TITLE 1.ADMINISTRATION

Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 355. MEDICAID REIMBURSEMENT RATES

Subchapter E. COMMUNITY CARE FOR AGED AND DISABLED

1 TAC §355.506

The Texas Health and Human Services Commission (HHSC) proposes new §355.506, concerning reimbursement methodology for the Consolidated Waiver program, in its Medicaid Reimbursement Rates chapter. The purpose of the proposal is to create the reimbursement methodology for the new Consolidated Waiver program. This methodology defines how payment rates will be determined for this new waiver program.

Don Green, chief financial officer, has determined that for the first five-year period the section is in effect there will be no fiscal implications for state government as a result of enforcing or administering the section. There will be no fiscal implications for local government as a result of enforcing or administering the section.

Commissioner Don Gilbert has determined that for the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be a reimbursement methodology that defines how payment rates will be determined for providers who contract to provide services in the Consolidated Waiver program. The rule explains that payment rates will come from existing payment rates for similar Medicaid services in other programs. If a similar service does not exist, the payment rates can be modeled.

There will be no adverse economic effect on small or micro businesses, because the proposal creates a new reimbursement methodology for the new Consolidated Waiver program. No changes in practice are required of any business, large or small. There is no anticipated economic cost to persons who are required to comply with the proposed section.

Questions about the content of this proposal may be directed to Carolyn Pratt at (512) 438-4057 in the Department of Human Services' Rate Analysis Department. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-152, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

The new section is proposed under Texas Government Code §531.033, which authorizes the commissioner of HHSC to adopt the rules necessary to carry out the commission's duties, and §531.021(b), which establishes the commission as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under Chapter 32, Human Resources Code.

The new section implements the Government Code, §§531.033 and 531.021(b).

§355.506.Reimbursement Methodology for Consolidated Waiver Program.

Payment rate determination. Payment rates are those rates determined for other Medicaid programs with similar services. When payment rates are not available from other Medicaid programs with similar services, payment rates are determined on a pro forma approach in accordance with §355.105(h) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures).

Related information. The information in §355.101 of this title (relating to Introduction) and §355.105(g) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures) also applies.

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 21, 2001.

Marina Henderson

Executive Deputy Commissioner

Texas Health and Human Services Commission

Earliest possible date of adoption: August 5, 2001

For further information, please call: (512) 438-3734