1 TAC §355.702, §355.706
The Texas Health and Human Services Commission (THHSC) proposes
an amendment to §355.702(f) and new §355.706 of Chapter 355, Subchapter
F, concerning general reimbursement methodology for all medical assistance
programs. Existing §355.706 of the subchapter is proposed for repeal
contemporaneously in this issue of the
Texas Register
.
The amendment to §355.702(f) updates a reference to §355.706
to reflect the new title of that section and clarifies that reimbursements
may be adjusted according to §355.706 notwithstanding program-specific
reimbursement methodology rules. New §355.706 allows TDMHMR to recommend
adjustments to reimbursement for the Medicaid programs it operates in response
to certain changes, including changes in legislation, economic factors and
funding. The amendment and new section will provide consistency in the rules
for adjusting reimbursements in Medicaid programs administered by THHSC as
the single Medicaid state agency.
Donald C. Green, chief financial officer, THHSC, has determined that for
each year of the first five years the amendment and new section as proposed
are in effect, enforcing or administering the amendment and new section does
not have foreseeable implications relating to costs or revenues of state or
local government. The amendment and new section do not impose any new requirements
on Medicaid providers and, therefore, there is no anticipated economic cost.
Steve Svadlenak, associate commissioner for Medicaid reimbursement, THHSC,
has determined that for each year of the first five years the amendment and
new section as proposed are in effect, the public benefit expected as a result
of adoption is to give the state the flexibility to adjust reimbursement to
Medicaid providers in response to changes, including changes to legislation,
economic factors and funding. It is not anticipated that the amendment and
new section will affect a local economy.
A hearing will be held at 9:30 a.m. on Friday, July 9, 1999, in Room 240
of the main building in TDMHMR's Central Office (building 2) at 909 West 45th
Street in Austin to accept oral and written testimony from the public concerning
this proposal. Persons requiring an interpreter for the deaf or hearing impaired
should contact the TDMHMR Central Operator at least 72 hours prior to the
hearing at TDD (512) 206-5330. Persons requiring any other accommodation for
a disability should notify the TDMHMR Office of Policy Development at least
72 hours prior to the hearing at (512) 206-4516 or at the TDY phone number
of Texas Relay, (800) 725-2988.
The amendment and new section proposed under the Texas Government
Code, §531.033, which provides the commissioner of THHSC with broad rulemaking
authority; the Texas Human Resources Code, §32.021, and the Texas Government
Code, §531.021(a), which provide THHSC with the authority to administer
the federal medical assistance (Medicaid) program in Texas; and the Texas
Government Code, §531.021(b), which provides THHSC with the authority
to adopt rules governing the determination of Medicaid reimbursements.
This new rule implements Texas Government Code, §531.021(a) and (b)
and §531.033, and Human Resources Code, Chapter 32, §32.021.
§355.702. Method for Cost Determination.
(a)-(e)
(No change.)
(f)
Other adjustments.
Notwithstanding reimbursement
methodologies described in program-specific rules,
TDMHMR may
recommend reimbursement adjustments
[
also adjust rates when new
legislation, regulations, or economic factors affect costs,
] as specified
in §355.706 of this title (relating to Adjusting
Reimbursement
[
Rates When New Legislation, Regulations, or Economic Factors Affect
Costs
].)
(g)-(i)
(No change.)
§355.706. Adjusting Reimbursement.
(a)
In conducting reimbursement reviews for adjustments the
Texas Department of Mental Health and Mental Retardation (TDMHMR) takes into
consideration changes in laws, rules, regulations, policies, guidelines, or
economic factors which will have a demonstrable material impact on most contracted
providers' costs of providing services meeting federal and state standards.
(1)
TDMHMR may recommend adjustments to reimbursement when
federal or state laws, rules, regulations, policies, or guidelines are adopted,
promulgated, judicially interpreted, or otherwise changed in ways that affect
allowable costs. The law, rule, regulation, policy, or guideline change must
result in necessary changes in allowable costs that:
(A)
affect most, if not all, contracted providers; and
(B)
require contracted providers to take definitive action
to incur additional allowable costs not included in the cost data base used
to determine reimbursements and which would not otherwise be covered in reimbursements.
