Part 1.
OFFICE OF THE GOVERNOR
Chapter 3.
CRIMINAL JUSTICE DIVISION
The Office of the Governor, Criminal Justice Division (CJD), adopts
the amendment of Subchapter A, §3.3 and §3.19; Subchapter B, §§3.51,
3.53, and 3.79; Subchapter C, §§3.103, 3.401, 3.403, 3.405, 3.503,
3.505, 3.511, 3.603, 3.703, 3.719, 3.721, 3.803, 3.1205, 3.1301, 3.1303, and
3.1305; Subchapter E, §§3.2501, 3.2519, and 3.2527; and Subchapter
G, §3.8210, without changes to the proposed text as published in the
December 24, 2004, issue of the
Texas Register
(29
TexReg 11825).
CJD adopts the amendment of Subchapter B, §3.87 with changes to the
proposed text as published in the December 24, 2004, issue of the
Texas Register
(29 TexReg 11825). A comma was added after the word
"agency" in subsection (c) to correct the grammar in this subsection.
CJD adopts the addition of Subchapter C, §3.1311, without changes
to the proposed text as published in the December 24, 2004, issue of the
CJD adopts the repeal of Subchapter C, §§3.1001, 3.1003, and
3.1005, without changes to the proposal as published in the December 24, 2004,
issue of the
Texas Register
(29 TexReg 11825).
The amendment to §3.3: (1) clarifies in paragraph (12) that drug court
fees collected pursuant to §469.004, Texas Health and Safety Code, are
not considered program income because drug courts are authorized by the legislature
to collect such fees; and (2) changes the way the dollar amount is written
in paragraph (13)(B) to ensure the use of uniform language in this chapter.
The amendment to §3.19: (1) corrects the punctuation in subsection
(b); and (2) in subsection (b)(5), clarifies the organizations to whom Office
of Management and Budget (OMB) Circular No. A-110 is applicable.
The amendment to subsections (a) and (c) of §3.51 clarifies that a
community plan must not simply address the community's criminal justice "needs,"
but must address the specific criminal justice "priorities" of the community.
The amendment to §3.53: (1) updates the section to include the current
priorities developed in coordination with the Governor's Juvenile Justice
Advisory Board; and (2) clarifies that projects must address the "priorities"
listed in this section.
Instead of requiring task force personnel to travel to points at least
50 miles from the agency headquarters to be permitted to receive reimbursement
for meals and lodging, the amendment to subsection (a) of §3.79 now requires
task force personnel to travel to points at least 50 miles from their assigned
location. This revision takes in account the fact that many task force personnel
are assigned to locations other than the agency headquarters.
The amendment to §3.87 clarifies that: (1) CJD may require or allow
a grantee receiving grant funds for a multi-jurisdictional drug task force
project under the Byrne Formula Grant Program or grant funds under the State
Criminal Justice Planning (421) Fund to transfer program income to another
grant, grantee, agency, or CJD in accordance with the Uniform Grant Management
Standards (UGMS) and the applicable federal requirements for the Byrne Formula
Grant Program; (2) the listed grantees may request to carry forward program
income from one grant period to the next in accordance with the requirements
of UGMS and the applicable federal requirements for the Byrne Formula Grant
Program; (3) a request to carry forward program income must be submitted to
CJD with the grantee's final financial expenditure report because a request
to carry forward program income necessitates the reporting of the amount of
program income earned by the grantee; (4) the grantee must report program
income in a timely and accurate manner to be eligible to carry over program
income from one grant period to the next to promote accurate and efficient
reporting of program income; (5) program income carried over from one grant
period to the next must be used to further the objective of the grant project
to ensure that the income is used in an effective and appropriate manner.
In addition, the amendment corrects the grammar in this subsection by adding
comma after the word "agency" in subsection (c).
The amendment to paragraph (2) of §3.103 clarifies that only applicants
that are requesting grant funds for a juvenile project or a project serving
delinquent or at-risk youth must meet the requirements of §3.53.
The amendment to subsections (a) and (b) of §3.401 updates the language
of the subsections to reflect the current federal legislation applicable to
the Safe and Drug-Free Schools and Communities Act Fund.
