission's Centralized Master
Bidders List, the HUB Directory, Internet resources, and/or other directories
as identified by the commission or agency when searching for HUB subcontractors.
Respondents may rely on the services of minority, women, and community organizations
contractor groups, local, state, and federal business assistance offices,
and other organizations that provide assistance in identifying qualified applicants
for the HUB program who are able to provide all or select elements of the
HUB subcontracting plan.
(4)
The respondent shall provide the notice described in this
section to three or more HUBs per each subcontracting opportunity that provide
the type of work required for each subcontracting opportunity identified in
the contract specifications or any other subcontracting opportunity the respondent
cannot complete with its own equipment, supplies, materials, and/or employees.
If more than three subcontracting opportunities are identified the respondent
shall contact a total minimum of nine (9) HUBs. The respondent must document
the HUBs contacted on the forms prescribed by the Texas Building and Procurement
Commission.
(c)
Professional Services Contracts
(1)
Evidence of good faith effort in developing a HUB subcontracting
plan for professional services contracts is established if the prime contractor
meets the following conditions and procedures:
(A)
A HUB subcontracting plan for a professional services contract
which meets or exceeds HUB participation goals in §111.13 of this title
(relating to Annual Procurement Utilization Goals), constitutes good faith
effort under this section, or
(B)
Develop a HUB Subcontracting Plan under the following procedures:
(i)
Divide the contract work into reasonable lots or portions
to the extent consistent with prudent industry practices.
(ii)
Notify HUBs of the subcontracting opportunities that the
respondent intends to subcontract. The preferable method of notification shall
be in writing. The notice shall, in all instances, include the scope of the
work, required qualifications, and identify a contact person. The notice shall
be provided to potential HUB subcontractors prior to submission of the respondent's
response.
(2)
The respondent shall provide potential HUB subcontractors
reasonable time to respond to the respondent's notice. "Reasonable time to
respond" in this context is no less than five (5) working days from receipt
of notice, unless circumstances require a different time period, which is
determined by the agency and documented in the contract file.
(3)
The respondent shall use the commission's Centralized Master
Bidders List, the HUB Directory, Internet resources, and/ or other directories
as identified by the commission or agency when searching for HUB subcontractors.
Respondents may rely on the services of minority, women, and community organizations,
contractor groups, local, state, and federal business assistance offices,
and other organizations that provide assistance in identifying qualified applicants
for the HUB program who are able to provide all or select elements of the
HUB subcontracting plan.
(4)
The respondent shall provide the notice described in this
section to three or more HUBs per each subcontracting opportunity that provide
the type of work required for each subcontracting opportunity identified in
the contract specifications or any other subcontracting opportunity the respondent
cannot complete with its own equipment, supplies, materials, and/or employees.
If more than three subcontracting opportunities are identified the respondent
shall contact a total minimum of nine (9) HUBs. The respondent must document
the HUBs contacted on the forms provided by the Texas Building and Procurement
Commission.
(A)
Provide written justification of the selection process
if a non HUB subcontractor is selected.
(B)
Provide notice to minority or women trade organizations
or development centers to assist in identifying HUBs by disseminating subcontracting
opportunities to their membership/participants. The notice shall, in all instances,
include the scope of the work, required qualifications, and identify a contact
person. Respondent must provide notice to organizations or development centers
no less than five (5) working days prior to submission of response (bid, proposal,
offer, or other applicable expression of interest).
(d)
Commodities and Other Services Contracts
(1)
Evidence of good faith effort in developing a HUB subcontracting
plan for commodities and other services contracts includes, but is not limited
to, the following procedures:
(A)
Divide the contract work into reasonable lots or portions
to the extent consistent with prudent industry practices.
(B)
Notify HUBs of the subcontracting opportunities that the
respondent intends to subcontract. The preferable method of notification shall
be in writing. The notice shall, in all instances, include the scope of the
work, specifications, and identify a contact person. The notice shall be provided
to potential HUB subcontractors prior to submission of the respondent's response.
(i)
The respondent shall provide potential HUB subcontractors
reasonable time to respond to the respondent's notice. "Reasonable time to
respond" in this context is no less than five working days from receipt of
notice, unless circumstances require a different time period, which is determined
by the agency and documented in the contract file.
(ii)
The respondent shall use the commission's Centralized
Master Bidders List, the HUB Directory, Internet resources, and/or other directories
as identified by the commission or agency when searching for HUB subcontractors.
Respondents rely on the services of minority, women, and community organizations,
contractor groups, local, state, and federal business assistance offices,
and other organizations that provide assistance in identifying qualified applicants
for the HUB program who are able to provide all or select elements of the
HUB subcontracting plan.
