Part 4.
OFFICE OF THE SECRETARY OF STATE
Chapter 72.
STATE SEAL
1 TAC §72.40
The Office of the Secretary of State proposes amendments
to §72.40, concerning definitions for the State Seal. The amendments
will update statutory references to conform to a codification of statutes.
This is a non-substantive change.
House Bill 2812, 77th Legislature, Regular Session, repealed Article 6139f,
Revised Civil Statutes. In its place the bill created a new Chapter 3101 of
the Government Code concerning State Symbols. The proposed amendments will
replace references to the old article numbers with the new Chapter 3101 citation.
Guy Joyner, Chief, Legal Support Unit, Statutory Documents Section has
determined that for the first five year period that the proposed amendments
are in effect there will be no fiscal implications for state or local government
or small business as a result of enforcing the amendments.
Mr. Joyner also has determined that for each year of the first five years
that the amendments are in effect the public benefit anticipated as a result
of the amendments will be updated statutory references in the text of the
rules. There will be no effect on large businesses, small businesses or micro-businesses.
There will be no additional economic cost to individuals. There is no anticipated
impact on local employment.
Comments on the proposed amendments may be submitted to Guy Joyner, Chief,
Legal Support Unit, Statutory Documents Section, P.O. Box 12887, Austin, Texas
78711-2887.
The amendments are proposed under the Business and Commerce Code, §17.08(d),
which provides the Secretary of State with the authority to adopt rules concerning
the private use of the state seal, and Government Code, §3101.001(f)
and §3101.002(b) which requires the Secretary of State to adopt rules
concerning standard designs for the state seal, reverse of the state seal,
and the state arms.
The amendments affect Texas Government Code, §3101.
§72.40.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise. Unless
otherwise expressly provided, the past, present, or future tense includes
the other; the masculine, feminine, or neuter gender each includes the other;
and the singular and plural number each includes the other.
(1) - (22)
(No change.)
(23)
Reverse of the state seal-has the meaning defined by
Government Code, §3101.001
[
(24) - (25)
(No change.)
(26)
State arms-has the meaning defined by
Government
Code, §3101.002
[
(27) - (30)
(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 April 25, 2002.
TRD-200202552
David N. Roberts
General Counsel
Office of the Secretary of State
Earliest possible date of adoption: June 9, 2002
For further information, please call: (512) 463-5562
Chapter 355.
MEDICAID REIMBURSEMENT RATES
Subchapter D. REIMBURSEMENT METHODOLOGY FOR THE INTERMEDIATE CARE FACILITIES FOR PERSONS WITH MENTAL RETARDATION (ICF/MR) PROGRAM
1 TAC §355.451
The Health and Human Services Commission (HHSC) proposes
amendments to §355.451, governing definitions and general reimbursement
information.
Background and Summary of Factual Basis for the Rules
Section 531.021, Government Code, entitled "Administration of Medicaid
Program," provides, among other things, that HHSC adopt rules and standards
to govern the determination of fees, charges, and rates for medical assistance
payments under Chapter 32, Human Resources Code, in consultation with the
agencies that operate the Medicaid program. The amendments describe how rates
for service coordination for individuals served through the MRLA program will
be established and how the service will be defined and limited.
Explanation
Subsection (a) of §355.451 is amended to state that cost data is required
annually.
Fiscal Note
Don Green, Chief Financial Officer, has determined that for the first five
years that the proposed amendments are in effect, there is no anticipated
fiscal impact resulting from the adoption of the amendments. No additional
costs will be borne by local governments as a result of the proposed amendments,
nor is there any anticipated impact of revenues of state or local government.
Small and Micro-business Impact Analysis
The proposed amendments will not result in additional costs to persons
required to comply with the rules, nor do the rules have any anticipated adverse
effect on small or micro-businesses. The rules will not affect local employment.
Public Benefit
Steve Lorenzen, Director, Medicaid Rates Setting, has determined that during
the first five years that the proposed amendments are in effect, the public
benefit is that consumers and families, other stakeholders, and MRAs within
the MRLA Program will have a better understanding of the MRLA service coordination
activities for which an MRA may receive reimbursement.
Regulatory Analysis
HHSC has determined that none of the proposed amended rules is a "major
environmental rule" as defined by §2001.0225, Government Code. "Major
environmental rule" is defined to mean a rule the specific intent of which
is to protect the environment or reduce risks to human health from environmental
exposure and that may adversely affect in a material way the economy, a sector
of the economy, productivity, competition, jobs, the environment, or the public
health and safety of the state or a sector of the state. The proposed amendments
are not specifically intended to protect the environment or reduce risks to
human health from environmental exposure.
Takings Impact Assessment
HHSC has assessed the takings impact of the proposed amended rules under
Texas Government Code, §2007.043. HHSC has determined that this action
does not restrict or limit an owner's right to property that would otherwise
exist in the absence of governmental action and therefore does not constitute
a taking. The proposed amended rules are reasonably taken to fulfill requirements
of state law.
Public Comment
A hearing to accept oral and written testimony from members of the public
concerning the proposal has been scheduled for 1:30 p.m., Monday, June 3,
2002, in the Texas Department of Mental Health and Mental Retardation Central
Office Auditorium in Building 2 at 909 West 45th Street, in Austin, Texas.
Persons requiring an interpreter for the deaf or hearing impaired should contact
the department's Central Office operator at least 72 hours prior to the hearing
at TDD (512) 206-5330. Persons requiring other accommodations for a disability
should notify Medicaid Administration, at least 72 hours prior to the hearing
at (512) 206-5753 or at the TDY phone number of Texas Relay, 1/800-735-2988.
Public comment may be submitted in writing to Mary Ann Roberts, Manager,
HHSC Medicaid Rates and Analysis, Health and Human Services Commission, by
mail to P.O. Box 12668, Austin, Texas 78711, or by fax to 512/206-5673. Comments
must be submitted by 5:00 p.m., Monday, June 10, 2002. Further information
may be obtained by calling Mary Ann Roberts at (512) 206-5682.
Statutory Authority
The amendments are proposed under §531.021(b), Government Code, which
requires HHSC to adopt reasonable rules and standards to govern the determination
of fees, charges, and rates for medical assistance payments under Chapter
32, Human Resources Code, in consultation with the agencies that operate the
Medicaid program; and §531.033, Government Code, which provides the commissioner
of health and human services with authority to adopt rules necessary to carry
the duties of HHSC under Chapter 531, Government Code.
