PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER E. COMMUNITY CARE FOR AGED AND DISABLED
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.503, Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs, without changes to the proposed text as published in the May 16, 2008, issue of the Texas Register (33 TexReg 3855) and will not be republished.
Background and Justification
This rule establishes the reimbursement methodology for the Community-Based Alternatives (CBA) waiver program and the Integrated Care Management-Home and Community Support Services (ICM-HCSS) and Assisted Living/Residential Care (AL/RC) programs. The CBA waiver program and the ICM-HCSS program include in their service arrays out-of-home respite care delivered in a nursing facility.
The Texas Medicaid nursing facility program currently uses the Texas Index for Level of Effort (TILE) case mix system to establish nursing facility reimbursement rates. Effective September 1, 2008, HHSC will replace the TILE case mix system with the Resource Utilization Groups (RUG) case mix system for setting nursing facility reimbursement. Reimbursement rates for CMA and ICM-HCSS out-of-home respite currently are based on nursing facility TILE rates. Because of the change to the nursing facility case mix system, the CMA and ICM-HCSS out-of-home respite reimbursement methodology must be revised to remove the reference to TILE.
HHSC, under its authority and responsibility to administer and implement rates, is updating these rules to replace the reference in subsection (d)(2)(C) to the TILE case mix class with a general reference to the Nursing Facility (NF) case mix class. This will allow HHSC to continue to reimburse out-of-home respite care provided in a nursing facility.
Comments
The 30-day comment period ended June 16, 2008. During this period, HHSC received no comments regarding the proposed amendment to this rule.
The amendment is adopted under the Human Resources Code, §32.021, which provides HHSC with the authority to adopt rules necessary to administer the federal medical assistance (Medicaid) program in Texas; Texas Government Code, §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules necessary to carry out the commission's duties; and the Texas Government Code §531.021(a), which authorizes the Executive Commissioner to adopt rules for the operation and provision of health and human services by the health and human services agencies and to adopt or approve rates of payment required by law to be adopted or approved by a health and human services agency.
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 August 14, 2008.
TRD-200804372
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: September 3, 2008
Proposal publication date: May 16, 2008
For further information, please call: (512) 424-6900