(2)
TDMHMR may recommend adjustments to reimbursement
when it can be clearly demonstrated that changes in economic factors will
result in changes in allowable costs. The changes in economic factors must
result in changes in allowable costs that:
(A)
affect most, if not all, providers; and
(B)
are allowable cost changes that the providers have little
or no control over and are allowable costs that are not included in the cost
data base used to determine reimbursements and which would not otherwise be
covered in reimbursements.
(b)
TDMHMR may recommend adjustments to reimbursement for
the reasons stated in subsection (a)(1) of this section at the earliest feasible
opportunity in order for the adjustment to become effective on the effective
date of the federal or state laws, rules, regulations, policies, or guidelines.
In the case of Medicaid state plan program reimbursements, the adjustments
will not be effective until after the federal requirements for notice are
met.
(c)
TDMHMR may recommend adjustments to reimbursement when
federal or state funding is changed in ways that affect the available funding
for programs.
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 June
7, 1999.
TRD-9903315
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: July 18, 1999
For further information, please call: (512) 424-6576
1 TAC §355.706
(Editor's note: The text of the following section proposed for
repeal will not be published. The section may be examined in the offices of
the Texas Health and Human Services Commission or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Health and Human Services Commission (THHSC)
proposes the repeal of §355.706 of Chapter 355, Subchapter F, concerning
general reimbursement methodology for all medical assistance programs. New
§355.706 is proposed contemporaneously in this issue of the
Texas Register
for public review and comment.
The repeal will permit THHSC to adopt a new section that will provide consistency
in the rules for adjusting reimbursements in Medicaid programs administered
by THHSC as the single Medicaid state agency.
Donald C. Green, chief financial officer, THHSC, has determined that for
each year of the first five years the repeal as proposed is in effect there
will not be foreseeable implications relating to costs or revenues of state
or local government. The repeal does not impose any new requirements on Medicaid
providers and, therefore, there is no anticipated economic cost.
Steve Svadlenak, associate commissioner for Medicaid reimbursement, THHSC,
has determined that for each year of the first five years the repeal as proposed
is in effect, the public benefit expected as a result of adoption is to give
the state the flexibility to adjust reimbursement to Medicaid providers in
response to changes, including changes to legislation, economic factors and
funding. It is not anticipated that the repeal will affect a local economy.
A hearing will be held at 9:30 a.m. on Friday, July 9, 1999, in Room 240
of the main building in TDMHMR's Central Office (building 2) at 909 West 45th
Street in Austin to accept oral and written testimony from the public concerning
this proposal. Persons requiring an interpreter for the deaf or hearing impaired
should contact the TDMHMR Central Operator at least 72 hours prior to the
hearing at TDD (512) 206-5330. Persons requiring any other accommodation for
a disability should notify the TDMHMR Office of Policy Development at least
72 hours prior to the hearing at (512) 206-4516 or at the TDY phone number
of Texas Relay, (800) 725-2988.
The repeal is proposed under the Texas Government Code, §531.033,
which provides the commissioner of THHSC with broad rulemaking authority;
the Texas Human Resources Code, §32.021, and the Texas Government Code,
§531.021(a), which provide THHSC with the authority to administer the
federal medical assistance (Medicaid) program in Texas; and the Texas Government
Code, §531.021(b), which provides THHSC with the authority to adopt rules
governing the determination of Medicaid reimbursements.
This repeal implements Texas Government Code, §531.021(a) and (b)
and §531.033, and Human Resources Code, Chapter 32, §32.021.
§355.706. Adjusting Rates When New Legislation, Regulations, or Economic Factors Affect Costs.
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 June
7, 1999.
TRD-9903316
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: July 18, 1999
For further information, please call: (512) 424-6576