The proposed amended rules implement §531.021(b), Government Code,
concerning the adoption of rules and standards to govern the determination
of fees, charges, and rates for medical assistance payments under Chapter
32, Human Resources Code, and §32.0281, Human Resources Code, concerning
the adoption of rules regarding Medicaid reimbursement rates.
§355.451.Definitions and General Reimbursement Information.
(a)
The following words and terms, when used in this subchapter,
shall have the following meanings, unless the context clearly indicates otherwise.
(1)-(2)
(No change.)
(3)
Full Cost Report - Cost data required
annually
by HHSC that includes all costs of providing services including direct services
costs, administration, facility costs, and all other operating costs relevant
to the provision of services.
(4)-(15)
(No change.)
(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 April 29, 2002.
TRD-200202661
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: June 9, 2002
For further information, please call: (512) 424-6576
1 TAC §§355.701, 355.743 - 355.746
The Health and Human Services Commission (HHSC) proposes
amendments to §355.701 concerning definitions and general specifications
and §355.743, concerning reimbursement methodology for Service Coordination
and new §355.744 concerning Service Coordination definitions for Mental
retardation Local Authority (MRLA) program, §355.745 concerning service
limitations for Service Coordination through MRLA , and §355.746, concerning
reimbursement methodology for MRLA Service Coordination.
Background and Summary of Factual Basis for the Rules
Section 531.021, Government Code, entitled "Administration of Medicaid
Program," provides, among other things, that HHSC adopt rules and standards
to govern the determination of fees, charges, and rates for medical assistance
payments under Chapter 32, Human Resources Code, in consultation with the
agencies that operate the Medicaid program. The amendments describe how rates
for Service Coordination for individuals served through the MRLA program will
be established and how the service will be defined and limited.
Explanation
Subsection (a) §355.743 is amended to state that cost data is required
annually.
The amendments to §355.701 and new §§355.744-355.746 maximize
the state's opportunity to draw federal funds to cover allowable costs in
community settings. The amendments will create another service coordination
rate for those individuals with Mental Retardation being served through the
MRLA program. Currently, the state sets a single rate for service coordination
provided to all individuals with mental retardation. The amendments will result
in one rate for persons being served through the MRLA program and another
rate for all other individuals with mental retardation.
Fiscal Note
Don Green, Chief Financial Officer, has determined that for the first five
years that the proposed amendments are in effect, there is no anticipated
fiscal impact resulting from the adoption of the amendments. No additional
costs will be borne by local governments as a result of the proposed amendments,
nor is there any anticipated impact of revenues of state or local government.
Public Benefit
Don Green, Chief Financial Officer, has determined that during the first
five years that the proposed amendments and new sections are in effect, the
public benefit is that consumers and families, other stakeholders, and MRAs
within the MRLA Program will have a better understanding of the MRLA service
coordination activities for which an MRA may receive reimbursement.
Small and Micro-business Impact Analysis
The proposed amendments will not result in additional costs to persons
required to comply with the rules, nor do the rules have any anticipated adverse
effect on small or micro-businesses. The rules will not affect local employment.
Regulatory Analysis
HHSC has determined that none of the proposed amended rules is a "major
environmental rule" as defined by §2001.0225, Government Code. "Major
environmental rule" is defined to mean a rule the specific intent of which
is to protect the environment or reduce risks to human health from environmental
exposure and that may adversely affect in a material way the economy, a sector
of the economy, productivity, competition, jobs, the environment, or the public
health and safety of the state or a sector of the state. The proposed amendments
are not specifically intended to protect the environment or reduce risks to
human health from environmental exposure.
Takings Impact Assessment
HHSC has assessed the takings impact of the proposed amended rules under
Texas Government Code, §2007.043. HHSC has determined that this action
does not restrict or limit an owner's right to property that would otherwise
exist in the absence of governmental action and therefore does not constitute
a taking. The majority of the proposed amendments are administrative, non-substantive,
and do not impose any new regulatory requirements. The proposed amended rules
are reasonably taken to fulfill requirements of state law.
Public Comment
A hearing to accept oral and written testimony from members of the public
concerning the proposal has been scheduled for 1:30 p.m., Monday, June 3,
2002, in the Texas Department of Mental Health and Mental Retardation Central
Office Auditorium in Building 2 at 909 West 45th Street, in Austin, Texas.
Persons requiring an interpreter for the deaf or hearing impaired should contact
the department's Central Office operator at least 72 hours prior to the hearing
at TDD (512) 206-5330. Persons requiring other accommodations for a disability
should notify Medicaid Administration, at least 72 hours prior to the hearing
at (512) 206-5753 or at the TDY phone number of Texas Relay, 1/800-735-2988.
Public comment may be submitted in writing to Mary Ann Roberts, Manager,
HHSC Medicaid Rates and Analysis, Health and Human Services Commission, by
mail to P.O. Box 12668, Austin, Texas 78711, or by fax to 512/206-5673. Comments
must be submitted by 5:00 p.m., Monday, June 10, 2002. Further information
may be obtained by calling Mary Ann Roberts at (512) 206-5682.
Statutory Authority
The amendments are proposed under §531.021(b), Government Code, which
requires HHSC to adopt reasonable rules and standards to govern the determination
of fees, charges, and rates for medical assistance payments under Chapter
32, Human Resources Code, in consultation with the agencies that operate the
Medicaid program; and §531.033, Government Code, which provides the commissioner
of health and human services with authority to adopt rules necessary to carry
the duties of HHSC under Chapter 531, Government Code.
The proposed amended rules implement §531.021(b), Government Code,
concerning the adoption of rules and standards to govern the determination
of fees, charges, and rates for medical assistance payments under Chapter
32, Human Resources Code, and §32.0281, Human Resources Code, concerning
the adoption of rules regarding Medicaid reimbursement rates.
§355.701.Definitions and General Specifications.
(a)
The following words and terms, when used in this chapter,
shall have the following meanings, unless the context clearly indicates otherwise.
(1)-(2)
(No change.)
(3)
Full Cost Report - Cost data required
annually
by Texas Health and Human Services Commission (HHSC) that includes all costs
of providing services including direct care costs, administration, facility
costs, and all other operating costs relevant to the provision of services.
(4)-(11)
(No change.)
(b)
(No change.)
§355.743.Reimbursement Methodology for Service.
