TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 29. PURCHASED HEALTH SERVICES

Subchapter D. MEDICAID HOME HEALTH SERVICES

25 TAC §29.307

(Editor's note: The text of the following section proposed for repeal will not be published.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 Department of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

Subject to the approval of the State Medicaid Director, the Texas Department of Health (department) proposes to repeal §29.307, concerning reimbursement methodology for home health services.

The department has determined the need to repeal the rule because it is unnecessary. The Texas Government Code §531.021, as amended in 1997, 75th Legislature, gave the Health and Human Services Commission responsibility for adopting all reimbursement rules and statutes regarding the setting of Medicaid rates, fees and charges. Therefore, there is no need for the Texas Department of Health to have a rule that the Health and Human Services Commission is responsible for now and in the future.

Mr. Joe Moritz, Health Care Financing Budget Director, has determined that for each year of the first five years the section is in effect, there will be no fiscal implications on state government on the proposal of repealing this rule. The proposed repeal does not have foreseeable implications relating to cost or revenues of local government.

Mr. Moritz also has determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be to ensure that all Medicaid reimbursement rules are administered by the Health and Human Services Commission per legislative mandate. There will be no effect on small business or micro-business to comply with the proposed repeal of this section. This was determined by interpretation of the rule that small businesses and micro-businesses will not be required to alter their business practices in order to comply with the proposed rule repeal. There are no anticipated economic costs to persons who are required to comply with the proposed repeal of this section. There will be no impact on local employment.

Comments on the proposal may be submitted to Beverly Williams, Program Specialist III, Health Care Financing, Texas Department of Health, Mail Code Y-927, 1100 West 49th Street, Austin, Texas 78756-3168, within 30 days of publication in the Texas Register .

The repeal of this rule is in accordance with the Human Resources Code, §32.021 and the Texas Government Code, §531.021, which provides the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program. Rules are submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program as authorized by Acts of the 72nd Legislature, First Called Session, Chapter 15, §1.07, (1991).

The proposed rule repeal affects Chapter 32 of the Human Resources Code and Chapter 531 of the Government Code.

§29.307.Reimbursement Methodology for Home Health Services.

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 August 14, 2000.

TRD-200005680

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: September 24, 2000

For further information, please call: (512) 458-7236


Subchapter E. MEDICAID CHIROPRACTIC SERVICES

25 TAC §§29.401, §29.403

Subject to the approval of the State Medicaid Director, the Texas Department of Health (department) proposes amendments to §§29.401 and 29.403, concerning Medicaid Chiropractic Services.

The department has determined the need to amend its rules in accordance with §4513(a) of the Balanced Budget Act of 1997, which eliminates the statutory provision that a spinal subluxation be demonstrated by an x-ray. The amendments will allow chiropractors participating in the Texas Medical Assistance Program to provide manual manipulations of the spine to correct a subluxation without an x-ray demonstrating the existence of subluxation.

Joe Moritz, Health Care Financing Budget Director, has determined that for each year of the first five years the sections are in effect, there will be fiscal implications as a result of enforcing or administering the sections as proposed. The effect on state government will mean an additional cost of $298,984 for Fiscal Year 2001, $301,562 for Fiscal Year 2002, $301,562 for Fiscal Year 2003, $301,562 for Fiscal Year 2004, and $301,562 for Fiscal Year 2005. The amendment does not have foreseeable implications relating to cost or revenues of local governments. It is anticipated that the amendments will result in increased provision of chiropractic services.

Mr. Moritz has also determined that for each year of the first five years the sections are in effect, the public benefit anticipated as a result of enforcing the sections will be an increase of services provided by a doctor of chiropractic. There will be no effect on small businesses or micro-businesses to comply with this section as proposed. This was determined by interpretation of the rule that small businesses and micro-businesses will not be required to alter their business practices to comply with the proposed rule. There are no anticipated economic costs to persons who are required to comply with the section as proposed. There will be no impact on local employment.

A public hearing on the proposed amendments will be held at 9:00 a.m. on August 28, 2000, in the Public Hearing Room, Texas Department of Health, 12555 Riata Vista Circle, Austin, Texas, to accept comments on the proposal.

Comments on the proposed amendments may be submitted to Kathy Gussman, Program Specialist, Policy Development and Utilization, Texas Department of Health, Mail Code Y-927, 1100 West 49th Street, Austin, Texas, 78756-3199, within 30 days of publication in the Texas Register . In order to comply with federal regulations, a copy of this proposal is being sent to each field office of the Texas Department of Human Services where this will be available for public review upon request for a period of 30 days.

The amendments are proposed under the Human Resources Code, §32.021 and the Texas Government Code, §531.021, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program. Rules are submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program as authorized by Acts of the 72nd Legislature, First Called Session, Chapter 15, §1.07, (1991).

The proposed amendments affect Chapter 32 of the Human Resources Code and Chapter 531 of the Government Code.

§29.401.Additional Claim Information Requirements.

In addition to the general requirements in §29.1 of this title (relating to Claim Information Requirements), the following information is required on chiropractic claims:

(1) - (2)

(No change)

[ (3)

Date of x-ray. In the case of an acute condition, the x-ray must be taken no more than three months prior to the initial date of treatment. For a chronic condition the x-ray must not have been taken more than 12 months prior to the initial course of treatment.]