The amendment to §3.403 makes changes to the spelling and grammar
in this section to ensure the use of uniform language in this chapter.
The amendment to §3.405 changes "These grantees" to "Grantees" to
ensure the use of uniform language in this chapter.
The amendment to §3.503 makes changes to the spelling and grammar
in this section to ensure the use of uniform language in this chapter.
The amendment to §3.505 conforms the requirements for eligible applicants
under the Victims of Crime Act Fund to the federal requirements for this funding
source.
The amendment to §3.511: (1) replaces former paragraph (6) with former
paragraph (21) because former paragraph (6) is duplicative of former paragraph
(21); and (2) makes a change to the grammar in paragraph (7) to ensure the
use of uniform language in this chapter.
The amendment to §3.603 makes a change to the spelling in this section
to ensure the use of uniform language in this chapter.
The amendment to paragraphs (3), (5), (9), (18) and (28) of §3.703
makes changes to the grammar in this section to ensure the use of uniform
language in this chapter.
The amendment to §3.719 requires an applicant for a multi-jurisdictional
drug task force project or other drug enforcement project to maintain on file
a signed copy of district attorney agreements instead of requiring the district
attorney agreements to be submitted to CJD with the grant application.
The amendment to §3.721: (1) requires that all projects that are involved
in drug enforcement are required to certify that they conduct drug testing;
and (2) clarifies the language of this section.
The amendment to §3.803: (1) clarifies that projects with a local
impact are eligible under the Local Law Enforcement Block Grant Program pursuant
to the federal requirements for this funding source; and (2) conforms the
language of paragraph (2) to the federal requirements for this funding source.
The amendment to subsection (a) of §3.1205: (1) adds nonprofit corporations
and faith-based organizations to the list of eligible applicants in accordance
with the federal requirements for the Juvenile Accountability Block Grant
Program; and (2) makes a change to the reference within this section to ensure
the use of uniform language in this chapter.
The amendment to subsection (b) of §3.1301 updates the language of
this subsection to reflect the current citation for the Coverdell Forensic
Sciences Program.
The amendment to §3.1303 expands the list of eligible applicants to
include accredited laboratories, as well as unaccredited laboratories that
are in the process of obtaining accreditation, and permits funds to be used
for the salaries and wages of state or local personnel, pursuant to the federal
requirements for the Coverdell Forensic Sciences Program.
The amendment to §3.1305 expands the list of eligible applicants to
include accredited laboratories, as well as unaccredited laboratories that
are in the process of obtaining accreditation, as allowed under the federal
requirements for the Coverdell Forensic Sciences Program.
The amendment to subsection (a)(2) of §3.2501 makes a change to the
grammar and capitalization in this section to ensure the use of uniform language
in this chapter.
The amendment to §3.2519 clarifies that CJD may reduce or terminate
a grant under the circumstances listed in this section. One of the circumstances
under which CJD is permitted to reduce or terminate a grant is when state
or federal funds are no longer available to CJD or are insufficient to fund
a grant project.
The amendment to subsection (c) of §3.2527 makes a change to the grammar
in this section to ensure the use of uniform language in this chapter.
The amendment to §3.8210 updates the language of the section to reflect
the current federal legislation applicable to the Governor's Juvenile Justice
Advisory Board.
The addition of §3.1311 clarifies ineligible activities and costs
under the Coverdell Forensic Sciences Program.
The repeal of §§3.1001, 3.1003 and 3.1005 deletes provisions
applicable to the federal Challenge Grant Program, which is no longer administered
by CJD.
CJD reviewed the rules affecting the CJD grant processes and procedures
with the goal of increasing efficiency and updating the rules to address changes
in the administration process. The review disclosed that a number of the rules
required further clarification and simplification. As a result, CJD adopts
the amendment, addition, and repeal of the sections in the Texas Administrative
Code identified above.
Subchapter A. GENERAL GRANT PROGRAM PROVISIONS
1 TAC §3.3, §3.19
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
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 January 28, 2005.
TRD-200500410
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1.
ELIGIBILITY REQUIREMENTS
1 TAC §3.51, §3.53
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
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 January 28, 2005.
