Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354.
MEDICAID HEALTH SERVICES
Subchapter A. PURCHASED HEALTH SERVICES
5.
PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES
1 TAC §354.1066, §354.1067
The Texas Health and Human Services Commission (HHSC) proposes
to add Physician Assistants to Division 5, Physician Services, and new §354.1066,
Conditions of Participation, and §354.1067, Benefits and Limitations,
which specify the requirements for a physician assistant to be a provider
of Medicaid services.
Background and Justification
These new rules are proposed pursuant to Rider 72, S.B. 1, 79th Legislature,
Regular Session, 2005. Rider 72 requires, in part, that physician assistants
be allowed to enroll as independent Medicaid providers and bill under their
own provider numbers.
Section-by-Section Summary
Section 354.1066 sets out all requirements a physician assistant must satisfy
in order to be a participating provider in the Texas Medicaid program. Section
354.1067 lists the requirements for a physician assistant to be reimbursed
under the Texas Medicaid program.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the rules are in effect
there will be no fiscal impact to state government. The proposed rules will
not result in any fiscal implications for local health and human services
agencies. Local governments will not incur additional costs.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the rules as they will not be required
to alter their business practices as a result of the rules. There are no anticipated
economic costs to persons who are required to comply with the proposed rules.
There is no anticipated negative impact on local employment.
Public Benefit
Mr. David Balland, Associate Commissioner for Medicaid and CHIP, has determined
that for each year of the first five years the proposed rules are in effect,
the public will benefit from the adoption of the rules. The anticipated public
benefit of enforcing the proposed rules will be improved access to and quality
of health care services.
Regulatory Analysis
HHSC has determined that this proposal 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 environmental 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. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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.
Public Comment
Written comments on the proposed rules may be submitted to Gilbert Estrada,
Policy Analyst in the Medicaid/CHIP Division, Texas Health and Human Services
Commission, P.O. Box 85200, MC-H600, Austin, Texas 78708-5200, by fax to (512)
491-1953, or by e-mail to gilbert.estrada@hhsc.state.tx.us within 30 days
of publication of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for May 15, 2006 at 1:00 p.m. in the HHSC
Lone Star Conference Room at 11209 Metric Boulevard, Austin, Texas. Persons
requiring further information, special assistance, or accommodations should
contact Meisha Spencer at (512) 491-1453.
Statutory Authority
The new rules are proposed under the Texas Government Code, §531.033,
which provides the Executive 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
program in Texas.
The new rules affect the Human Resources Code, Chapter 32, and the Texas
Government Code, Chapter 531. No other statutes, articles, or codes are affected
by this proposal.
§354.1066.Conditions of Participation.
To be a provider of Medicaid covered services, a physician assistant
must:
(1)
be licensed as a physician assistant by the Texas Physician
Assistant Board as described in the Occupations Code §204.101(2) and
(3);
(2)
comply with all applicable federal and state laws and regulations
governing the service provided;
(3)
be enrolled and approved for participation in the Texas
Medical Assistance Program;
(4)
sign a written provider agreement with the Health and Human
Services Commission (HHSC) or its designee;
(5)
comply with the terms of the provider agreement and all
requirements of the Texas Medical Assistance Program, including federal and
state regulations, rules, manuals, standards, and guidelines published by
HHSC or its designee; and
(6)
bill for services covered by the Texas Medical Assistance
Program in the manner and format prescribed by HHSC or its designee.
§354.1067.Benefits and Limitations.
(a)
Subject to the specifications, conditions, requirements,
and limitations established by HHSC or its designee, services performed by
a licensed physician assistant are considered for reimbursement if the services:
(1)
are within the scope of practice for a physician assistant,
as defined by the licensing board and state law;
(2)
are consistent with rules and regulations promulgated by
the Texas Medical Board; and
(3)
would be covered by the Texas Medical Assistance Program
if provided by a licensed physician (MD or DO).
(b)
Services must be reasonable and medically necessary as
determined by HHSC or its designee to be considered for reimbursement.
(c)
Covered services provided by a physician assistant may
be billed under the physician assistant's Texas Medical Assistance Program
provider number. Licensed physician assistants who are employed or remunerated
by a physician, hospital, facility, or other provider may bill the Texas Medical
Assistance Program directly for their services, using the licensed physician
assistant provider number. If the services are benefits reimbursed through
Medicaid and the physician assistant bills under a licensed physician assistant
provider number, payment will be made to the physician assistant.
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 April 10, 2006.
TRD-200602061
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
1 TAC §354.1251
The Texas Health and Human Services Commission (HHSC) proposes
to amend Division 16, Nurse-Midwife Services, §354.1251, Benefits and
Limitations, which specifies the requirements for a nurse-midwife to be a
provider of Medicaid services.
Background and Justification
Rider 72, S.B. 1, 79th Legislature, Regular Session, 2005, requires, in
part, that HHSC reimburse advanced practice nurses (APNs) for services billed
under the APN's Medicaid provider number. APNs include certified nurse midwives
(CNMs). Reimbursement rules are being amended pursuant to Rider 72, and the
process of amending the reimbursement rules resulted in revisions to Nurse-Midwife
Services, §354.1251, Benefits and Limitations.