(a)
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) reimburses qualified local authorities for service coordination provided
to Medicaid-eligible individuals who are eligible for service coordination
according to
25 Texas Administrative Code
§412.455 [
(1)-(3)
(No change.)
(b)-(d)
(No change.)
(e)
Reimbursement methodology. HHSC determines reimbursement
according to §355.701 of this title (relating to General Specifications).
As specified in §355.706 of this title (relating to Adjusting Rates When
New Legislation, Regulations, or Economic Factors Affect Costs), HHSC may
also adjust reimbursements.
(1)
Local
[
(A)-(B)
(No change.)
(2)-(3)
(No change.)
(f)-(h)
(No change.)
§355.744.Service Coordination Definitions for Mental Retardation Local Authority (MRLA) Program.
The following words and terms, when used in §§355.744-355.746,
shall have the following meanings, unless the context clearly indicates otherwise.
(1)
Allowable costs - Those expenses that are reasonable and
necessary costs in the normal conduct of operations relating to case management
services. See also definitions of "reasonable cost" and of "necessary cost"
in this section and §355.743(e)(2) of this title (relating to Reimbursement
Methodology for Service).
(2)
MRLA - Mental Retardation Local Authority Program operated
by TDMHMR.
(3)
Necessary cost - A cost that is usual and customary in
the operation of case management services and that meets the following requirements.
(A)
The cost is not for personal or other activity not specifically
related to the provision of case management services.
(B)
The cost does not appear on the list of specific unallowable
costs and is not unallowable under other federal, state, or local laws or
regulations. See definition of "unallowable cost" in this section, and see §355.743(e)(3)
of this title (relating to Reimbursement Methodology for Service).
(C)
The cost bears a significant relationship to case management
services. The test of significance is whether there would be an adverse impact
on the delivery of case management services if the expenditure were eliminated.
(4)
Prospective reimbursement - Reimbursement payment amounts
that are determined for a future period of time and that are not to be readjusted
during that period.
(5)
Reasonable cost - The amount that does not exceed the cost
that would be incurred by a prudent business operator seeking to contain costs.
(6)
Unallowable cost - A cost that is not a reasonable or necessary
cost for the provision of case management services. See definitions of "necessary
cost" and of "reasonable cost" in this section.
§355.745.Service Limitations for Service Coordination through MRLA.
MRLA service coordination activities will not be reimbursable as a
Medicaid service for which another payor is liable. Service coordination activities
associated with the following are not reimbursable as an optional targeted
case management service:
(1)
Medicaid eligibility determinations and redeterminations;
(2)
Medicaid eligibility intake processing;
(3)
Medicaid preadmission screening;
(4)
prior authorization for Medicaid services;
(5)
required Medicaid utilization review;
(6)
Texas Health Steps administration; and
(7)
Medicaid "lock-in" provided for under §1915(a) of
the Omnibus Reconciliation Act of 1987.
§355.746.Reimbursement Methodology for MRLA Service Coordination.
(a)
The Texas Department of Mental Health and Mental Retardation
(TDMHMR) reimburses qualified authorities for service coordination provided
to Medicaid-eligible individuals who are eligible for service coordination
and are enrolled in the MRLA program in accordance with 25 TAC, Chapter 409,
Subchapter L (relating to Mental Retardation Local Authority (MRLA) Program).
HHSC determines reimbursement for service coordination. Reimbursement is:
(1)
uniform statewide;
(2)
prospective; and
(3)
cost related with a year-end settlement.
(b)
Service coordination rates are set for services provided
to individuals with mental retardation or a related condition who are enrolled
in and receiving services through the MRLA Program;
(c)
Local authority qualifications. 42 U.S.C. §1396n(g)
is invoked to limit the provision of service coordination to the state mental
retardation authorities, the state mental health authorities, TDMHMR, or its
designated local authorities authorized under §534.054 of the Texas Health
and Safety Code, which offer a service delivery system of required services
as outlined in §534.053 of the Texas Health and Safety Code.
(d)
Rules and procedures. TDMHMR has implemented rules and
procedures to ensure that service coordination is provided by persons who
meet the requirements specified by TDMHMR and is provided in compliance with
federal and state laws, rules, and regulations.
(e)
Reimbursement methodology. HHSC determines reimbursement
according to §355.701 of this title (relating to General Specifications).
As specified in §355.706 of this title (relating to Adjusting Rates When
New Legislation, Regulations, or Economic Factors Affect Costs), HHSC may
also adjust reimbursements.
(1)
MRLA authorities will be reimbursed a statewide rate comprising
a modeled rate plus a statewide weighted average associated service add-on.
(A)
The modeled rate is based on cost calculations that include
a statewide weighted average hourly wage for persons who provide service coordination
as 100 percent of their job responsibilities, a predetermined caseload size,
a statewide weighted average supervisory wage rate and span of control, and
a statewide weighted average benefits factor.
(B)
The associated service add-on includes clerical and support
costs, travel and training costs, and other allowable operating costs (e.g.,
rent, utilities, office supplies, administration, and depreciation) necessary
to provide service coordination.
(2)
At the end of each reimbursement period HHSC will compare
the difference between the statewide rate and each MRLA authority's service
coordination costs as submitted on its cost report in accordance with subsection
(g) of this section.
(A)
If a MRLA authority's costs are less than 95 percent of
the statewide rate, the MRLA authority will pay TDMHMR the difference between
that MRLA authority's costs and 95 percent of the statewide rate. The MRLA
authority will be notified of the amount due to TDMHMR by certified mail.
(i)
The MRLA authority will have 30 days to make payment. If
payment is not received from the MRLA authority within 30 days of the date
that the notice was received, as specified on the certified mail receipt,
HHSC will notify TDMHMR to place the MRLA authority on vendor hold.
(ii)
A MRLA authority that has been placed on vendor hold may
request an administrative hearing in accordance with §355.707 of this
title (relating to Reviews and Administrative Hearings).
(B)
If a MRLA authority's costs exceed the statewide rate,
TDMHMR will reimburse the MRLA authority its costs up to 125 percent of the
statewide rate. TDMHMR will notify the local authority by certified mail within
30 days of the date that the notice of the amount due to the local authority
was received, as specified on the certified mail receipt.
(3)
At such time as HHSC determines that cost data collected
as described in subsection (g) of this section are reliable, statewide reimbursement
rates will be developed based on the cost data submitted by MRLA authorities
in the following manner:
(A)
Total allowable costs for each provider for each rate will
be determined from analyzing the allowable historical costs reported on the
cost report.