(iii)
The respondent shall provide the notice described in
this section to three or more HUBs per each subcontracting opportunity that
provide the type of work required for each subcontracting opportunity identified
in the contract specifications or any other subcontracting opportunity the
respondent cannot complete with its own equipment, supplies, materials, and/or
employees. If more than three subcontracting opportunities are identified
the respondent shall contact a total minimum of nine (9) HUBs. The respondent
must document the HUBs contacted on the forms provided by the Texas Building
and Procurement Commission.
(C)
Provide written justification of the selection process
if a non HUB subcontractor is selected.
(D)
Provide notice to minority or women trade organizations
or development centers to assist in identifying HUBs by disseminating subcontracting
opportunities to their membership/participants. The notice shall, in all instances,
include the scope of the work, specifications, and identify a contact person.
Respondent must provide notice to organizations or development centers no
less than five (5) working days for construction contracts prior to submission
of the response (bid, proposal, offer, or other applicable expression of interest).
(2)
In making a determination if a good faith effort has been
made in the development of the required HUB subcontracting plan, a state agency
may require the respondent to submit supporting documentation explaining how
the respondent has made a good faith effort according to each criterion listed
in subsection (a)(3)(A)(i), (a)(3)(A)(ii), and (a)(3)(A)(iii). The documentation
shall include at least the following:
(A)
how the respondent divided the contract work into reasonable
lots or portions consistent with prudent industry practices;
(B)
how the respondent's notices contain adequate information
about bonding, insurance, the availability of plans, the specifications, scope
of work, required qualifications and other requirements of the contract to
three or more certified HUBs per each identified subcontracting opportunity
or a minimum of nine HUBs for contracts with more than three (3) identified
subcontracting opportunities per contract allowing reasonable time for HUBs
to participate effectively;
(C)
how the respondent negotiated in good faith with qualified
HUBs, not rejecting qualified HUBs who were also the best value responsive
bidder;
(D)
how the respondent provided notice to minority or women
trade organizations or development centers to assist in identifying HUBs by
disseminating subcontracting opportunities to their membership/participants;
(E)
for contracts subject to (c)(1)(A), how the respondent
plans to subcontract with certified HUBs in an effort to meet or exceed HUB
participation goals in §111.13 of this title (relating to Annual Procurement
Utilization Goals) for each identified subcontracting opportunity.
(3)
A respondent's participation in a Mentor Protégé
Program under the Texas Government Code §2161.065, and the submission
of a protégé as a subcontractor in the HUB subcontracting plan
constitutes a good faith effort for the particular area to be subcontracted
with the protégé. When submitted, state agencies may accept
a Mentor Protégé Agreement that has been entered into by the
respondent (mentor) and a certified HUB (protégé). The agency
shall consider the following in determining the respondent's good faith effort:
(A)
if the respondent has entered into a fully executed Mentor
Protégé Agreement that has been registered with the commission
prior to submitting the plan, and
(B)
if the respondent's HUB subcontracting plan identifies
the areas of subcontracting that will be performed by the protégé.
(4)
If the respondent is able to fulfill any of the potential
subcontracting opportunities identified with its own equipment, supplies,
materials and/or employees, respondent must sign an affidavit and provide
a statement explaining how the respondent intends to fulfill each subcontracting
opportunity. The respondent must agree to provide the following if requested
by the agency:
(A)
evidence of existing staffing to meet contract objectives,
(B)
monthly payroll records showing company staff fully engaged
in the contract, and
(C)
on site reviews of company headquarters or work site where
services are to be performed.
(D)
documentation proving employment of qualified personnel
holding the necessary licenses and certificates required to perform the work.
(5)
The HUB subcontracting plan shall be reviewed and evaluated
prior to contract award and, if accepted, shall become a provision of the
agency's contract. Revisions necessary to clarify and enhance information
submitted in the original HUB subcontracting plan may be made in an effort
to determine good faith effort. State agencies shall review the documentation
submitted by the respondent to determine if a good faith effort has been made
in accordance with this section. If the agency determines that a submitted
HUB subcontracting plan was not developed in good faith, the agency shall
treat the lack of good faith as a material failure to comply with advertised
specifications, and the subject response (bid, proposal, offer, or other applicable
expression of interest) shall be rejected. The reasons for rejection shall
be recorded in the procurement file.
(6)
If the respondent is selected and decides to subcontract
any part of the contract after the award, as a provision of the contract,
the contractor/vendor must comply with provisions of this section relating
to developing and submitting a subcontracting plan before any modifications
or performance in the awarded contract involving subcontracting can be authorized
by the state agency. If the selected contractor/vendor subcontracts any of
the work without prior authorization and without complying with this section,
the contractor/vendor would be deemed to have breached the contract and be
subject to any remedial actions provided by Texas Government Code, Chapter
2161, state law and this section. Agencies may report nonperformance relative
to its contracts to the commission in accordance with Chapter 113, Subchapter
F of this title (relating to the Vendor Performance and Debarment Program).