Section-by-Section Summary
Section 354.1251 lists all requirements for a nurse-midwife to be a participating
provider in the Texas Medicaid program. In the process of amending the CNM
reimbursement rule, HHSC deleted some program language from the reimbursement
rule. This amendment adds the deleted program language to §354.1251.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the amended 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.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the amendment 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.
Public Benefit
Mr. David Balland, Associate Commissioner for Medicaid and CHIP, has determined
that for each year of the first five years the proposed amendments are in
effect, the public will benefit from the adoption of the rule. The anticipated
public benefit of enforcing the proposed amendments will be improved access
to and quality of health care services.
Regulatory Analysis
HHSC has determined that this proposal 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 environmental 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. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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.
Public Comment
Written comments on the proposed amendments to the rule may be submitted
to Gilbert Estrada, Policy Analyst in the Medicaid/CHIP Division, Texas Health
and Human Services Commission, P.O. Box 85200, MC-H600, Austin, Texas 78708-5200,
by fax to (512) 491-1953, or by e-mail to gilbert.estrada@hhsc.state.tx.us
within 30 days of publication of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for May 15, 2006, at 1:00 p.m. in the HHSC
Lone Star Conference Room at 11209 Metric Boulevard, Austin, Texas. Persons
requiring further information, special assistance, or accommodations should
contact Meisha Spencer at (512) 491-1453.
Statutory Authority
The amendment is proposed under the Texas Government Code, §531.033,
which provides the Executive 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.
The proposed amendment affects the Human Resources Code, Chapter 32, and
the Texas Government Code, Chapter 531. No other statutes, articles, or codes
are affected by this proposal.
§354.1251.Benefits and Limitations.
Subject to the specifications, conditions, requirements, and limitations
established by the
Texas Health and Human Services Commission (HHSC)
[
(1)
Nurse-midwife services must be provided by a certified
nurse-midwife (CNM) who is enrolled and approved for participation in the
Texas Medical Assistance (Medicaid) Program.
(2)
Nurse-midwife services are covered if the services:
(A)
are within the scope of practice for certified nurse midwives,
as defined by state law;
(B)
are consistent with rules and regulations promulgated by
the Board of Nurse Examiners for the State of Texas or other appropriate state
licensing authority; and
(C)
would be covered by the Texas Medical Assistance Program
if provided by a licensed physician (M.D. or D.O.).
(3)
For purposes of coverage and reimbursement by the Medicaid
Program, deliveries by a CNM that are performed in a general or acute care
hospital or special hospital or facility must be done in a hospital or facility
licensed and approved by the appropriate state licensing authority for the
operation of maternity and newborn services and approved by the department
for participation in the Texas Medical Assistance Program. Home deliveries
performed by a CNM are reimbursable when
HHSC
[
(4)
To be directly reimbursed by the Texas Medical Assistance
Program, a CNM who manages the medical aspects of a case under a physician's
control and supervision according to the rules of the State Board of Nurse
Examiners and the Medical Practice Act must perform the services according
to the written protocols required by the State Board of Nurse Examiners and
the services must not be duplicative of other charges to the Medicaid Program.
For services other than nurse-midwife services, other provisions of the state
plan apply.
(5)
The Medicaid Program does not reimburse the CNM for conducting
childbirth education classes.
(6)
HHSC or its designee reimburses
only the CNM actually performing or directing the approved service, unless
federal requirements related to reassignment of claims have been met.
(7)
Certified nurse-midwives who
manage the medical aspects of a case under a physician's control and supervision
according to the rules of the State Board of Nurse Examiners and the Medical
Practice Act are reimbursed by the Medicaid Program for those services only
if they are performed according to the written protocols required by the State
Board of Nurse Examiners and are not duplicative of other charges to the Medicaid
Program.
(8)
Reimbursement for services
that are other than nurse-midwife services are governed by the applicable
provisions of the Medicaid Program, as specified by HHSC.
(9)
A nurse-midwife is not reimbursed
directly by the Medicaid Program for services provided if employed, salaried,
or reimbursed by a hospital, nursing facility, other institution, or facility
where the nurse-midwife's remuneration for services is included in the reimbursement
formula or vendor payment to the hospital, facility, institution, or other
provider.
(10)
Certified nurse-midwives who
are employed by or remunerated by a physician, health maintenance organization
(HMO), hospital, or other facility may not bill the Medicaid Program directly
for nurse-midwife services if that billing would result in duplicate payment
for the same services. If the services are covered and reimbursable by the
Medicaid Program, payment may be made to the physician, hospital, or other
provider, if approved for participation in the Medicaid Program who employs
or reimburses the nurse-midwife. The basis and amount of Medicaid reimbursement
depends on the nurse-midwife services actually provided, who provided the
services, and the reimbursement methodology utilized by the Medicaid Program
as appropriate for the services and provider(s) involved.
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 April 10, 2006.
TRD-200602062
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
1 TAC §354.1301
The Texas Health and Human Services Commission (HHSC) proposes
to amend Division 21, Certified Registered Nurse Anesthetists' Services, §354.1301,
Benefits and Limitations, which specifies the requirements for a certified
registered nurse anesthetist to be a provider of Medicaid services.
