Part II.
Texas Rehabilitation Commission
Chapter 104.
Informal Appeals, Formal Appeals, and Mediation by Applicants/Clients of Determinations by Agency Personnel that Affect the Provision of Vocational Rehabilitation Services
40 TAC §104.6
The Texas Rehabilitation Commission (TRC) adopts an amendment
to §104.6, concerning Motion for Reconsideration, without changes to
the proposed text as published in the May 28, 1999, issue of the
Texas Register
(24 TexReg 3991). The text will not be republished.
The section is being amended to provide more time for filing appeals.
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Texas Human Resources Code,
Title 7, Chapter 111, §111.018 and §111.023, which provides the
Texas Rehabilitation Commission with the authority to promulgate rules consistent
with Title 7, Texas Human Resources Code.
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 June
28, 1999.
TRD-9903809
Charles Schiesser
Chief of Staff
Texas Rehabilitation Commission
Effective date: July 18, 1999
Proposal publication date: May 28, 1999
For further information, please call: (512) 424-4050
40 TAC §117.3
The Texas Rehabilitation Commission (TRC) adopts an amendment
to §117.3, concerning Board Policies, without changes to the proposed
text as published in the May 28, 1999, issue of the
Texas Register
(24 TexReg 3991). The text will not be republished.
The section is being amended to update board policies.
No comments were received regarding adoption of the amendment.
The amendment is adopted under the Texas Human Resources Code,
Title 7, Chapter 111, §111.018 and §111.023, which provides the
Texas Rehabilitation Commission with the authority to promulgate rules consistent
with Title 7, Texas Human Resources Code.
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 June
28, 1999.
TRD-9903810
Charles Schiesser
Chief of Staff
Texas Rehabilitation Commission
Effective date: July 18, 1999
Proposal publication date: May 28, 1999
For further information, please call: (512) 424-4050
Chapter 700.
Child Protective Services
Subchapter R. Cost-Finding Methodology for 24-Hour Child-Care Facilities
40 TAC §700.1802
The Texas Department of Protective and Regulatory Services
(TDPRS) adopts an amendment to §700.1802, with changes to the proposed
text published in the May 14, 1999, issue of the
Texas Register
(24 TexReg 3696).
Rules for the cost-finding methodology for 24-hour child care facilities
currently include therapy costs in its recommended payment rates for Levels
of Care 3 through 6. The justification for the amendment is to require contractors
to access Medicaid for Medicaid-allowable therapy with certain exceptions.
The current payment rate for Levels of Care 3 through 6 will not change as
a result of this rule change.
The amendment will function by providing children in TDPRS conservatorship
who reside in TDPRS contracted 24-hour child care facilities access to an
additional resource for therapy services.
During the public comment period, TDPRS received comments from the Texas
Association of Licensed Children's Services, The Settlement Home, and Roy
Maas' Youth Alternatives, Inc. A summary of the comments and TDPRS's responses
follow:
Comment: Two commenters sought clarification on the proposed rule and how
it would relate to therapists who have their temporary licensure as professional
counselors while working towards full licensure. While these therapists cannot
enroll as a Medicaid provider, they have been considered by TDPRS as appropriately
qualified to provide therapy.
Response: TDPRS follows policy of the Texas State Board of Examiners of
Professional Counselors, which recognizes Licensed Professional Counselor
(LPC) interns holding a temporary license as qualified to provide therapy.
As this therapy is not a service allowable under Medicaid, it meets the second
exception in the proposed rule and therefore would be considered as an allowable
cost on the annual cost report.
Comment: A commenter suggested a language change for the second exception
to "the necessary therapy is not a service allowable under Medicaid."
Response: TDPRS agrees with the suggested change. This change in the wording
clarifies that there may be instances where a service is allowable under Medicaid
(therapy provided by an LPC) but is not reimbursable because the provider
cannot enroll in Medicaid (LPC intern with a temporary license) and that when
that service is provided by a LPC intern with a temporary license, the service
is not "allowable" under Medicaid.
Comment: Two commenters requested a longer transition period from a non-Medicaid
provider to a Medicaid provider prior to requesting TDPRS approval beyond
this allowable time period. It was felt that this longer period would allow
new therapists to begin seeing their caseload immediately rather than using
an interim therapist who is Medicaid enrolled, and would allow time for the
new therapist to become Medicaid enrolled. One commenter suggested a language
change for the fifth exception to change the transition period in the proposed
rule from "six weeks or six sessions" to "90 days or 14 sessions."
Response: In the fifth exception, TDPRS agrees to remove the "six weeks
or six sessions" and replace it with "90 days or 14 sessions." Services provided
by the new staff member up to the "90 days or 14 sessions" may be included
on the annual cost report.
Comment: A commenter expressed concern that in complying with the proposed
rule, the facility will have additional administrative costs and has suggested
that these costs be allowable as part of allowable administrative costs for
rate setting purposes.
Response: Medicaid administrative costs are included in the Medicaid payment.
Therefore, Medicaid administrative costs will not be considered allowable
for cost reporting purposes. Administrative costs associated with complying
with the exceptions to the rule will be allowable for cost reporting purposes.
These costs, along with other increasing administrative costs, have caused
TDPRS to raise the benchmark used for analysis from 20% to 25%.
Comment: A commenter expressed concern about the Medicaid requirement for
prior approval beyond an initial 30-encounter threshold. The commenter would
like assurances that Medicaid will grant extensions beyond the initial 30
encounters.
Response: By accessing Medicaid for Medicaid allowable therapy, an additional
resource will be available for providing therapy. The established extension
process should be followed, and if denied, the necessary therapy that is not
Medicaid allowable will continue to be an allowable cost for inclusion on
the annual cost report.