(B)
Each provider's total allowable costs are projected from
the historical cost reporting period to the prospective reimbursement period
using inflation factors according to §355.704 of this title (relating
to Determination of Inflation Indices) for each covered contact.
(C)
Each provider's projected cost per unit of service is calculated.
The mean provider cost per contact is calculated, and the statistical outliers
(those providers whose cost per contact exceeds plus or minus (+/-) two standard
deviations from the mean provider cost per contact) are removed. After removal
of the statistical outliers, the mean cost per contact is calculated. This
mean cost per contact becomes the recommended cost per contact. Following
each annual reimbursement period, allowable costs will be compared to reimbursement
and any resulting monetary reconciliation will be made in accordance with
paragraph (2) of this subsection.
(f)
Reimbursable unit of service.
(1)
The unit of service upon which reimbursement is made is
a face-to-face contact with a Medicaid-eligible individual eligible for MRLA
service coordination in accordance with 25 TAC, §409.505 (relating to
Eligibility Criteria).
(2)
Reimbursement is limited to one unit of service per Medicaid-eligible
individual per month.
(g)
Reporting of costs. HHSC or its designee collects from
MRLA authorities statistical and cost data. The statistical data include,
but are not limited to, the total number of individuals receiving service
coordination, and the number of Medicaid-eligible individuals receiving service
coordination. The cost data include direct costs, programmatic indirect costs,
and general and administrative costs including salaries, benefits, and non-labor
costs.
(1)
Cost reports. Each MRLA authority must submit financial
and statistical information in a cost report or survey format designated by
HHSC or its designee. The cost report will capture the expenses of the MRLA
authority including salaries and benefits, administration, building and equipment,
utilities, supplies, travel, and indirect overhead costs related to the provision
of service coordination. Only allowable cost information is used to compile
the cost base, as defined in §355.741 of this title (relating to Definitions
and General Specifications) and §355.708 of this title (relating to Allowable
and Unallowable Costs).
(A)
Accounting requirements. All information submitted on the
cost reports must be based upon the accrual method of accounting unless the
governmental entity operates on a cash or modified accrual basis. The MRLA
authority must complete the cost report according to the prescribed statement
of allowable and unallowable costs as referenced in §355.702 of this
title (relating to Method of Cost Determination). Cost reporting should be
consistent with generally accepted accounting principles (GAAP) in this subchapter.
In cases in which cost reporting rules conflict with GAAP, Internal Revenue
Service, or other authorities, the cost reporting rules take precedence.
(B)
Reporting period. The MRLA authority must prepare the cost
report according to §355.702 of this title (relating to Method of Cost
Determination).
(2)
Exclusions or adjustments. MRLA authorities must exclude
unallowable costs from the cost report. HHSC or its designee excludes from
the cost reimbursement base any unallowable costs included in the cost report
and makes adjustments to expenses reported by MRLA authorities to ensure that
the cost reimbursement base reflects costs that are consistent with efficiency,
economy, and quality care, are necessary for the provision of service coordination
services, and are consistent with federal and state Medicaid regulations as
specified in §355.701 of this title (relating to Definitions and General
Specifications). If there is doubt as to the accuracy of allowability of a
significant part of the information reported, individual cost reports may
be eliminated from the cost base.
(3)
Desk reviews. As specified in §355.703 of this title
(relating to Basic Objectives and Criteria for Review of Cost Reports), HHSC
or its designee reviews such cost reports or surveys. Cost reports not completed
according to instructions or rules will be corrected and resubmitted by the
MRLA authority within the time frame prescribed by HHSC.
(4)
On-site audit of cost reports. HHSC or its designee performs
a sufficient number of audits each year to ensure the fiscal integrity of
the service coordination reimbursement. The number of on-site audits actually
performed each year may vary.
(A)
HHSC or its designee notifies MRLA authorities of disallowances
and adjustments to reported expenses made during desk reviews and on-site
audits of cost reports according to §355.705 of this title (relating
to Notification).
(B)
Reviews of cost report disallowances. A MRLA authority
which disagrees with HHSC or its designee on cost report disallowances may
request a review of the disallowances as specified in §355.707 of this
title (relating to Reviews and Administrative Hearings).
(5)
Recordkeeping requirements. Each MRLA authority must maintain
records according to the requirements specified in TDMHMR rules and the provider
agreement. The MRLA authority must ensure that the records are accurate and
sufficiently detailed to support the financial and statistical information
reported in the cost report. If a MRLA authority does not maintain records
that support the financial and statistical information submitted on the cost
report, the MRLA authority will be notified by certified mail that the local
authority has 90 days to correct this recordkeeping. HHSC will notify TDMHMR
to place the MRLA authority on vendor hold if the correction is not made within
90 days from the date the MRLA authority receives notification.
(6)
Access to records. The MRLA authority must allow HHSC access
to any and all records necessary to verify information on the cost report.
(h)
Billing and payment reviews. The provider must allow TDMHMR
access to any and all records regarding service coordination.
(1)
TDMHMR will conduct periodic billing and payment reviews
utilizing TDMHMR's Billing and Payment Review Protocol.
(2)
Recoupment will be taken according to the application of
error calculations contained in TDMHMR's Billing and Payment Review Protocol.
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 April 29, 2002.
TRD-200202655
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: June 9, 2002
For further information, please call: (512) 424-6630
6.
RURAL HEALTH CLINICS
1 TAC §355.8101
The Health and Human Services Commission (HHSC) proposes
an amendment to §355.8101. The proposed amendment incorporates federally-mandated
changes to the reimbursement methodology for rural health clinics. The amendment
also explains how reimbursement rates will be calculated. The proposed reimbursement
methodology is either a prospective payment system (PPS) or an alternative
payment system. The per visit rates for both payment systems will be derived
from a facility's reasonable costs for a specified period of time.
Don Green, Chief Financial Officer, has determined that during the first
five years the proposed rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
section.
Mr. Steve Lorenzen, Director of Rate Setting, has determined that during
the first five years the proposed rule is in effect, it will benefit the public
by providing a clear description of the RHC reimbursement methodology. Small
businesses and micro-businesses will not be required to alter their business
practices to comply with the proposed rule, so it will not effect these businesses.
There are no anticipated economic costs to persons required to comply with
the proposed rule, nor any impact on local employment.