TRD-200500408
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §3.79, §3.87
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
§3.87.Program Income.
(a)
Rules governing the use of program income are included
in the provisions adopted by reference in §3.19 of this chapter.
(b)
Program income may only be used for allowable project costs
as reflected in an approved budget, except as provided in subsection (c) of
this section. Otherwise, grantees must refund program income to CJD.
(c)
CJD may require or allow a grantee receiving grant funds
for a multi-jurisdictional drug task force project under the Byrne Formula
Grant Program or grant funds under the State Criminal Justice Planning (421)
Fund to transfer the CJD portion of program income to another grant, grantee,
agency, or to CJD.
(d)
Grantees may not carry forward program income from one
grant year to the next, except as provided by subsections (e) and (f) of this
section.
(e)
A grantee receiving grant funds for a multi-jurisdictional
drug task force project under the Byrne Formula Grant Program may request
to carry forward program income obtained from forfeiture actions from one
grant period to the next.
(f)
A grantee receiving grant funds under the State Criminal
Justice Planning (421) Fund may request to carry forward program income from
one grant period to the next.
(g)
A request to carry forward program income in accordance
with subsections (e) and (f) of this section must be submitted to CJD with
the grantee's final financial expenditure report. Program income may not be
carried forward without written CJD approval. A grantee must report program
income on its quarterly financial expenditure reports in a timely and accurate
manner to be eligible to carry forward program income in accordance with subsections
(e) and (f) of this section.
(h)
Program income carried forward in accordance with subsections
(e) and (f) of this section must be used to further the objectives of the
grant project.
(i)
As provided in §3.3(12) of this chapter, all funds,
accrued interest, and property awarded to a grantee under a forfeiture action
represent program income.
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 January 28, 2005.
TRD-200500407
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1.
STATE CRIMINAL JUSTICE PLANNING (421) FUND
1 TAC §3.103
The amendment of this rule is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rule implements the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
this rule.
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 January 28, 2005.
TRD-200500406
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §§3.401, 3.403, 3.405
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
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 January 28, 2005.
TRD-200500405
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §§3.503, 3.505, 3.511
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
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 January 28, 2005.
TRD-200500404
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §3.603
The amendment of this rule is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rule implements the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
this rule.
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 January 28, 2005.
TRD-200500403
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §§3.703, 3.719, 3.721
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
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 January 28, 2005.
TRD-200500411
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §3.803
The amendment of this rule is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rule implements the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
this rule.
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 January 28, 2005.
TRD-200500402
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §§3.1001, 3.1003, 3.1005
The repeal of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The repealed rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the repeal of these
rules.
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 January 28, 2005.
TRD-200500401
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §3.1205
The amendment of this rule is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rule implements the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
this rule.
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 January 28, 2005.
TRD-200500400
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §§3.1301, 3.1303, 3.1305, 3.1311
The amendment and addition of these rules are adopted under
the Texas Government Code, Title 7, §772.006(a)(10), which authorizes
CJD to adopt rules and procedures as necessary.
The amended and added rules implement the Texas Government Code, Title
7, §772.006(a), which requires CJD to award and administer state and
federal grant programs, and to assist the Governor in developing policies,
plans, programs, and proposed legislation for improving the coordination,
administration, and effectiveness of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment and
addition of these rules.
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 January 28, 2005.
TRD-200500399
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
1 TAC §§3.2501, 3.2519, 3.2527
The amendment of these rules is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rules implement the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
these rules.
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 January 28, 2005.
TRD-200500398
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
2.
GOVERNOR'S JUVENILE JUSTICE ADVISORY BOARD
1 TAC §3.8210
The amendment of this rule is adopted under the Texas Government
Code, Title 7, §772.006(a)(10), which authorizes CJD to adopt rules and
procedures as necessary.
The amended rule implements the Texas Government Code, Title 7, §772.006(a),
which requires CJD to award and administer state and federal grant programs,
and to assist the Governor in developing policies, plans, programs, and proposed
legislation for improving the coordination, administration, and effectiveness
of the criminal justice system.