(7)
If at any time during the term of the contract, a contractor/vendor
desires to make changes to the approved subcontracting plan, proposed changes
must be received for prior review and approval by the state agency before
changes will be effective under the contract. The contractor/vendor must comply
with provisions of subsection (a), paragraph 3, relating to developing and
submitting a subcontracting plan for substitution of work or of a subcontractor,
prior to any alternatives being approved under the subcontracting plan. The
state agency shall approve changes by amending the contract or by another
form of written agency approval. The reasons for amendments or other written
approval shall be recorded in the procurement file.
(8)
If a state agency expands the original scope of work through
a change order or contract amendment, including a contract renewal that expands
the scope of work, the state agency shall determine if the additional scope
of work contains additional probable subcontracting opportunities not identified
in the initial solicitation. If the agency determines additional probable
subcontracting opportunities exist, the agency will require the contractor/vendor
to submit a HUB subcontracting plan/revised HUB subcontracting plan for the
additional probable subcontracting opportunities.
(9)
The HUB subcontracting plan/revised HUB subcontracting
plan shall comply with the provisions of this section relating to development
and submission of a subcontracting plan before any modifications or performance
in the awarded contract involving the additional scope of work can be authorized
by the agency. If the contractor/vendor subcontracts any of the additional
subcontracting opportunities identified by the agency without prior authorization
and without complying with this section, the contractor/vendor would be deemed
to have breached the contract and be subject to any remedial actions provided
by Texas Government Code, Chapter 2161, state law and this section. Agencies
may report nonperformance relative to its contracts to the commission in accordance
with Chapter 113, Subchapter F of this title (relating to the Vendor Performance
and Debarment Program.)
(10)
The contractor/vendor shall maintain business records
documenting its compliance with the HUB subcontracting plan and shall submit
a compliance report to the contracting agency monthly and in the format required
by the Texas Building and Procurement Commission. The compliance report submission
shall be required as a condition for payment.
(11)
During the term of the contract, the state agency shall
monitor the HUB subcontracting plan monthly to determine if the value of the
subcontracts to HUBs meets or exceeds the HUB subcontracting provisions specified
in the contract. Accordingly, state agencies shall audit and require a contractor/vendor
to whom a contract has been awarded to report to the agency the identity and
the amount paid to its subcontractors in accordance with §111.16(c) of
this title (relating to State Agency Reporting Requirements). If the contractor/vendor
is meeting or exceeding the provisions, the state agency shall maintain documentation
of the contractor's/vendor's efforts in the contract file. If the contractor/vendor
fails to meet the HUB subcontracting provisions specified in the contract,
the state agency shall notify the contractor of any deficiencies. The state
agency shall give the contractor/vendor an opportunity to submit documentation
and explain to the state agency why the failure to fulfill the HUB subcontracting
plan should not be attributed to a lack of good faith effort by the contractor/vendor.
(12)
To determine if the contractor/vendor made the required
good faith effort, the agency may not consider the success or failure of the
contractor/vendor to subcontract with HUBs in any specific quantity. The agency's
determination is restricted to considering factors indicating good faith effort
including, but not limited to, the following:
(A)
whether the contractor gave timely notice to the subcontractor
regarding the time and place of the subcontracted work;
(B)
whether the contractor facilitated access to the work site,
electrical power, and other necessary utilities; and
(C)
whether documentation or information was provided that
included potential changes in the scope of contract work.
(13)
If a determination is made that the contractor/vendor
failed to implement the HUB subcontracting plan in good faith, the agency,
in addition to any other remedies, may report nonperformance to the commission
in accordance with Chapter 113, Subchapter F of this title (relating to Vendor
Performance and Debarment Program). In addition, if the contractor/vendor
failed to implement the subcontracting plan in good faith, the agency may
revoke the contract for breach of contract and make a claim against the contractor/vendor.
(14)
State agencies shall review their procurement procedures
to ensure compliance with this section. In accordance with §111.26 of
this title (relating to HUB coordinator responsibilities) the agency's HUB
coordinator and contract administrators should facilitate institutional compliance
with this section.
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 January 22, 2004.
TRD-200400443
Cynthia de Roch
General Counsel
Texas Building and Procurement Commission
Proposed date of adoption: March 17, 2004
For further information, please call: (512) 463-4257
Chapter 354.
MEDICAID HEALTH SERVICES
Subchapter A. PURCHASED HEALTH SERVICES
32.
DISEASE MANAGEMENT
1 TAC §354.1415
The Texas Health and Human Services Commission (HHSC) proposes
to amend Chapter 354, Medicaid Health Services by adding a new division to
the existing subchapters. HHSC adds Division 32, Disease Management §354.1415,
concerning Conditions for Participation. Chapter 354 describes the benefits
and provider requirements of the Texas medical assistance (Medicaid) program.