HHSC has determined that this proposed rule is not a "major environmental
rule" as defined by §2001.0225 of the Texas Government Code. "Major environmental
rule" is defined to mean a rule the specified intent of which is to protect
the environment or reduce risk to human health from environmental exposure
and that may adversely affect in a material way the economy, a sector of the
economy, productivity, competition, jobs, the environment or the public health
and safety of a state or a a sector of the state. The proposed rule is not
specifically intended t protect the environment or reduce risks to human health
from environmental exposure.
HHSC has determined that this proposed rule does not restrict or limit
an owner's right to their property that would otherwise exist in the absence
of governmental action and therefore does not constitute a taking under §2007.043,
Government Code.
Written comments on the proposed rule may be submitted to Jennifer Stansbury,
Program Specialist, Medicaid/CHIP Benefits, Texas Health and Human Services
Commission, 1100 W. 49th, Austin, Texas 78756, within 30 days of publication
of this proposal in the
Texas Register
. In
addition, a public hearing concerning the proposed rule will be held on May
21, 2002, 2:00 p.m. to 5:00 p.m., at the Texas Health and Human Services Commission,
12555 Riata Vista Circle, Bldg. #3, Austin, Texas. To comply with federal
regulations, a copy of the proposal is being sent to each Texas Department
of Human Services (DHS) office where it will be available for public review
upon request.
The amendment is proposed under the Texas Government Code, §531.033,
which provides the Commissioner of HHSC with broad rulemaking authority; Human
Resources Code, §32.021 and the Texas Government Code, §531.021(a),
which provide the Health and Human Services Commission (HHSC) with the authority
to administer the federal medical assistance (Medicaid) program in Texas;
and the Texas Government Code, §531.021(b), which provides HHSC with
the authority to propose and adopt rules governing the determination of Medicaid
reimbursements.
The proposed amendment affects the Human Resources Code, Chapter 32 and
the Government Code, Chapter 531. No other statutes, articles, or codes are
affected by the proposed rule.
§355.8101.Reimbursement.
(a)
Prospective Payment System.
Rural health clinics (RHCs) employing the Prospective Payment System (PPS)
methodology, in accordance with section 1902 (aa) of the Social Security Act
as amended by the Benefits Improvement and Protection Act (BIPA) of 2000 (42
U.S.C. §1396a (aa)) effective for the RHC's fiscal year that includes
dates of service occurring January 1, 2001, and after, RHC's will be reimbursed
a PPS per visit rate for Medicaid covered services. There will no longer be
a cost settlement for RHCs for dates of services on or after January 1, 2001.
(1)
The PPS per visit rate for both hospital-based
and freestanding RHCs will be calculated based on one hundred percent (100%)
of the average of the RHC's reasonable costs for providing Medicaid covered
services as determined from audited cost reports for the RHC's 1999 and 2000
fiscal years. The PPS per visit rates will be calculated by adding the total
audited reimbursable costs as determined from the 1999 and 2000 cost reports
and dividing by the total audited visits for these same two periods.
(2)
For hospital-based RHCs, an interim PPS per
visit rate for each RHC will be calculated based upon the encounter rate from
the latest finalized cost report settlement, adjusted as provided for in paragraph
(7) of this subsection . For freestanding RHCs, the interim PPS per visit
rate for each RHC will be based upon the per visit rate in the Medicaid payment
system as of December 31, 2000, adjusted as provided for in paragraph (7)
of this subsection. When HHSC has determined a final PPS rate, interim payments
will be reconciled back to January 1, 2001.
(3)
Reasonable costs, as used in setting the interim
PPS rate, the PPS rate or any subsequent effective rate, is defined as those
costs that are allowable under Medicare Cost. Principles as outlined in 42
CFR part 413. The cost limits that were in place on December 31, 2000, shall
be maintained in determining reasonable costs. Reasonable costs shall not
include unallowable costs.
(4)
Unallowable costs are expenses that are incurred
by an RHC and that are not directly or indirectly related to the provision
of covered services according to applicable laws, rules, and standards. An
RHC may expend funds on unallowable cost items, but those costs must not be
included in the cost report/survey, and they are not used in calculating a
rate determination. Unallowable costs include, but are not necessarily limited
to, the following:
(A)
compensation in the form of salaries, benefits,
or any form of compensation given to individuals who are not directly or indirectly
related to the provision of covered services;
(B)
personal expenses not directly related to the
provision of covered services;
(C)
management fees or indirect costs that are not
derived from the actual cost of materials, supplies, or services necessary
for the delivery of covered services, unless the operational need and cost
effectiveness can be demonstrated;
(D)
advertising expenses other than those for advertising
in the telephone directory yellow pages, for employee or contract labor recruitment,
and for meeting any statutory or regulatory requirement;
(E)
business expenses not directly related to the
provision of covered services. For example, expenses associated with the sale
or purchase of a business or expenses associated with the sale or purchase
of investments;
(F)
political contributions;
(G)
depreciation and amortization of unallowable
costs, including amounts in excess of those resulting from the straight line
depreciation method; capitalized lease expenses, less any maintenance expenses,
in excess of the actual lease payment; and goodwill or any excess above the
actual value of the physical assets at the time of purchase. Regarding the
purchase of a business, the depreciable basis will be the lesser of the historical
but not depreciated cost to the previous owner or the purchase price of the
assets. Any depreciation in excess of this amount is unallowable;
(H)
trade discounts and allowances of all types,
including returns, allowances, and refunds received on purchases of goods
or services. These are reductions of costs to which they relate and thus,
by reference, are unallowable;
(I)
donated facilities, materials, supplies, and
services including the values assigned to the services of unpaid workers and
volunteers whether directly or indirectly related to covered services, except
as permitted in 42 C.F.R. Part 413;
(J)
dues to all types of political and social organizations,
and to professional associations whose functions and purpose are not reasonably
related to the development and operation of patient care facilities and programs,
or the rendering of patient care services;
(K)
entertainment expenses except those incurred
for entertainment provided to the staff of the RHC as an employee benefit.