Comment: A commenter expressed a need for TDPRS to initiate a committee
consisting of providers and Medicaid and TDPRS staff to address provider problems
under this new system as they arise, such as rejection of extensions.
Response: TDPRS has established specific contact persons at TDPRS, the
Texas Department of Health, the Texas Health and Human Services Commission,
and the National Heritage Insurance Company to facilitate resolution of enrollment
and claiming problems.
Comment: One commenter asked who at TDPRS will provide the approval for
exceptions to the provisions.
Response: The Child Protective Services (CPS) Program Directors will provide
approvals for the fifth exception. The first through fourth exceptions will
not require approval.
Comment: One commenter asked for clarification between what therapists
are appropriate as part of the level-of-care reviews and which of these costs
are allowable for inclusion in the annual cost report.
Response: TDPRS will include this requested information in a packet to
be sent to 24-hour child-care contractors by November 1, 1999.
Comment: One commenter expressed concern that Medicaid policy could change
which would adversely affect children, such as limitation on providers, a
limitation on services authorized, etc.
Response: Access to Medicaid is being developed as an additional resource
for what otherwise are allowable costs on the annual cost report. Any Medicaid
restriction is only a restriction on what can be billed to Medicaid. Reimbursement
for allowable costs through the annual cost reporting process will continue
as in the past.
Comment: One commenter suggested a language change for the first exception
to "the child is not eligible for Medicaid or not enrolled with fee-for-service
Medicaid coverage." The commenter believes that this wording change will fill
any gaps in the system of care and providers enrolling in Medicaid.
Response: TDPRS agrees that Medicaid service coordination is complicated
when a child has Medicaid under a Managed Care program and then comes into
TDPRS care under the fee-for-service system. TDPRS will not use the commenter's
wording but will make a similar wording change to the first exception which
will read: "the child is not eligible for Medicaid or is transitioning from
Medicaid Managed Care to fee-for-service Medicaid." TDPRS believes that this
change in wording will assist with the transition in systems of care and support
providers enrolling in Medicaid.
Comment: Two commenters requested the postponement of the implementation
date for this rule change, one to November 1, 1999, and one to January 1,
2000.
Response: TDPRS will postpone the implementation date for this rule change
to November 1, 1999, to allow additional time for provider enrollment.
In addition to the above changes, TDPRS has reorganized and renumbered
the wording in paragraph (9) for clarification.
The amendment is adopted under the Human Resources Code (HRC),
Chapter 40, which describes the services authorized to be provided by the
Texas Department of Protective and Regulatory Services, specifically §40.029
granting rulemaking authority to TDPRS, §40.052 regarding delivery of
services, §40.0563 relating to the use of federal funds, and §40.058
relating to contracts and agreements.
The amendment implements the HRC, Chapter 40, which authorizes the department
to enter into agreements with federal, state, or other public or private agencies
or individuals to accomplish the purposes of the programs authorized by the
HRC and which authorizes the department to enter into contracts as necessary
to perform any of its powers or duties.
§700.1802.Cost-finding Analysis.
(a)-(b)
(No change.)
(c)
To develop rate recommendations for Board consideration
for Levels of Care 2 through 6 and emergency shelters, TDPRS analyzes the
information submitted in provider cost reports and related documentation in
the following ways.
(1)-(8)
(No change.)
(9)
TDPRS includes therapy costs in its recommended payment
rates for emergency shelters. TDPRS includes therapy costs in its recommended
payment rates for Levels of Care 3 through 6, which will be considered as
allowable costs for inclusion on the provider's annual cost report, only if
one of the following conditions apply. The provider must access Medicaid for
therapy for children in their care unless:
(A)
the child is not eligible for Medicaid or is transitioning
from Medicaid Managed care to fee-for-service Medicaid; or
(B)
the necessary therapy is not a service allowable under
Medicaid; or
(C)
service limits have been exhausted and the provider has
been denied an extension; or
(D)
there are no Medicaid providers available that meet the
needs identified in the service plan within 45 miles to provide the therapy;
or
(E)
it is essential and in the child's best interest for a
non-Medicaid provider to provide therapy to the child and arrange for a smooth
coordination of services for a transitional period of time not to exceed 90
days or 14 sessions. Any exception beyond the 90 days or 14 sessions must
be approved by TDPRS prior to the provision of services.
(10)-(17)
(No change.)
(d)
(No change.)
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 June
28, 1999.
TRD-9903833
C. Ed Davis
Deputy Director, Legal Services
Texas Department of Protective and Regulatory Services
Effective date: November 11, 1999
Proposal publication date: May 14, 1999
For further information, please call: (512) 438-3765
The Texas Department of Protective and Regulatory Services (TDPRS)
adopts amendments to §725.2024 and §725.3044, without changes to
the proposed text published in the May 14, 1999, issue of the
Texas Register
(24 TexReg 3697).
The justification for the amendment to §725.2024 is to clarify procedures
for requesting administrative reviews of actions or decisions made by Licensing
staff. The justification for the amendment to §725.3044 is to clarify
which facilities are exempt from application fees and licensing fees and eliminate
inconsistencies regarding timeframes for notifying applicants regarding the
acceptance of their applications.
The amendments will function by (1) clarifying which facilities are exempt
from application and license fees, (2) clarifying the procedures for accepting
applications, and (3) eliminating inconsistencies in timeframes for requesting
administrative reviews.
No comments were received regarding adoption of the amendments.
Subchapter U. Day Care Licensing Procedures
Chapter 117.
Special Rules and Policies
Part XIX.
Texas Department of Protective and Regulatory Services
Chapter 725.
General Licensing Procedures