No other statutes, articles, or codes are affected by the amendment of
this rule.
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 January 28, 2005.
TRD-200500397
David Zimmerman
Assistant General Counsel
Office of the Governor
Effective date: February 17, 2005
Proposal publication date: December 24, 2004
For further information, please call: (512) 463-1919
Chapter 354.
MEDICAID HEALTH SERVICES
Subchapter A. PURCHASED HEALTH SERVICES
32.
DISEASE MANAGEMENT
1 TAC §§354.1415 - 354.1417
The Texas Health and Human Services Commission (HHSC) adopts
amendments to §354.1415, concerning disease management vendor requirements
and conditions for participation in the Medicaid program, with changes to
the proposed text as published in the December 3, 2004, issue of the
HHSC did not receive any comments regarding the proposed amendments to §354.1415
or to the proposed new §354.1416 and §354.1417 during the comment
period, which included a public hearing on December 16, 2004.
The amendment and new rules are adopted 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 provide HHSC with the authority to administer
the federal medical assistance (Medicaid) program in Texas; and the Texas
Government Code, §531.021(b), which provides HHSC with the authority
to propose and adopt rules governing the determination of Medicaid reimbursements.
§354.1415.Vendor Requirements and Conditions for Participation.
(a)
In addition to the general requirements for contractors
listed in Chapter 391, Purchase of Goods and Services by the 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 nationally recognized evidence-based healthcare practice
guidelines 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;
(10)
Provide access to 24 hour-a-day, seven days-per-week nurse
call center;
(11)
Have the ability to guarantee program savings;
(12)
Ensure compliance with all laws, regulations, and administrative
rules that govern the performance of the disease management services and deliverables
including all state and federal tax laws, employment laws, regulatory requirements,
and licensing provisions;
(13)
Ensure each of its personnel who provides services or
deliverables through the disease management program is properly licensed,
certified, and/or has proper permits to perform the required disease management
activities;
(14)
Ensure data entered, maintained, or generated to meet
disease management program requirements are retained and accessible according
to Federal requirement 42 CFR §431.17 and in accordance with the Health
and Human Services Commission Medicaid Records Retention and Disposition Schedule;
(15)
Maintain an accounting system that provides an audit trail
containing sufficient financial documentation to allow for the reconciliation
of billings, expenses, and financial information with all general ledger accounts
applicable to the contract;
(16)
Maintain and retain financial records and supporting documents
relating to the disease management program for a period of five years, after
the date of the final payment under the contract, or until the resolution
of all litigation, claims, and financial management review or audit pertaining
to the contract, whichever is longer.
(17)
Provide authorized state and federal governments full
access to all information needed to conduct reviews and audits required by
law or by the contract in accordance with applicable auditing standards;
(18)
Ensure contractor's systems and processes, to include
files or data transferred from the contractor's internal system, comply with
the requirements of the Health Insurance Portability Accountability Act of
1996 (Public Law 104-191) ("HIPAA"); and
(19)
Ensure contractor and its subcontractors will comply with
any policy, rule, or reasonable requirement of HHSC that relates to the safeguarding
or disclosure of information relating to Medicaid applicants and recipients,
contractor's operations, or the disease management services.
(b)
The contracted disease management vendor must provide at
a minimum, the following services to eligible clients and participating providers:
(1)
Identify eligible clients and stratify them based on health
severity level and risk for non-adherence to recommended care;
(2)
Provide appropriate interventions that may include, at
a minimum, development, implementation, and evaluation of an individual plan
of care that:
(A)
addresses the client's (multiple) health, behavioral, and
social needs to ensure continuity, quality of care, and effectiveness;
(B)
assures and facilitates appropriate collaboration between
the client's family and/or caregivers, health care providers, and community
case managers; and
(C)
links health care providers with allied health and social
services agencies to facilitate access to necessary services. This includes,
but is not limited to, medically necessary services such as pharmacy, mental
health, equipment and supplies, rehabilitative therapies, and transportation
or interpreter services.