An example of entertainment expenses is lunch during the provision of continuing
medical education on-site;
(L)
board of director's fees, including travel costs
and meals provided for these directors;
(M)
fines and penalties for violations of statutes,
regulations, and ordinances of all types;
(N)
fund raising and promotional expenses except
as noted in subparagraph (D) of this subsection;
(O)
interest expenses on loans pertaining to unallowable
items, such as investments. Also the interest expense on that portion of interest
paid that is reduced or offset by interest income;
(P)
insurance premiums pertaining to items of unallowable
cost;
(Q)
any accrued expenses that are not a legal obligation
of the provider or are not clearly enumerated as to dollar amount;
(R)
mileage expense exceeding the current reimbursement
rate set by the federal government for its employee travel;
(S)
cost for goods or services that are purchased
from a related party and which exceed the original cost to the related party;
(T)
out-of-state travel expenses not related to
the provision of covered services, except out-of-state travel expenses for
training courses that increase the quality of medical care and/or the operating
efficiency of the RHC;
(U)
over-funding contributions to self-insurance
funds that do not represent payments based on current liabilities;
(5)
A visit is a face-to-face encounter between
an RHC patient and a physician, physician assistant, advanced nurse practitioner,
certified nurse-midwife, visiting nurse, or clinical nurse practitioner. Encounters
with more than one health professional and multiple encounters with the same
health professional that take place on the same day and at a single location
constitute a single visit, except where one of the following conditions exists:
(A)
after the first encounter, the patient suffers
illness or injury requiring additional diagnosis or treatment; or
(B)
the RHC patient has a medical visit and an "other"
health visit.
(6)
A visit is a face-to-face encounter between
an RHC patient and a physician, physician assistant, advanced nurse practitioner,
certified nurse mid-wife, visiting nurse, or clinical nurse practitioner.
An "other" health visit includes, but is not limited to, a face-to-face encounter
between an RHC patient and a clinical social worker.
(7)
Effective for each RHC's fiscal year that includes
dates of services occurring on or after October 1, 2001, subsequent increases
in an RHC's PPS per visit rate or the effective rate shall be the rate of
change in the Medicare Economic Index (MEI) for Primary Care.
(8)
The effective rate is the rate paid to the RHC
for the current fiscal year. The effective rate equals the base rate plus
the MEI for each of the RHC's fiscal years since the setting of its PPS rate.
The effective rate shall be calculated at the start of each RHC's fiscal year
and shall be applied prospectively for that fiscal year.
(9)
An adjustment shall be made to the effective
rate if change is due to a change in scope. An RHC or HHSC may request an
adjustment of the effective rate equal to one hundred percent (100%) of reasonable
costs by the filing of a cost report and the necessary documentation to support
a claim that the RHC has undergone a change in scope. A cost report, filed
to request an adjustment in the effective rate, may be filed at any time during
an RHC's fiscal year but no later than five (5) calendar months after the
end of the RHC's fiscal year. All requests for adjustment in the RHC's effective
rate must include at least 6 months of financial data. Any effective rate
adjustment granted as a result of such a filing must be completed within sixty
(60) days of receipt of a workable cost report and documentation supporting
the RHC's claim that it has undergone a change in scope. Within sixty (60)
days of submitting a workable cost report, HHSC or its designee shall make
a determination regarding a new effective rate. The new effective rate shall
become effective the first day of the month immediately following its determination.
All subsequent increases shall be calculated using the adjusted effective
rate.
(10)
Any request to adjust an effective rate must
be accompanied by documentation showing that the RHC has had a change in scope.
(11)
A change in scope of services provided by an
RHC includes the addition or deletion of a service or a change in the magnitude,
intensity, or character of services currently offered by an RHC or one of
the RHC's sites. A change in scope includes:
(A)
an increase in service intensity attributable
to changes in the types of patients served, including but not limited to,
HIV/AIDS, the homeless, elderly, migrant, other chronic diseases or special
populations;
(B)
any changes in services or provider mix provided
by an RHC or one of its sites;
(C)
changes in operating costs that have occurred
during the fiscal year and that are attributable to capital expenditures,
including new service facilities or regulatory compliance;
(D)
Changes in operating costs attributable to changes
in technology or medical practices at the RHC;
(E)
indirect medical education adjustments and a
direct graduate medical education payment that reflects the costs of providing
teaching services to interns and residents; or
(F)
any changes in scope approved by the Health
Resources and Service Administration (HRSA).
(12)
A workable cost report includes the following:
(A)
for a hospital-based RHC, complete HCFA Form
2552 and HCFA Form 339 with certification by an officer or administrator including:
(i)
M-1 (analysis of provider-based RHC costs);
(ii)
M-2 (allocation of overhead to RHC services);
(iii)
M-3 (calculation of reimbursement settlement
for RHC services);
(iv)
M-5 (analysis of payments to hospital-based
RHC services rendered to program beneficiaries);
(v)
S-8 (statistical data/information purposes);
(vi)
RHC net expenses for allocation of costs for
services rendered on or after January 1, 1998, reported on the hospital's
worksheet A, column 7 traced properly to the RHC's total facility costs on
line 32, column 7 on M-1 worksheet; and
(vii)
hospital's overhead worksheet expenses allocated
to each of the hospital-based RHC cost centers on worksheet B, Part I (column
27 minus column 0) traced properly to line 15, column 5 on M-2 worksheet for
each hospital-based RHC.
(B)
for a freestanding RHC, a complete HCFA 222
Form and HCFA 339 Form with certification by an officer of administrator.
(13)
Once the base rate for an RHC has been calculated,
the RHC will be paid its effective rate without the need to file a cost report.
Except as specified in paragraph (14) of this subsection, a cost report will
be required only if the RHC is seeking to adjust its effective rate as an
RHC.
(14)
New RHCs will file a projected cost report
within 90 days of their designation to establish an initial payment rate.
The cost report will contain the RHC's reasonable costs anticipated to be
incurred during the RHC's initial fiscal year. The RHC will file a cost report
within five (5) months of the end of the RHC's initial fiscal year. The cost
settlement must be completed within six (6) months of receipt of a cost report.
The cost per visit rate established by the cost settlement process shall be
the base rate. Any subsequent increases will be calculated as provided herein.
A new RHC location established by an existing RHC participating in the Medicaid
program will receive the same effective rate as the RHC establishing the new
location. An RHC establishing a new location may request an adjustment to
its effective rate as provided herein if its costs have increased as a result
of establishing a new location.
(15)
In the event that the total amount paid to
an RHC by a managed care organization is less than the amount the RHC would
receive under PPS, the state will reimburse the difference on a quarterly
basis. The state's quarterly supplemental payment obligation will be determined
by subtracting the baseline payment under the contract for services being
provided from the effective rate without regard to the effects of financial
incentives that are linked to utilization outcomes, reductions in patient
cost, or bonuses.
(16)
An RHC shall submit a copy of its audited Medicare
cost report to HHSC within 15 days of receipt.
