1 TAC §371.208
The Health and Human Services Commission (HHSC) proposes
the repeal of §371.208, relating to Appeals Requirements under the Texas
Medical Review Program (TMRP) and Tax Equity and Fiscal Responsibility Act
(TEFRA) and Hospital Notification. This rule was originally promulgated by
the Texas Department of Health (TDH) as 25 T.A.C. §41.110 and became
a rule of HHSC in 1997, with the passage of Senate Bill 30, 75th Legislature,
1997. This bill transferred responsibility for conducting utilization review
of certain Medicaid services from TDH and the Texas Department of Human Services
(TDHS) to HHSC and redesignated all rules of TDH and TDHS governing this function
as HHSC rules. Although the performance of utilization review activities transferred
to HHSC, the conduct of appeals of utilization review decisions remained with
TDH and TDHS.
The Social Security Act, §1902a(30) (codified at 42 U.S.C. §1396a(a)(30))
requires HHSC to implement methods and procedures to safeguard against unnecessary
care and services, and to assure that the payments made for services are consistent
with efficiency, economy and quality of care in the Medicaid program. Federal
regulations found at 42 C.F.R. Part 456, Subpart C, set forth the utilization
control requirements for states participating in the Medicaid program. TDH
adopted rules to govern the conduct of utilization review for inpatient hospitals
submitting claims to the Texas Medicaid program. With the transfer of this
function to HHSC via Senate Bill 30, the rules governing this function were
redesignated rules of HHSC. HHSC has determined that responsibility for the
review of utilization review decisions by HHSC should be conducted in accordance
with provisions of the current Texas Medicaid Provider Procedures Manual,
as updated by the Texas Medicaid Bulletin, which is incorporated by reference
into each Medicaid provider agreement.
Don Green, Chief Financial Officer, has determined that there will be a
cost savings to the state for each year of the first five years following
the repeal of the rule. The cost to the state of providing each informal hearing
is approximately five hundred dollars ($500.00). The number of informal provider
hearings varies from year to year from approximately 60 to over 200. This
would result in a cost savings to the state from $30,000 to $100,000 per year
for each year following the repeal of the rule. There are no foreseeable fiscal
implications on local government.
Mr. Green has also determined that for each year of the five years the
repeal is in effect, the public benefits anticipated as a result of repeal
of the rule are administrative simplification, increased efficiencies in the
use of state resources resulting in savings of tax dollars, and a more expedient
resolution of utilization review appeals. There will be no effect on small
businesses or micro-businesses, because they are not required to comply with
the rule. There is no anticipated economic costs to persons who are no longer
required to comply with the rule. There is no impact on local employment.
Comments on the proposed repeal of the rule may be submitted to Steve Aragon,
General Counsel, Health and Human Services Commission, 4900 N. Lamar, Fourth
Floor, Austin, Texas 78756, (512) 424-6578. Comments will be accepted for
30 days following the publication in the
Texas Register
.
The repeal is proposed under the Human Resources Code, §32.021,
and the Government Code, §531.021 and §531.033, which provide the
Health and Human Services Commission with the authority to administer federal
medical assistance funds and the state's medical assistance program and authorize
HHSC to adopt rules necessary to carry out its statutory duties.
The repeal affects Government Code, §531.021 and §531.033, which
provide the Health and Human Services Commission with the authority to administer
federal medical assistance funds and the state's medical assistance program
and authorize HHSC to adopt rules necessary to carry out its statutory duties.
§371.208.Appeals Requirements under the Texas Medical Review Program (TMRP) and Fiscal Responsibility Act (TEFRA) and Hospital Notification.
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 February 7, 2000.
TRD-200000942
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: March 19, 2000
For further information, please call: (512) 424-6576