(3)
Intensive outreach to find hard-to-serve clients, including
home visits if the client does not have telephone service available, or cognitive
or physical difficulties that interfere with phone usage. The vendor must
use effective, appropriate, and culturally sensitive methods to accomplish
this service;
(4)
Enroll eligible clients in the disease management program
and track active acceptance, refusal to participate, and disenrollment information;
(5)
Establish a medical home or primary care provider for clients
as needed;
(6)
Identify gaps between recommended prevention and treatment
and actual care provided to clients. Assure that client's medical care follows
nationally recognized evidence-based guidelines for practice. Give providers
feedback on differences between recommended prevention and treatment and actual
care received by clients, and client adherence to their plan of care;
(7)
Assess client's adherence to prescribed medical care and
instructions;
(8)
Prepare initial health assessments and conduct periodic
health status follow-ups based on the risk and health severity level of the
client. In-person visits are required for hard to reach clients;
(9)
Assist client in accessing appropriate primary and preventive
medical care;
(10)
Development and demonstration of educational and care
management techniques by phone and face-to-face personal interaction;
(11)
Development and circulation of client educational materials
which must be:
(A)
written at the 5th grade reading level;
(B)
available for clients who are blind, sight impaired, or
have reading impairments; and
(C)
provided in a language that may be understood by each individual
client.
(12)
Educate eligible clients and/or their caregivers regarding
the client's particular health care condition and needs to:
(A)
Increase the client's understanding of his or her disease
and become more effective in self-care management of their health problems;
(B)
understand the appropriate use of resources needed to care
for his or her problem(s);
(C)
identify negative changes in his or her health condition
and seek appropriate attention before reaching crisis levels; and
(D)
become more compliant with medical recommendations.
(13)
Provide a 24 hour-a-day, seven day-a-week, culturally
sensitive, toll-free nurse consultation service to respond to eligible clients
and/or caregivers' questions;
(14)
Have English and Spanish-speaking nurses, with other languages
available through a translation or interpretation service. Translation and
interpreter services should be available on-line and not require an additional
phone call by the client;
(15)
Provide service referrals for specialty, social and ancillary
services through the use of a nurse consultation telephone line;
(16)
Maintain documentation of disease management services
in a member file and distribute to appropriate providers on a periodic basis;
(17)
Develop collaboration with client and local hospitals
to receive timely notification of hospital admissions of disease management
clients;
(18)
Provide care coordination support, discharge planning
for early discharge and to prevent readmissions, revisions to client's plan
of care as appropriate, and on-site visits when needed;
(19)
Develop a process to respond to client and provider complaints;
(20)
Provide intensive recruitment of providers (including
specialists when warranted by the client's medical condition) to participate
in the disease management program and serve as primary care providers, or
as a medical home for eligible clients as needed;
(21)
Develop and offer provider education regarding specific
evidence-based guidelines selected for use;
(22)
Ensure that there are no barriers to medical provider
input into the development of the eligible client's plan of care;
(23)
Implement a system for providers to request specific disease
management interventions;
(24)
Provide assistance in assuring necessary specialists care;
and
(25)
Provide reports on client's health status changes to their
participating primary care provider.
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 January 31, 2005.
TRD-200500429
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 20, 2005
Proposal publication date: December 3, 2004
For further information, please call: (512) 424-6900
Subchapter J. PURCHASED HEALTH SERVICES
Subchapter B. GENERAL GRANT PROGRAM POLICIES
2.
GRANT BUDGET REQUIREMENTS
Subchapter C. FUND-SPECIFIC GRANT POLICIES
4.
SAFE AND DRUG-FREE SCHOOLS AND COMMUNITIES ACT FUND
5.
VICTIMS OF CRIME ACT FUND
6.
CRIME STOPPERS ASSISTANCE FUND
7.
BYRNE FORMULA GRANT PROGRAM
8.
LOCAL LAW ENFORCEMENT BLOCK GRANT PROGRAM
10.
CHALLENGE GRANT PROGRAM
12.
JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM
13.
COVERDELL FORENSIC SCIENCES PROGRAM
Subchapter E. ADMINISTERING GRANTS
Subchapter G. CRIMINAL JUSTICE DIVISION ADVISORY BOARDS
Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355.
REIMBURSEMENT RATES