Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 43.
MEDICAID RECIPIENT UTILIZATION REVIEW AND CONTROL
On behalf of the State Medicaid Director, the Texas Department of
Health (department) adopts the repeal of §§43.22 - 43.25 and adopts
new §§43.21 - 43.24, concerning Medicaid recipient review and control,
without changes to the proposed text as published in the November 5, 1999,
issue of the
Texas Register
(24 TexReg 9745)
, and therefore, the sections will not be republished.
The department monitors the use of health care services by Medicaid recipients.
If the recipient's usage pattern appears to be unnecessary, excessive, or
inappropriate, the recipient is placed in the limited program. The repeal
of §§43.22 - 43.25 and the adoption of new §§43.21 - 43.24
will allow the department to review a broader base of recipients who may be
misusing, wasting, or fraudulently acquiring Medicaid services.
Additionally, §§43.21 - 43.24 have been reviewed in accordance
with Government Code §2001.039, which requires each state agency to review
and consider for readopting each rule adopted by that agency pursuant to the
Government Code, Chapter 2001 (Administrative Procedure Act). The department
has determined that the reasons for adopting the sections continue to exist
in that rules are needed; however, the rules need revision as described in
this preamble. The department published a Notice of Intention to Review §§43.22
- 43.25 in the May 7, 1999, issue of the Texas Register (24 TexReg 3546),
and no comments were received as a result of this publication.
No comments concerning the proposed repeal or proposed new rules were received
during the 30-day comment period.
25 TAC §§43.21 - 43.24
The new sections are adopted under the Human Resource Code §32.021,
and 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 and is submitted by the Texas Department of Health under
its agreement with the Health and Human Services Commission to operate the
purchased health services program and as authorized under Chapter 15, §1.07,
Acts of the 72nd Legislature, First Call Session (1991). Government Code, §2001.039
is implemented by this adoption.
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 March 13, 2000.
TRD-200001909
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: April 2, 2000
Proposal publication date: November 5, 1999
For further information, please call: (512) 458-7236
25 TAC §§43.22 - 43.25
The repeals are adopted under the Human Resource Code §32.021,
and 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 and is submitted by the Texas Department of Health under
its agreement with the Health and Human Services Commission to operate the
purchased health services program and as authorized under Chapter 15, §1.07,
Acts of the 72nd Legislature, First Call Session (1991). Government Code, §2001.039
is implemented by this adoption.
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 March 13, 2000.
TRD-200001908
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: April 2, 2000
Proposal publication date: November 5, 1999
For further information, please call: (512) 458-7236
Chapter 43.
UTILIZATION CONTROL
Part 5.
CENTER FOR RURAL HEALTH INITIATIVES