[ (4)

Certification that an x-ray film is available demonstrating the existence of a subluxation at the specified level of the spine.]

(3)

[ (5) ] Place of service.

(4)

[ (6) ] The type of each treatment procedure.

(5)

[ (7) ] The individual charge for each authorized service related to a major diagnosis.

(6)

[ (8) ] Number of manual manipulations that have been performed.

§29.403.Authorized Chiropractic Services.

(a)

Chiropractic services include those services provided by a doctor of chiropractic and which are within the scope of practice of his profession as defined by state law. Benefits are limited to services which consist of necessary treatment or correction by means of manual manipulation of the spine, by use of hands only, to correct a subluxation [ demonstrated by x-ray to exist ] to the same extent that such benefits are provided under Part B of Medicare. Benefits are available under this section only for services which are provided during the first 12 visits to any one eligible recipient by a doctor of chiropractic during any one benefit period. Benefit period for purposes of this section means a 12 consecutive month period which begins with the month of the first treatment.

(b)

(No change)

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 August 14, 2000.

TRD-200005679

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: September 24, 2000

For further information, please call: (512) 458-7236


Subchapter L. GENERAL ADMINISTRATION

25 TAC §29.1118

Subject to the approval of the State Medicaid Director, the Texas Department of Health (department) proposes an amendment to §29.1118 concerning provider re-enrollment in the Medicaid Program.

The department has determined the need to amend the rule to comply with Human Resources Code, Chapter 32, as amended by Senate Bill 30, of the 75th Legislative Session, 1997, which requires each provider to re-enroll in the state Medicaid program or make necessary contract modifications, in accordance with commission or agency procedures as necessary, not later than September 1, 1999, to retain eligibility to participate in the program.

The 76th Legislative Session, 1999, passed House Bills 2641 and 2896, which grants an extension to the original Senate Bill 30 law date of September 1, 1999 to September 1, 2000, due to the implementation of an electronic method of re-enrolling. House Bill 2896 allows for a further extension to ensure a significant number of providers re-enroll. In accordance with this section of House Bill 2896, the Texas Department of Health is extending the deadline to December 31, 2000.

Joe Moritz, Health Care Financing Budget Director, has determined that for each year of the first five years the section is in effect, there will be fiscal implications as a result of enforcing or administering the section as proposed. The impact on state government is a projected additional state cost of $895,104 for Fiscal Year 2000, $428,620 for Fiscal Year 2001, $0 for Fiscal Year 2002, $0 for Fiscal Year 2003, and $0 for Fiscal Year 2004, with an associated increase in the federal Medicaid matching funds received by the state. The amendment does not have foreseeable implications relating to cost or revenues of local government.

Mr. Moritz has also determined that the public benefit anticipated as a result of enforcing the section will be to provide increased access for Texas Medical Assistance Program recipients of medical services, due to a potential increase of enrolled providers. There will be no effect on small business or micro-businesses to comply with this section as proposed. This was determined by interpretation of the rule that small businesses and micro-businesses will not be required to alter their business practices in order to comply with the rule as proposed. There are no anticipated economic costs to persons who are required to comply with the section as proposed. There will be no impact on local employment.

A public hearing on the proposed amendment will be held at 9:00 a.m. on September 13, 2000, in the Public Hearing Room, Texas Department of Health, 12555 Riata Vista Circle, Austin, Texas, to accept comments on the proposal.

Comments on the proposed amendment may be submitted to Brenda Watson, Program Specialist, Health Care Financing, Texas Department of Health, Mail Code Y-927, 1100 West 49th Street, Austin, Texas, 78756-3168, within 30 days of publication in the Texas Register .

The amendment is proposed under the Human Resources Code, §32.021 and the Texas Government Code, §531.021, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program. Rules are submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program as authorized by Acts of the 72nd Legislature, First Called Session, Chapter 15, §1.07, (1991).

The proposed amendment affects Chapter 32 of the Human Resources Code and Chapter 531 of the Government Code.

§29.1118.Provider Re-enrollment or Provider Contract or Agreement Modification.

(a)

No later than the date specified in Title 1 §371.1000 (Provider Re-enrollment or Provider Contract Modification) [ September 1, 1999 ], a provider who is enrolled in the Medicaid program who wants to continue to participate in the program must, in accordance with instructions from an agency operating part of the Medicaid program, either re-enroll in the Medicaid program under a new contract or agreement approved by the Health and Human Services Commission or modify the provider's existing contract or agreement using language approved by the Health and Human Services Commission.

(b)

A provider enrolled in the Medicaid program who does not re-enroll in the program under the new contract or agreement or modify the existing provider contract or agreement in accordance with the instructions of an agency operating part of the Medicaid program by the date specified in Title 1 §371.1000 (Provider Re-enrollment or Provider Contract Modification) [ September 1, 1999 ], does not retain eligibility to participate in the Medicaid program.

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 August 14, 2000.

TRD-200005694

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: September 24, 2000

For further information, please call: (512) 458-7236