The new division added at §354.1415, Conditions for Participation, outlines
the requirements for entities that wish to contract with HHSC to provide disease
management services to recipients of Medicaid. The proposed section is required
to satisfy the requirements of House Bill 727, 78th Legislature, regular session
(2003), which mandates that HHSC, by rule, shall prescribe the minimum requirements
that a provider of a disease management program must meet to be eligible to
receive a contract.
Tom Suehs, Deputy Commissioner for Financial Services, has determined that
during the first five-year period the proposed rule is in effect there will
be no fiscal impact to state government. The proposed rule will not result
in any fiscal implications for local health and human services agencies. Local
governments will not incur additional costs.
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the new rule as proposed as they will not
be required to alter their business practices as a result of the rule. There
are no anticipated economic costs to persons who are required to comply with
the proposed rule. There is no anticipated negative impact on local employment.
Dena Stoner, Associate Medicaid and CHIP director for Program Innovation,
has determined that for each year of the first five years the section is in
effect, the public will benefit from the adoption of the section. The anticipated
public benefit, as a result of enforcing the section, will be the establishment
of minimum program requirements for providers of disease management services,
and to ensure Medicaid recipients obtain consistent, quality health service
interventions.
HHSC has determined that the proposed rule is not a "major environmental
rule" as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risk to human health from environment exposure and
that may adversely affect, in a material way, the economy, a sector of the
economy, productivity, competition, jobs, the environment or the public health
and safety of a state or a sector of the state. The proposed rule is not specifically
intended to protect the environment or reduce risks to human health from environment
exposure.
HHSC has determined that the proposed rule does not restrict or limit an
owner's right to his or her property that would otherwise exist in the absence
of government action and, therefore, does not constitute a taking under §2007.043
of the Government Code.
Written comments on the proposal may be submitted to Geri Willems, Program
Analyst, at P.O. Box 13247 Mail Code H-100, Austin, Texas 78711-3247, by fax
to 512-424-6665, or by e-mail to geri.willems@hhsc.state.tx.us within 30 days
of publication of this proposal in the
Texas Register
. A public hearing is scheduled for February 17, 2004 from 9:00 a.m.
to 11:00 a.m. (central time) in the Public Hearing Room of the Brown Heatly
State Office Building, 4900 North Lamar, Austin, Texas. Persons requiring
further information, special assistance, or accommodations should contact
Linda Williams at (512) 424-6646.
The new rule is proposed under the Texas Government Code, §531.033,
which provides the Commissioner of HHSC with broad rulemaking authority; the
Human Resources Code, §32.021, and the Texas Government Code, §531.021(a),
which provides the Health and Human Services Commission (HHSC) with the authority
to administer the federal medical assistance (Medicaid) program in Texas.
The proposed rule affects the Human Resources Code, Chapter 32, and the
Texas Government Code, Chapter 531. No other statutes, articles, or codes
are affected by the proposed new rule.
§354.1415.Conditions for Participation.
In addition to the general requirements for contractors listed in Chapter
391, Purchase of Goods and Services by Health and Human Services Agencies
and Chapter 392, Procurements by the Health and Human Services Commission,
disease management companies must meet all of the following program requirements
to be considered for a contract with the state. Entities who wish to contract
with the Health and Human Services Commission (HHSC) to provide disease management
services must meet the following conditions:
(1)
Have an appropriate method for using HHSC healthcare data
to identify targeted disease populations;
(2)
Have an evidence-based healthcare practice guideline with
minimum standards of care and clinical outcomes for each targeted disease;
(3)
Have collaborative healthcare practice models in place
to include HHSC's contracted physicians, support service providers, and existing
community resources;
(4)
Ensure that a recipient's primary care physician (PCP)
and other appropriate specialty physicians, or registered nurses, advance
practice nurses, or physician assistants become directly involved in the disease
management program through which the recipient receives services;
(5)
Have patient self-care management education materials and
methods appropriate to each targeted disease population that demonstrate cultural
competency;
(6)
Have service provider education materials and methods appropriate
to each targeted disease population;
(7)
Have process and outcome measurements, evaluations, and
management systems based on standardized best practice guidelines;
(8)
Have routine reporting processes that are proven to properly
support disease management goals;
(9)
Have demonstrable, measurable, and successful experience
in disease management for the targeted disease populations;
(9)
Provide access to 24 hour-a-day, seven days-per-week nurse
call center;
(10)
Have the ability to guarantee program savings; and
(11)
Meet applicable federal and state laws and regulations
governing the participation of providers in the Medicaid program.
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 January 27, 2004.
TRD-200400515
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: March 7, 2004
For further information, please call: (512) 424-6576
Subchapter G. TELEMEDICINE SERVICES AND OTHER COMMUNITY-BASED SERVICES
Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355.
MEDICAID REIMBURSEMENT RATES