[
(b)
Alternative Payment System.
RHCs employing the alternative to the PPS methodology in accordance with section
1902 (aa) of the Social Security Act as amended by the Benefits Improvement
and Protection Act (BIPA) of 2000 (42 U.S.C. §1396a (aa)) effective for
the RHC fiscal year that includes dates of service occurring January 1, 2001,
and after, will be reimbursed a per visit rate for Medicaid covered services.
There will no longer be a cost settlement for RHCs for dates of services on
or after January 1, 2001.
(1)
Written and signed agreements will be obtained
from all RHC providers agreeing to the alternative methodology.
(2)
The alternative PPS per visit rate for both
hospital-based and freestanding RHCs will be calculated based on one hundred
percent (100%) of the average of the RHC's reasonable costs for providing
Medicaid covered services as determined from audited cost reports for the
RHC's 1999 and 2000 fiscal years. The alternative PPS per visit rates will
be calculated by adding the total audited reimbursable costs as determined
from the 1999 and 2000 cost reports and dividing by the total audited visits
for these same two periods. The per visit rate using this alternative methodology
will provide reimbursement equal to or greater than what would have occurred
under PPS.
(3)
For hospital-based RHCs, an interim alternative
PPS per visit rate for each RHC will be calculated based upon the encounter
rate from the latest cost report settlement, adjusted as provided for in paragraph
(8) of this subsection. For freestanding RHCs, the interim alternative PPS
per visit rate for each RHC will be based upon the per visit rate in the Medicaid
payment system as of December 31, 2000, adjusted as provided for in paragraph
(8) of this subsection. When HHSC has determined a final alternative PPS rate,
interim payments will be reconciled back to January 1, 2001. Adjustments will
be made only if the interim payments are less than what would have occurred
under PPS.
(4)
Reasonable costs, as used in setting the interim
alternative PPS rate, the alternative PPS rate or any subsequent effective
rate, is defined as those costs that are allowable under Medicare Cost Principles
as outlined in 42 C.F.R. part 413. The cost limits that were in place on December
31, 2000, shall be maintained in determining reasonable costs. Reasonable
costs shall not include unallowable costs.
(5)
Unallowable costs are expenses that are incurred
by an RHC and that are not directly or indirectly related to the provision
of covered services according to applicable laws, rules, and standards. An
RHC may expend funds on unallowable cost items, but those costs must not be
included in the cost report/survey, and they are not used in calculating a
rate determination. Unallowable costs include, but are not necessarily limited
to, the following:
(A)
compensation in the form of salaries, benefits,
or any form of compensation given to individuals who are not directly or indirectly
related to the provision of covered services;
(B)
personal expenses not directly related to the
provision of covered services;
(C)
management fees or indirect costs that are not
derived from the actual cost of materials, supplies, or services necessary
for the delivery of covered services, unless the operational need and cost
effectiveness can be demonstrated;
(D)
advertising expenses other than those for advertising
in the telephone directory yellow pages, for employee or contract labor recruitment,
and for meeting any statutory or regulatory requirement;
(E)
business expenses not directly related to the
provision of covered services. For example, expenses associated with the sale
or purchase of a business or expenses associated with the sale or purchase
of investments;
(F)
political contributions;
(G)
depreciation and amortization of unallowable
costs, including amounts in excess of those resulting from the straight line
depreciation method; capitalized lease expenses, less any maintenance expenses,
in excess of the actual lease payment; and goodwill or any excess above the
actual value of the physical assets at the time of purchase. Regarding the
purchase of a business, the depreciable basis will be the lesser of the historical
but not depreciated cost to the previous owner or the purchase price of the
assets. Any depreciation in excess of this amount is unallowable;
(H)
trade discounts and allowances of all types,
including returns, allowances, and refunds received on purchases of goods
or services. These are reductions of costs to which they relate and thus,
by reference, are unallowable;
(I)
donated facilities, materials, supplies, and
services including the values assigned to the services of unpaid workers and
volunteers whether directly or indirectly related to covered services, except
as permitted in 42 C.F.R. part 413;
(J)
dues to all types of political and social organizations,
and to professional associations whose functions and purpose are not reasonably
related to the development and operation of patient care facilities and programs,
or the rendering of patient care services;
(K)
entertainment expenses except those incurred
for entertainment provided to the staff of the RHC as an employee benefit.
An example of entertainment expenses is lunch during the provision of continuing
medical education on-site;
(L)
board of director's fees, including travel costs
and meals provided for these directors;
(M)
fines and penalties for violations of statutes,
regulations, and ordinances of all types;
(N)
fund raising and promotional expenses except
as noted in subparagraph (D) of this subsection;
(O)
interest expenses on loans pertaining to unallowable
items, such as investments. Also the interest expense on that portion of interest
paid that is reduced or offset by interest income;
(P)
insurance premiums pertaining to items of unallowable
cost;
(Q)
any accrued expenses that are not a legal obligation
of the provider or are not clearly enumerated as to dollar amount;
(R)
mileage expense exceeding the current reimbursement
rate set by the federal government for its employee travel;
(S)
cost for goods or services that are purchased
from a related party and which exceed the original cost to the related party;
(T)
out-of-state travel expenses not related to
the provision of covered services, except out-of-state travel expenses for
training courses that increase the quality of medical care and/or the operating
efficiency of the RHC;
(U)
over-funding contributions to self-insurance
funds that do not represent payments based on current liabilities;
(6)
A visit is a face-to-face encounter between
an RHC patient and a physician, physician assistant, advanced nurse practitioner,
certified nurse-midwife, visiting nurse, or clinical nurse practitioner. Encounters
with more than one health professional and multiple encounters with the same
health professional that take place on the same day and at a single location
constitute a single visit, except where one of the following conditions exists:
(A)
after the first encounter, the RHC patient suffers
illness or injury requiring additional diagnosis or treatment; or
(B)
the RHC patient has a medical visit and an "other"
health visit.
(7)
A visit is a face-to-face encounter between
an RHC patient and a physician, physician assistant, advanced nurse practitioner,
certified nurse mid-wife, visiting nurse, or clinical nurse practitioner.
An "other" health visit includes, but is not limited to, a face-to-face encounter
between an RHC patient and a clinical social worker.
(8)
Effective for each RHC's fiscal year that includes
dates of services occurring on or after October 1, 2001, subsequent increases
in an RHC's alternative PPS per visit rate or the effective rate shall be
the rate of change in the MEI for Primary Care.