Background and Justification
Rider 72, S.B. 1, 79th Legislature, Regular Session, 2005, requires, in
part, that HHSC reimburse advanced practice nurses (APNs) for services billed
under the APN's Medicaid provider number. APNs include certified registered
nurse anesthetists (CRNAs). Reimbursement rules are being amended pursuant
to Rider 72, and the process of amending the reimbursement rules results in
revisions to Certified Registered Nurse Anesthetists' Services, §354.1301,
Benefits and Limitations.
Section-by-Section Summary
Section 354.1301 lists all the requirements for a certified registered
nurse anesthetist to be a participating provider in the Texas Medicaid program.
In the process of amending the CRNA reimbursement rule, HHSC deleted program
language from the reimbursement rule. This amendment adds some of the deleted
reimbursement language to §354.1301.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the amended 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.
Small and Micro-business Impact Analysis
Mr. Suehs has also determined that there will be no effect on small businesses
or micro businesses to comply with the amendment 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.
Public Benefit
Mr. David Balland, Associate Commissioner for Medicaid and CHIP, has determined
that for each year of the first five years the proposed amendments are in
effect, the public will benefit from the adoption of the rule. The anticipated
public benefit of enforcing the proposed amendments will be improved access
to and quality of health care services.
Regulatory Analysis
HHSC has determined that this proposal 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 environmental 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. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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.
Public Comment
Written comments on the proposed amendments to the rule may be submitted
to Gilbert Estrada, Policy Analyst in the Medicaid/CHIP Division, Texas Health
and Human Services Commission, P.O. Box 85200, MC-H600, Austin, Texas 78708-5200,
by fax to (512) 491-1953, or by e-mail to gilbert.estrada@hhsc.state.tx.us
within 30 days of publication of this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for May 15, 2006, at 1:00 p.m. in the HHSC
Lone Star Conference Room at 11209 Metric Boulevard, Austin, Texas. Persons
requiring further information, special assistance, or accommodations should
contact Meisha Spencer at (512) 491-1453
Statutory Authority
The amendment is proposed under the Texas Government Code, §531.033,
which provides the Executive 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.
The proposed amendment affects the Human Resources Code, Chapter 32, and
the Texas Government Code, Chapter 531. No other statutes, articles, or codes
are affected by this proposal.
§354.1301.Benefits and Limitations.
(a)
Effective for services provided on or after September 1,
1991, and subject to the specifications, conditions, requirements, and limitations
specified in this section and established by the
Texas Health and Human
Services Commission (HHSC)
[
(b)
To be payable, the services must be:
(1)
within the CRNA's scope of practice, as defined by state
law;
(2)
reasonable and medically necessary as determined by
HHSC
[
(3)
prescribed and supervised by a physician (MD or DO), dentist,
or podiatrist, to the extent allowed by state law, who must be licensed in
the state in which he or she practices; and
(4)
provided under one of the following conditions:
(A)
no physician anesthesiologist is on the medical staff of
the facility where the services are provided;
(B)
as determined in accordance with the policies of the facility
in which the services are provided, no physician anesthesiologist is available
to provide the services;
(C)
the physician, dentist, or podiatrist performing the procedure
requiring the services specifically requests the services of a CRNA;
(D)
the eligible recipient requiring the services specifically
requests the services of a CRNA;
(E)
the CRNA is scheduled or assigned to provide the services
in accordance with policies of the facility in which the services are provided;
or
(F)
the services are provided by the CRNA in connection with
a medical emergency.
(c)
The Texas Medical Assistance Program will not reimburse
the CRNA for equipment or supplies. Equipment and supplies are the responsibility
of the facility in which the CRNA services are provided. If the equipment
and supplies are covered and reimbursable by the Texas Medical Assistance
Program, payment may be made to the facility if the facility is approved for
participation in the Texas Medical Assistance Program. The basis and amount
of reimbursement depends on the reimbursement methodology utilized by the
Texas Medical Assistance Program for the services and providers involved.
(d)
The scope of this section is limited to reimbursement policy
for anesthesia services under the Texas Medical Assistance Program. Nothing
contained in this section shall be construed to modify, supersede, or otherwise
affect any other existing federal or state law or regulation or institutional
practice regarding the administration of anesthesia.
(e)
Reimbursement for covered CRNA
services may be made to the CRNA actually performing the services or, provided
that federal requirements related to reassignment of claims are met, to a
hospital, physician, dentist, podiatrist, group practice, or ambulatory surgical
center with which the CRNA has an employment or contractual relationship.
(f)
Physician reimbursement for
supervision of CRNAs is governed by the Health and Human Services Commission's
policies regarding physician services.
(g)
HHSC or its designee reimburses
Texas Medical Assistance Program allowable CRNA services only when the services
are submitted for payment under a CRNA provider number.
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 April 10, 2006.
TRD-200602063
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
1 TAC §354.1430, §354.1432
The Texas Health and Human Services Commission (HHSC) proposes
to amend §354.1430, Definitions, and §354.1432, Benefits and Limitations,
which relate to Texas Medicaid telemedicine services.
Background and Justification
The proposed amendments to the telemedicine services rules are to satisfy
the requirements of Senate Bill 1340, 79th Legislature, Regular Session, 2005,
which requires HHSC to develop by rule a pilot program under which Medicaid
recipients in need of mental health services are provided those services through
telemedicine. The Department of State Health Services (DSHS) is responsible
for implementing the program. The pilot will be evaluated by the state to
determine whether extension of the use of telemedicine improves the access
of mental health services.
