Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355.
MEDICAID REIMBURSEMENT RATES
Subchapter J. PURCHASED HEALTH SERVICES
The Health and Human Services Commission (HHSC) proposes to amend §355.8401,
concerning case management reimbursement methodology, and to repeal §355.8481,
concerning EPSDT: Texas Health Steps medical case management, in its Medicaid
Reimbursement Rates chapter. HHSC also proposes to re-title Division 21 from
Case Management for High-Risk Pregnant Women and High-Risk Infants to Case
Management for Children and Pregnant Women. The amendment and repeal are necessary
to reflect the consolidation by the Texas Department of Health of two existing
case management programs, Targeted Case Management Services for Pregnant Women
and Infants and Texas Health Steps Medical Case Management, to form one program,
Case Management for Children and Pregnant Women. Section 355.8401 is being
amended to reflect the name of the new program and to correct organizational
references. Section 355.8481 is being repealed as it is no longer needed.
There are no changes to the methodology or rates used to reimburse providers
for covered case management services.
Tom Suehs, Deputy Commissioner for Financial Services, has determined that
for the first five years the proposed amendment and repeal are in effect,
there will be no fiscal implications for the state or local governments as
a result of enforcing or administering the amendment and repeal. The reimbursement
methodology and rates for the new consolidated case management program remain
the same as those used in the previous programs.
Steve Lorenzen, Director of Rate Analysis, has determined that for each
year of the first five years the proposed amendment and repeal are in effect,
the public benefit anticipated as a result of enforcing the amendment and
repeal is that HHSC reimbursement rules will be consistent with the consolidated
case management program. There is no anticipated impact on small businesses
and micro-businesses to comply with the amendment and repeal as proposed as
they will not be required to alter their business practices as a result of
the amendment and repeal. There are no anticipated economic costs to persons
who are required to comply with the proposed amendment and repeal. There is
no anticipated impact on local employment.
HHSC has determined that the proposed amended rule and repeal are 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 specific 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 sector of the state. The proposed
amendment and repeal are not specifically intended to protect the environment
or reduce risks to human health from environmental exposure.
HHSC has determined that this proposed amendment and repeal do not restrict
or limit an owner's right to their property that would otherwise exist in
the absence of governmental action and therefore do not constitute a taking
under §2007.043, Government Code.
Written comments on the proposal may be submitted to Mr. Joe Branton, Rate
Analysis Department, Texas Health and Human Services Commission, 1100 West
49th Street, Austin, Texas 78756, within 30 days of publication of this proposal
in the
Texas Register
.
21.
CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN
1 TAC §355.8401
The amendment is proposed under the Texas Government Code, §531.033,
which provides the commissioner of HHSC with broad rulemaking authority; the
Human Resources Code, §32.021, and the Texas Government Code, §531.021(a),
which provide 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 Texas Government Code, Chapter 531.
§355.8401.Case Management Reimbursement Methodology.
(a)
General information. The
Health and Human Services
Commission (HHSC)
[
(1)
uniform throughout the geographic area(s) providing the
service; and
(2)
cost-related.
(b)
Basis for rate analysis.
(1)
For the initial reimbursement period, providers are reimbursed
based on rates set as a result of modeling other rates for case management
services, and cost information provided by the
Texas Department of Health
[
(2)
At some future date, as yet unspecified, reimbursements
will be based on cost-based prospective rates.
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 March 24, 2003.
TRD-200301884
Steve Aragon
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: May 4, 2003
For further information, please call: (512) 424-6576
Texas Department of Health (department)
]
will reimburse qualified providers for case management services provided to
Medicaid-eligible
children and
[
individuals who are high-risk
] pregnant women [
or high-risk infants
]. The
HHSC
[
department
] determines reimbursement rates at least annually for case
management services. These rates are:
department
].
25.
EPSDT: TEXAS HEALTHSTEPS MEDICAL CASE MANAGEMENT