(9)
The effective rate is the rate paid to the RHC
for the current fiscal year. The effective rate equals the base rate plus
the MEI for each of the RHC's fiscal years since the setting of its alternative
PPS rate. The effective rate shall be calculated at the start of each RHC's
fiscal year and shall be applied prospectively for that fiscal year.
(10)
An adjustment shall be made to the effective
rate if change is due to a change in scope. An RHC or HHSC may request an
adjustment of the effective rate equal to one hundred percent (100%) of reasonable
costs by the filing of a cost report and the necessary documentation to support
a claim that the RHC has undergone a change in scope. A cost report, filed
to request an adjustment in the effective rate, may be filed at any time during
an RHC's fiscal year but no later than five (5) calendar months after the
end of the RHC's fiscal year. All requests for adjustment in the RHC's effective
rate must include at least 6 months of financial data. Any effective rate
adjustment granted as a result of such a filing must be completed within sixty
(60) days of receipt of a workable cost report and documentation supporting
the RHC's claim that it has undergone a change in scope. Within sixty (60)
days of submitting a workable cost report, HHSC or its designee shall make
a determination regarding a new effective rate. The new effective rate shall
become effective the first day of the month immediately following its determination.
All subsequent increases shall be calculated using the adjusted effective
rate.
(11)
Any request to adjust an effective rate must
be accompanied by documentation showing that the RHC has had a change in scope.
(12)
A change in scope of services provided by an
RHC includes the addition or deletion of a service or a change in the magnitude,
intensity, or character of services currently offered by an RHC or one of
the RHC's sites. A change in scope includes:
(A)
an increase in service intensity attributable
to changes in the types of patients served, including but not limited to,
HIV/AIDS, the homeless, elderly, migrant, other chronic diseases or special
populations;
(B)
any changes in services or provider mix provided
by an RHC or one of its sites;
(C)
changes in operating costs that have occurred
during the fiscal year and that are attributable to capital expenditures including
new service facilities or regulatory compliance;
(D)
changes in operating costs attributable to changes
in technology or medical practices at the RHC;
(E)
indirect medical education adjustments and a
direct graduate medical education payment that reflects the costs of providing
teaching services to interns and residents; or
(F)
any changes in scope approved by the Health
Resources and Service Administration (HRSA).
(13)
A workable cost report includes the following:
(A)
for a hospital-based RHC, complete HCFA Form
2552 and HCFA Form 339 with certification by an officer or administrator including:
(i)
M-1 (analysis of provider-based RHC costs);
(ii)
M-2 (allocation of overhead to RHC services);
(iii)
M-3 (calculation of reimbursement settlement
for RHC services);
(iv)
M-5 (analysis of payments to hospital-based
RHC services rendered to program beneficiaries);
(v)
S-8 (statistical data/information purposes);
(vi)
RHC net expenses for allocation of costs for
services rendered on or after January 1, 1998, reported on the hospital's
worksheet A, column 7 traced properly to the RHC's total facility costs on
line 32, column 7 on M-1 worksheet; and
(vii)
hospital's overhead worksheet expenses allocated
to each of the hospital-based RHC cost centers on worksheet B, Part I (column
27 minus column 0) traced properly to line 15, column 5 on M-2 worksheet for
each hospital-based RHC.
(B)
for a freestanding RHC, a complete HCFA 222
Form and HCFA 339 Form with certification by an officer of administrator.
(14)
Once the base rate for an RHC has been calculated,
the RHC will be paid its effective rate without the need to file a cost report.
Except as specified in paragraph (15) of this subsection, a cost report will
be required only if the RHC is seeking to adjust its effective rate as an
RHC.
(15)
New RHCs must file a projected cost report
within 90 days of their designation to establish an initial payment rate.
The cost report will contain the RHC's reasonable costs anticipated to be
incurred during the RHC's initial fiscal year. The RHC will file a cost report
within five (5) months of the end of the RHC's initial fiscal year. The cost
settlement must be completed within six (6) months of receipt of a cost report.
The cost per visit rate established by the cost settlement process will be
the base rate. Any subsequent increases will be calculated as provided herein.
A new RHC location established by an existing RHC participating in the Medicaid
program will receive the same effective rate as the RHC establishing the new
location. An RHC establishing a new location may request an adjustment to
its effective rate as provided herein if its costs have increased as a result
of establishing a new location.
(16)
In the event that the total amount paid to
an RHC by a managed care organization is less than the amount that the RHC
would receive under the alternative PPS, the state will reimburse the difference
on a quarterly basis. The state's quarterly supplemental payment obligation
will be determined by subtracting the baseline payment under the contract
for services being provided from the effective rate without regard to the
effects of financial incentives that are linked to utilization outcomes, reductions
in patient cost, or bonuses.
(17)
An RHC shall submit a copy of its audited Medicare
cost report to HHSC within 15 days of receipt.
[
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 April 29, 2002.
TRD-200202654
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: June 9, 2002
For further information, please call: (512) 424-6630
Article 6139f, Revised Civil Statutes
].
Article 6139f, Revised Civil Statutes
].
Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Subchapter F. GENERAL REIMBURSEMENT METHODOLOGY FOR ALL MEDICAL ASSISTANCE PROGRAMS
of this title
] (relating to
Eligibility
[
Reimbursement
Methodology for Service
]). HHSC determines reimbursement for service
coordination. Reimbursement is:
For the reimbursement period beginning
April 1, 1999, local
] authorities will be reimbursed a statewide rate
comprising a modeled rate plus a statewide weighted average associated service
add-on.
Subchapter J. PURCHASED HEALTH SERVICES
(a)
Reimbursement for rural health
clinic services as defined in §29.1201 of this title (relating to Authorized
Services by Rural Health Clinics) will be made on the basis of reasonable
costs according to the principles specified in federal regulations at 42 Code
of Federal Regulations §450.30(a)(10)(i).]
(b)
Reimbursement for other ambulatory
services as defined in §29.1201 of this title (relating to Authorized
Services by Rural Health Clinics), which are covered under the Texas Medical
Assistance Program, will be made at rates and charges established under the
program for payment to providers of these services in settings other than
a rural health clinic. Payment for other ambulatory services is subject to
the upper limits specified in federal regulations at 42 Code of Federal Regulations §450.30(b).]
14.
FEDERALLY QUALIFIED HEALTH CENTER SERVICES