Section-by-Section Summary
Section 354.1430 defines Texas Medicaid telemedicine terms. HHSC proposes
to add the following additional provider types contracted with or employed
by a local mental health authority as allowable remote site providers: psychologists,
licensed professional counselors (LPCs), licensed clinical social workers
(LCSWs), licensed marriage and family therapists (LMFTs), and qualified mental
health professionals. HHSC also proposes to add physician assistants (PAs)
as allowable remote site providers.
Section 354.1432 outlines the benefits and limitations of Texas Medicaid
telemedicine services. The amendment adds local mental health authority clinics
and outreach sites as allowable places of service for telemedicine services.
Fiscal Note
Thomas Suehs, Deputy Commissioner for Financial Services, has determined
that during the first 5-year period the amended rules are 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.
Small and Micro-business Impact Analysis
Mr. Suehs, has also determined that there will be no effect on small businesses
or micro businesses to comply with the amendments 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.
Public Benefit
Mr. David J. Balland, Associate Commissioner for Medicaid and CHIP, has
determined that for each year of the first five years the proposal is in effect,
the public will benefit from adoption of the amendments. The anticipated public
benefit, as a result of enforcing the amendments, will be the accessibility
of mental health services through telemedicine to the Medicaid population.
Regulatory Analysis
HHSC has determined that this proposal 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. This proposal is not specifically
intended to protect the environment or reduce risks to human health from environment
exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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.
Public Comment
Written comments on the proposal may be submitted to Arnulfo Gomez, at
11209 Metric Blvd., Austin, Texas, 78758, by fax to (512) 491-1953, or by
e-mail to arnulfo.gomez@hhsc.state.tx.us within 30 days of publication of
this proposal in the
Texas Register
.
Public Hearing
A public hearing is scheduled for April 16, 2006, from 1:30 p.m. to 3:00
p.m. (Central Time) in the public hearing room of the Health and Human Services
Commission, 11209 Metric Blvd, Austin, Texas. Persons requiring further information,
special assistance, or accommodations should contact Meisha Spencer at (512)
491-1453.
Statutory Authority (Medicaid)
The amendments are proposed under the Texas Government Code, §531.033,
which provides the Executive 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.
The amendments affect the Human Resources Code, Chapter 32, and the Texas
Government Code, Chapter 531. No other statutes, articles, or codes are affected
by this proposal.
§354.1430.Definitions.
Definitions. The following words and terms, when used in this chapter,
have the following meanings.
(1)
Hub Site--A hub site is the location where the consulting
physician is physically located.
(2)
Hub Site Provider--A hub site provider must be a:
(A)
Physician at a rural health facility or an accredited medical
or osteopathic school located in Texas, or a physician at one of the following
entities affiliated through a written contract or agreement with a government
agency, accredited medical, or osteopathic school located in Texas:
(B)
Hospital;
(C)
Teaching hospital;
(D)
Tertiary center; or
(E)
Health clinic.
(3)
Remote Site--A remote site is where the Medicaid client
is physically located.
(4)
Remote Site Provider--A remote site provider is located
in rural or medically underserved areas and is limited to the following provider
types:
(A)
Physician;
(B)
Advanced practice nurse (APN);
(C)
Certified nurse midwife (CNM);
(D)
Hospital;
(E)
Federally qualified health center (FQHC); [
(F)
Rural health clinic (RHC)
;
[
(G)
Physician assistant (PA); or
(H)
one of the following qualified
professionals contracted with or employed by a local mental health authority:
(i)
Licensed psychologist;
(ii)
Licensed professional counselor (LPC);
(iii)
Licensed clinical social worker (LCSW);
(iv)
Licensed marriage and family therapist (LMFT);
or
(v)
Qualified mental health professional (QMHP)
as defined in 25 TAC §412.303(31).
(5)
Rural area--A rural area is defined as a county with a
population of 50,000 or less or a county that was not designated as a metropolitan
area by the United States Bureau of the Census according to the most current
federal census and does not have within the boundaries of the county a hospital,
licensed under chapter 241, Health and Safety Code, with more than 100 beds.
(6)
Rural Health Facility--A rural health facility is located
in a rural county and is affiliated with an accredited medical school, teaching
hospital, or government agency through a written contract or agreement.
(7)
Telemedicine--Telemedicine is a method of health care service
delivery used to facilitate medical consultations by a physician to health
care providers in rural or underserved areas for purposes of patient diagnosis
or treatment that requires advanced telecommunications technologies.
(8)
Telepathology--Telepathology is the practice of pathology
(consultation, education and research) using telecommunications to transmit
data and images between two or more sites remotely located from each other.
(9)
Teleradiology--Teleradiology is a means of electronically
transmitting radiographic patient images and consultative text from one location
to another.
(10)
Underserved--An underserved area that meets the definition
of Medically Underserved Area (MUA) or Medically Underserved Population (MUP)
by the U.S. Department of Health and Human Services.
§354.1432.Benefits and Limitations.
(a)
Telemedicine services are a health care benefit of the
Texas Medicaid Program. Telemedicine services are described below.
