TITLE 1.ADMINISTRATION

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) adopts an amendment to §355.8401, concerning case management reimbursement methodology, and the repeal of §355.8481, concerning EPSDT: Texas Health Steps medical case management, in its Medicaid Reimbursement Rates chapter, without changes to the proposed text as published in the April 4, 2003, issue of the Texas Register (28 TexReg 2829). The text of the amendment and repeal will not be republished. HHSC also has re-titled 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 amended to reflect the name of the new program and to correct organizational references. Section 355.8481 is repealed, as it is no longer needed.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.

No comments were received during the public comment period.

21. CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN

1 TAC §355.8401

The amendment is adopted 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.

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 July 7, 2003.

General Counsel

Texas Health and Human Services Commission

Effective date: September 1, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 424-6576

25. EPSDT: TEXAS HEALTHSTEPS MEDICAL CASE MANAGEMENT

1 TAC §355.8481

The repeal is adopted 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.

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 July 7, 2003.

General Counsel

Texas Health and Human Services Commission

Effective date: September 1, 2003

Proposal publication date: April 4, 2003

For further information, please call: (512) 424-6576

Chapter 371. MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY

Subchapter G. LEGAL ACTION RELATING TO PROVIDERS OF MEDICAL ASSISTANCE

1. FRAUD OR ABUSE INVOLVING MEDICAL PROVIDERS

1 TAC §371.1627

The Health and Human Services Commission (HHSC) adopts an amendment to §371.1627, concerning Request for Reinstatement, without changes to the proposed text as published in the March 7, 2003, issue of the Texas Register (28 TexReg 2015), and therefore will not be republished.

The adopted amendments to §371.1627 add clarification to more accurately reflect the essential components as well as the functional and operational elements of the program for excluded medical providers requesting reinstatement. The adopted amendments more clearly state that the provider requesting reinstatement will reimburse all outstanding receivables prior to enrollment or re-enrollment.

There were no comments received by HHSC concerning the proposed amendments.

The amendment is adopted 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 HHSC with the authority to administer the federal medical assistance Title XIX Medicaid program in Texas.

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 July 7, 2003.

General Counsel

Texas Health and Human Services Commission

Effective date: July 27, 2003

Proposal publication date: March 7, 2003

For further information, please call: (512) 424-6576