(1)
Telemedicine services are direct "face-to-face" interactive
video communications with the client. Teleradiology and telepathology are
exceptions to the direct face-to-face requirement.
(2)
Telemedicine hub site providers may be reimbursed only
for consultation or interpretation using interactive video as defined by Medicaid
telemedicine medical policy and as currently reimbursed under the Texas Medicaid
Program.
(3)
Telemedicine remote sites may be reimbursed for services
when any one of the following places of service are utilized and billed:
(A)
Practitioner's office;
(B)
Rural Health Clinic;
(C)
Federally Qualified Health Clinic;
(D)
Inpatient hospital;
(E)
Outpatient hospital;
(F)
Emergency room;
(G)
ICF-MR facility;
or
(H)
a local mental health authority
clinic as defined in Health and Safety Code §533.035 or outreach site
associated with a local mental health authority.
(4)
Telephone conversations, chart reviews, electronic mail
messages and facsimile transmissions do not constitute a telemedicine interactive
video consultation, and will not be reimbursed as telemedicine service.
(5)
Texas Health Steps (THSteps), also known as Early and Periodic
Screening, Diagnosis and Treatment, preventive health visits are not reimbursed
if performed via telemedicine. Health care or treatment provided for conditions
identified during these preventive health visits may be reimbursed if the
health care is provided via telemedicine.
(6)
Nursing facilities, skilled nursing facilities, and client
homes are not approved places of service as remote sites for telemedicine
services.
(b)
Reimbursement for Services Performed Using Telemedicine.
(1)
Providers seeking reimbursement for telemedicine services
must provide and bill for the service in the manner prescribed by the Texas
Medicaid Program.
(2)
Telemedicine services are reimbursed in accordance with
the existing Medicaid reimbursement methodology as defined in §355.7001,
Telemedicine Services Reimbursement.
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 April 5, 2006.
TRD-200602010
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
Subchapter G. TELEMEDICINE SERVICES AND OTHER COMMUNITY-BASED SERVICES
1 TAC §355.7001
The Health and Human Services Commission (HHSC) proposes
an amendment to §355.7001, concerning the reimbursement methodology for
telemedicine services in Chapter 355, Reimbursement Rates.
Background and Purpose
The purpose of the amendment is to revise the reimbursement methodology
for telemedicine services to add provider types delivering mental health services
through telemedicine under the pilot program required by Senate Bill (S.B.)
1340 of the 79th Legislature, Regular Session, 2005. S.B. 1340 requires that
the Health and Human Services Commission (HHSC) establish, by rule, a pilot
program under which Medicaid recipients in need of mental health services
are provided those services through telemedicine. The bill also directs the
Department of State Health Services (DSHS) to implement the pilot program.
The pilot is to enable the state to determine whether extension of the use
of telemedicine would improve the delivery of mental health services in a
cost-effective manner. By December 1, 2006, HHSC is to submit a report to
the Legislature regarding the results of the pilot program.
Section-by-Section Summary
No change is being proposed to the first paragraph. The addition of the
reimbursement methodology rule reference for physician assistants is proposed
to be added as new paragraph (2), with previous paragraphs (2) - (6) renumbered
as paragraphs (3) - (7).
Renumbered paragraph (5) is amended to include by reference the reimbursement
methodology for inpatient hospital services at 1 TAC §355.8063, relating
to Reimbursement Methodology for Inpatient Hospital Services.
Paragraph (8) is added to include the telemedicine reimbursement methodology
for the following provider types employed by or contracted with local mental
health authorities: psychologists, licensed professional counselors, licensed
clinical social workers, and licensed marriage and family therapists.
Fiscal Note
Tom Suehs, Deputy Executive Commissioner for Financial Services, has determined
that during the first five-year period the amended rule is in effect there
will be no fiscal impact to state government for the period of state fiscal
year 2006 through state fiscal year 2010. The proposed rule will not result
in any fiscal implications for local health and human services agencies. Local
governments will incur no additional costs.
Small Business and Micro-business Impact Analysis
HHSC has determined that there is no adverse economic effect on small businesses
or micro-businesses, or on businesses of any size, as a result of enforcing
or administering the amendment, because the fees for healthcare professionals
delivering services via telemedicine are the same as the fees for those same
healthcare professionals delivering the services in person.
Public Benefit
Ed White, Director of Rate Analysis, has determined that, for each year
of the first five years the amendment is in effect, the public benefit expected
as a result of enforcing the amendment is that HHSC will be in compliance
with the requirements of S.B. 1340 of the 79th Legislature, Regular Session,
2005. HHSC does not anticipate that there will be any economic cost to persons
who are required to comply with this amendment. The amendment will not affect
a local economy.
Regulatory Analysis
HHSC has determined that this proposal 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. This proposal is not specifically
intended to protect the environment or reduce risks to human health from environment
exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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 Texas
Government Code, §2007.043.
Public Comment
Questions about the content of this proposal may be directed to Nancy Kimble
(telephone: (512) 491-1363; FAX: (512) 491-1983) in HHSC Rate Analysis for
Acute Care and Cost Reporting Services. Written comments on the proposal may
be submitted to Ms. Kimble via facsimile, E-mail to nancy.kimble@hhsc.state.tx.us,
or mail to HHSC Rate Analysis for Acute Care and Cost Reporting Services,
Mail Code H-400, P.O. Box 85200, Austin, TX 78708-5200, within 30 days of
publication in the
Texas Register
.
To comply with federal regulations, a copy of the proposal is being sent
to each Department of Aging and Disability Services office, where it will
be available for public review upon request.
Statutory Authority
The amendment is proposed under the Texas Government Code, §531.033,
which authorizes the Executive 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.
The proposed rule affects the Human Resources Code, Chapter 32, and the
Texas Government Code, Chapters 531 and 533. No other statutes, articles,
or codes are affected by this proposal.
§355.7001.Telemedicine Services Reimbursement.
Telemedicine services are reimbursed in accordance with the existing
Medicaid reimbursement methodology for the applicable provider type as follows:
(1)
physicians, 1 TAC §355.8085;
(2)
physician assistants, 1 TAC §355.8091;
(3)
[
(4)
[
(5)
[
(6)
[
(7)
[
(8)
the following qualified professionals
contracted with or employed by a local mental health authority:
(A)
psychologists, 1 TAC §355.8081 and 1 TAC §355.8085;
and
(B)
licensed professional counselors (LPCs), licensed
clinical social workers (LCSWs), and licensed marriage and family therapists
(LMFTs), 1 TAC §355.8091.
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 April 10, 2006.
TRD-200602056
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
5.
GENERAL ADMINISTRATION
1 TAC §355.8093
The Texas Health and Human Services Commission (HHSC) proposes
to amend Division 5, General Administration, by adding new §355.8093,
Physician Assistants.
Background and Justification
This new rule is proposed pursuant to Rider 72, S.B. 1, 79th Legislature,
Regular Session, 2005. Rider 72 requires, in part, that physician assistants
be allowed to enroll as independent Medicaid providers and bill under their
own provider numbers. The rule sets out the methodology by which services
provided and billed by a PA will be reimbursed.
Section-by-Section Summary
Section 355.8093 provides that covered professional services provided and
billed by a PA are reimbursed on the basis of the lesser of the PA's billed
charges or 92 percent of the reimbursement for the same service paid to a
physician. It also provides that PAs are reimbursed at the same reimbursement
level as physicians for laboratory services, x-ray services and injections.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the amended rule is
in effect there will be no fiscal impact to the state government for each
year of the period SFY07 - SFY11. The proposed rule will not result in any
fiscal implications for local health and human services agencies. Local governments
will incur no additional costs.
Small and Micro-Business Impact Analysis
HHSC has determined that there would be no adverse economic effect on small
businesses or micro-businesses, or on businesses of any size, as a result
of enforcing or administering the amendments. Physician practices that are
currently reimbursed under the physician's Medicaid provider number for services
provided by PAs at 100 percent of the allowable physician rate would continue
to be reimbursed at the same rate. Physician assistants would now be able
to enroll as Medicaid providers and receive direct reimbursement for their
services.
Public Benefit
Ed White, Director of Rate Analysis, has determined that, for each year
of the first five years the amendments are in effect, the public benefit expected
as a result of enforcing the amendments is that PAs would be able to enroll
as Medicaid providers and be reimbursed for services, potentially resulting
in increased access to services. The amendments will not affect a local economy.
Regulatory Analysis
HHSC has determined that this proposal 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 environmental 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. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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 Texas
Government Code, §2007.043.
Public Comment
Questions about the content of this proposal may be directed to Nancy Kimble
(telephone: (512) 491-1363; FAX: (512) 491-1983) in HHSC Rate Analysis for
Acute Care and Cost Reporting Services. Written comments on the proposal may
be submitted to Ms. Kimble via facsimile, E-mail to nancy.kimble@hhsc.state.tx.us,
or mail to HHSC Rate Analysis for Acute Care and Cost Reporting Services,
Mail Code H-400, P.O. Box 85200, Austin, TX 78708-5200, within 30 days of
publication in the
Texas Register
.
To comply with federal regulations, a copy of the proposal is being sent
to each Department of Aging and Disability Services office, where it will
be available for public review upon request.
Statutory Authority
The new rule is proposed under the Texas Government Code, §531.033,
which confers on the Executive Commissioner of HHSC 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.
The proposed rule affects the Human Resources Code, Chapter 32, and the
Texas Government Code, Chapters 531 and 533. No other statutes, articles,
or codes are affected by this proposal.
§355.8093.Physician Assistants.
Covered professional services provided by a physician assistant (PA)
and billed under the PA's own provider number are reimbursed the lesser of
the PA's billed charges or 92% of the reimbursement for the same professional
service paid to a physician (M.D. or D.O.). Physician assistants are reimbursed
at the same reimbursement level as physicians for laboratory services, x-ray
services and injections.
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 April 10, 2006.
TRD-200602057
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
The Texas Health and Human Services Commission (HHSC) proposes amendments
to the following reimbursement methodology rules: Division 9, Certified Nurse
Midwives, §355.8161; Division 12, Certified Registered Nurse Anesthetists, §355.8221;
and Division 15, Nurse Practitioners and Clinical Nurse Specialists, §355.8281.
Background and Justification
These rule amendments are proposed pursuant to Rider 72, S.B. 1, 79th Legislature,
Regular Session, 2005. Rider 72 requires, in part, that HHSC reimburse advanced
practice nurses (APNs) for services billed under the APN's Medicaid provider
number. According to the Texas Board of Nurse Examiners, the correct titles
for APNs are nurse practitioners (NPs), clinical nurse specialists (CNSs),
certified registered nurse anesthetists (CRNAs), and certified nurse midwives
(CNMs). The amendments revise the methodology by which these providers will
be reimbursed.
Section-by-Section Summary
Proposed revisions to §355.8161, concerning certified nurse midwives
(CNMs), increase the reimbursement percentage for covered professional services
from 85 to 92 percent of the reimbursement for the same professional service
paid to a physician (M.D. or D.O.). Certified nurse midwives will be reimbursed
for other billing codes at the same reimbursement level as physicians. The
proposed amendments remove program policy language that is not appropriate
for reimbursement methodology rules, change the title of Division 9 from "Nurse-Midwife
Services" to "Certified Nurse Midwives," and change the title of the rule
from "Reimbursement" to "Reimbursement Methodology."
Proposed revisions to §355.8221, concerning Certified Registered Nurse
Anesthetists (CRNAs), increase the reimbursement percentage for covered anesthesia
services from 85 to 92 percent of the reimbursement for the same anesthesia
service paid to a physician (M.D. or D.O.). The proposed amendments remove
program policy language that is not appropriate for reimbursement methodology
rules, change the title of Division 12 from "Certified Registered Nurse Anesthetists'
Services" to "Certified Registered Nurse Anesthetists," and change the title
of the rule from "Reimbursement" to "Reimbursement Methodology."
Proposed revisions to §355.8281, concerning Nurse Practitioners and
Clinical Nurse Specialists (NPs and CNSs) increase the reimbursement percentage
for covered professional services from 85 to 92 percent of the reimbursement
for the same professional services paid to a physician (M.D. or D.O.). Nurse
practitioners and clinical nurse specialists will be reimbursed for other
billing codes at the same reimbursement level as physicians. The proposed
amendments change the title of Division 15 from "Certified Family Nurse Practitioner
and Pediatric Nurse Practitioner" to "Nurse Practitioners and Clinical Nurse
Specialists, "as well as changing the title of the rule from "Reimbursement"
to "Reimbursement Methodology."
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Financial Services,
has determined that during the first five-year period the amended rule is
in effect that there will be a fiscal impact to the state government of estimated
increased costs of about $877,109 for SFY07, and about $876,885 for each year
of the period SFY08 - SFY11. The proposed rules will not result in any fiscal
implications for local health and human services agencies. Local governments
will incur no additional costs.
Small and Micro-Business Impact Analysis
HHSC has determined that there would be no adverse economic effect on small
businesses or micro-businesses, or on businesses of any size, as a result
of enforcing or administering the amendments. Physician practices that are
currently reimbursed under the physician's Medicaid provider number for services
provided by NPs, CNSs, CNMs, and CRNAs at 100 percent of the allowable physician
rate would continue to be reimbursed at the same rate. NPs, CNSs, CNMs and
CRNAs would continue to be able to enroll as Medicaid providers and receive
direct reimbursement for their services.
Public Benefit
Ed White, Director of Rate Analysis, has determined that, for each year
of the first five years the amendments are in effect, the public benefit expected
as a result of enforcing the amendments is that NPs, CNSs, CNMs, and CRNAs
will receive higher reimbursement and the number of Medicaid providers could
increase, resulting in increased access to services. The amendments will not
affect a local economy.
Regulatory Analysis
HHSC has determined that this proposal 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 environmental 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. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal 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 Texas
Government Code, §2007.043.
Public Comment
Questions about the content of this proposal may be directed to Nancy Kimble
(telephone: (512) 491-1363; FAX: (512) 491-1983) in HHSC Rate Analysis for
Acute Care and Cost Reporting Services. Written comments on the proposal may
be submitted to Ms. Kimble via facsimile, E-mail to nancy.kimble@hhsc.state.tx.us,
or mail to HHSC Rate Analysis for Acute Care and Cost Reporting Services,
Mail Code H-400, P.O. Box 85200, Austin, TX 78708-5200, within 30 days of
publication in the
Texas Register
.
To comply with federal regulations, a copy of the proposal is being sent
to each Department of Aging and Disability Services office, where it will
be available for public review upon request.
9.
CERTIFIED NURSE MIDWIVES
1 TAC §355.8161
Statutory Authority
The amendment is proposed under the Texas Government Code, §531.033,
which confers on the Executive Commissioner of HHSC 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.
The proposed rule affects the Human Resources Code, Chapter 32, and the
Texas Government Code, Chapters 531 and 533. No other statutes, articles,
or codes are affected by this proposal.
§355.8161.Reimbursement Methodology .
[
[
[
[
[
[
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 April 10, 2006.
TRD-200602058
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
1 TAC §355.8221
Statutory Authority
The amendment is proposed under the Texas Government Code, §531.033,
which confers on the Executive Commissioner of HHSC 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.
The proposed rule affects the Human Resources Code, Chapter 32, and the
Texas Government Code, Chapters 531 and 533. No other statutes, articles,
or codes are affected by this proposal.
§355.8221.Reimbursement Methodology .
[
[
[
[
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 April 10, 2006.
TRD-200602059
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 21, 2006
For further information, please call: (512) 424-6900
16.
NURSE-MIDWIFE SERVICES
department
] or its designee and according to state and
federal laws, rules, and regulations, and in the case of services furnished
in an institution, hospital or other facility to the extent permitted by the
institution, hospital, or facility, nurse-midwife services are limited as
follows.
the department
] or its designee has prior authorized the home delivery. The CNM must
submit a written request for prior authorization during the recipient's third
trimester of pregnancy. The CNM must include a statement signed by a licensed
physician who has examined the recipient during the third trimester and determined
that at that time she is not at high risk and is suitable for a home delivery.
21.
CERTIFIED REGISTERED NURSE ANESTHETISTS' SERVICES
department
] or its designee,
anesthesia services provided by a certified registered nurse anesthetist (CRNA)
are covered by the Texas Medical Assistance Program.
the department
] or its designee;
33.
TELEMEDICINE SERVICES
or
]
.
]
Chapter 355.
REIMBURSEMENT RATES
(2)
]
nurse practitioners (NPs)
and clinical nurse specialists (CNSs)
[
advanced practice nurses
(APNs)
] , 1 TAC §355.8281;
(3)
] certified nurse midwives (CNMs),
1 TAC §355.8161;
(4)
] hospitals, 1 TAC §355.8061
and 1 TAC §355.8063
;
(5)
] federally qualified health
centers (FQHCs), 1 TAC §355.8261; [
and
]
(6)
] rural health clinics (RHCs),
1 TAC §355.8101
;
[
.
]
Subchapter J. PURCHASED HEALTH SERVICES
Subchapter J. PURCHASED HEALTH SERVICES
(a)
]
Effective for services delivered on and
after March 1, 2006, covered professional
[
Subject to specifications,
conditions, and limitations established by the department, payment for covered
nurse-midwife
] services provided by a [
participating
] certified
nurse[
-
] midwife (CNM)
and billed under the CNM's own provider
number are reimbursed the lesser
[
will be limited to the lower
] of the
CNM's billed charges or 92% of the reimbursement for the
same professional service paid to a physician (M.D. or D.O.). CNMs are reimbursed
at the same reimbursement level as physicians for laboratory services, x-ray
services, and injections.
[
customary charge or the maximum allowable
fee(s), rate(s), or reimbursement schedule, if any, as established by the
department or its designee.
]
(b)
The department or its designee
reimburses only the CNM actually performing or directing the covered service,
unless federal requirements related to reassignment of claims have been met.]
(c)
Certified nurse-midwives who
manage the medical aspects of a case under a physician's control and supervision
according to the rules of the State Board of Nurse Examiners and the Medical
Practice Act are reimbursed by the Medicaid Program for those services only
if they are performed according to the written protocols required by the State
Board of Nurse Examiners and are not duplicative of other charges to the Medicaid
Program.]
(d)
Reimbursement for services
which are other than nurse-midwife services are governed by the applicable
provisions of the Medicaid Program, as specified by the department.]
(e)
A nurse-midwife is not reimbursed
by the Medicaid Program for services provided if employed, salaried, or reimbursed
by a hospital, nursing facility, other institution, or facility where the
nurse-midwife's remuneration for services is included in the reimbursement
formula or vendor payment to the hospital, facility, institution, or other
provider.]
(f)
Certified nurse-midwives who
are employed by or remunerated by a physician, health maintenance organization
(HMO), hospital, or other facility may not bill the Medicaid Program directly
for nurse-midwife services if that billing would result in duplicate payment
for the same services. If the services are covered and reimbursable by the
Medicaid Program, payment may be made to the physician, hospital, or other
provider, if approved for participation in the Medicaid Program who employs
or reimburses the nurse-midwife. The basis and amount of Medicaid reimbursement
depends on the nurse-midwife services actually provided, who provided the
services, and the reimbursement methodology utilized by the Medicaid Program
as appropriate for the services and provider(s) involved.]
12.
CERTIFIED REGISTERED NURSE ANESTHETISTS
(a)
]
Effective for services delivered on and
after March 1, 2006, covered
[
Subject to the specifications, conditions,
limitations, and requirements established by the department or its designee,
payment for covered
] anesthesia services provided by a [
participating
] certified registered nurse anesthetist (CRNA)
and billed under
the CRNA's own provider number are reimbursed
[
will be limited
to
] the lesser of the
CRNA's billed charges or 92%
[
actual charge or 85%
] of the
reimbursement for the same anesthesia
service paid to a physician (M.D. or D.O.)
[
rate reimbursed to
a physician
] anesthesiologist [
for the same service
].
(b)
Reimbursement for covered
CRNA services may be made to the CRNA actually performing the services or,
provided that federal requirements related to assignment of claims are met,
to a hospital, physician, dentist, podiatrist, group practice, or ambulatory
surgical center with which the CRNA has an employment or contractual relationship.]
(c)
The department or its designee
reimburses covered CRNA services only when the services are submitted for
payment under a CRNA provider number.]
(d)
Physician reimbursement for
supervision of CRNAs is governed by the department's policies regarding physician
services.]
15.
NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS