TITLE 1.ADMINISTRATION

Part 12. COMMISSION ON STATE EMERGENCY COMMUNICATIONS

Chapter 251. REGIONAL PLANS--STANDARDS

1 TAC §251.1

The Commission on State Emergency Communications (CSEC) proposes an amendment to §251.1, concerning regional plans for 9-1-1 service to outline the procedures for implementing and managing a mobile Primary Safety Answering Point (PSAP) and to propose changes to existing sections as necessary.

The amendment provides a definition for a mobile PSAP and a section outlining the procedures for implementing and managing a mobile PSAP, including the submission of standard operating procedures.

Paul Mallett, executive director, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Mallett has determined that for each year of the first five years the section is to be in effect, the public benefit anticipated as a result of enforcing the section will be improved effectiveness and reliability of 9-1-1 call delivery systems in the state program regions throughout the state. No historical data is available, however, there appears to be no direct impact on small or large businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. There is no anticipated local employment impact as a result of enforcing the section.

Comments on the proposed rule may be submitted in writing within 30 days after publication of the proposal in the Texas Register to Paul Mallett, Executive Director, Commission on State Emergency Communications, 333 Guadalupe Street, Suite 2-212, Austin, Texas 78701-3942.

The amendment is proposed under Health and Safety Code, Chapter 771, §§771.051, 771.055, 771.056, 771.057, and 771.075; and Title 1 Texas Administrative Code, Part 12, Chapter 251, Regional Plan Standards, which provide the Commission on State Emergency Communications with the authority to plan, develop, provide provisions for and enhance the effectiveness and efficiency of 9-1-1 service.

No other statutes, articles or codes are affected by the proposed amendment.

§251.1.Regional Strategic Plans for 9-1-1 Service.

(a) Purpose. The Commission on State Emergency Communications ( Commission [ CSEC ]) herein establishes a framework for regional planning commissions (RPCs) to use in the development of regional strategic plans for provisioning 9-1-1 service. Regional strategic plans should include, but not be limited to, the elements and subsections of this rule. Other rules provide specific standards for performance of these requirements.

(b) Definitions. The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.

(1) 9-1-1 Call Taking Position--Equipment acquired with 9-1-1 funds to answer the delivery of an emergency 9-1-1 call. The position is defined as the equipment necessary to answer the call, not the associated personnel. A position consists of a device for answering the 9-1-1 calls, a device to display 9-1-1 call information, and the related telephone circuitry and computer and/or router equipment necessary to ensure reliable handling of the 9-1-1 call.

(2) 9-1-1 Database--An organized collection of information, which is typically stored in computer systems that are comprised of fields, records (data), and indexes. In 9-1-1, such databases include master street address guides (MSAG), telephone numbers, emergency service numbers (ESN), and telephone customer records. This information is used for the delivery of location information to a designated public safety answering point (PSAP). Use of the 9-1-1 database must be authorized by the Commission [ CSEC ] and RPC. The database is developed and maintained by the local government agency and/or the RPC as described within the regional strategic plan in accordance with Commission [ CSEC ] §251.9 of this title (relating to Guidelines for Database Maintenance Funds).

(3) 9-1-1 Equipment and Services--Equipment and services acquired partially or in whole with 9-1-1 funds and designed to support and/or facilitate the delivery of an emergency 9-1-1 wireline or wireless call to an appropriate PSAP.

(4) 9-1-1 Network--The dedicated network of equipment, circuits, and controls assembled to establish communication paths to deliver 9-1-1 emergency communications.

(5) 9-1-1 Funds--Funds assessed and disbursed in accordance with the Texas Health and Safety Code, Chapter 771.

(6) Automatic Location Identification (ALI)--A system that enables the automatic display at the PSAP of the caller's telephone number, the address/location of the telephone, and supplementary emergency services information.

(7) Automatic Number Identification (ANI)--A system that enables the automatic display at the PSAP of the ten-digit number associated with the device from which a 9-1-1 call originates.

(8) Capital Equipment Asset--Items and components that comprise the technology used to deliver and answer 9-1-1 calls whose cost is over $5,000 and which have a useful life of at least one year.

(9) Contingency Routing Plan--Routing scheme to provide for the provision of uninterrupted 9-1-1 service in the event of an incident that requires the temporary rerouting of 9-1-1 calls due to man-made or natural disasters.

(10) Local Monitoring Plan--The RPC schedule for monitoring all interlocal contracts, 9-1-1 funded activities, equipment, PSAPs, and subcontractors.

(11) Public Safety Answering Point (PSAP)--A 24-hour communications facility established as an answering location for 9-1-1 calls originating within a given service area, as further defined in applicable law Texas Health and Safety Code, Chapters 771 and 772.

(A) Primary PSAP (P-PSAP)--A facility equipped and staffed with the ability to extend, receive, answer, transfer or relay to the appropriate public safety response agencies 9-1-1 calls. The P-PSAP must be in service 24 hours per day, 7 days per week, 365 days per year and meet the criteria of subsection (f) of this section.

(B) Secondary PSAP (S-PSAP)--A PSAP to which 9-1-1 calls are transferred or relayed from a P-PSAP, which may operate less than 24 hours per day, but which has the ability to extend, receive, answer, transfer or relay 9-1-1 calls and which meets the criteria of subsection (f) of this section.

(C) Remote PSAP--Equipment located at an emergency service responder's facility that is capable of conveying call information via printer, fax, or telephone and used as a means of call delivery.

(D) Mobile PSAP--An answering location, usually temporary, for receiving 9-1-1 calls originating within a given service area which is capable of and intended to be easily moved or relocated.

(12) Redundant Equipment and Services--Duplication of components running in parallel to increase reliability.

(13) Regional Planning Commission (RPC)--A commission established under Local Government Code, Chapter 391, also referred to as a regional council of governments.

(14) Regional Strategic Plan--A plan developed by each RPC for the establishment and operation of 9-1-1 service throughout the region that the RPC serves. The service and contents must meet the standards established by the Commission [ CSEC ].

(15) Selective Router Tandem (SR)--A switching office placed in front of a set of PSAPs that allows the routing of 9-1-1 calls to the proper PSAP.

(16) TDD/TTY--A Telecommunication Device for the Deaf (TDD) or Teletypewriter (TTY) or Text Telephone (TT).

(17) Wireless Phase I E9-1-1 Service--The service by which the wireless service provider (WSP) delivers to the designated PSAP the wireless end user's call back number, cell site/sector information in accordance with Commission [ CSEC ] §251.10 of this title (relating to Guidelines for Implementing Wireless E9-1-1 Service).

(c) Regional Plan Submission. All regional strategic plans for 9-1-1 service, or amendments to those regional plans, must be submitted to the Commission [ CSEC ] by a RPC as specified by Health and Safety Code, Chapter 771, §771.056, Submission of Regional Plan to the Commission [ CSEC ], and §771.057, Amendment of Plan. The RPC shall comply with all applicable federal and state laws in carrying out its approved regional plan.

(d) Regional Plan Scope. All regional plans for 9-1-1 service submitted for approval must address the entire geographic area within the boundaries of a RPC. The regional plan must identify all participating public safety agencies. All counties with a population greater than 120,000, according to the latest federal census, must have 9-1-1 service by September 1, 1995. In counties with less than 120,000 in population, resolutions supporting the regional plan must be included for all participating cities and counties. Because the definition of Public Agency in Health and Safety Code, Chapter 771, §771.001(7) creates a possibility of overlapping jurisdictions, the city or county government of that area should submit the resolution to support the regional plan.

(e) Regional Plan Criteria. The regional plan must include a description of how the 9-1-1 service is to be administered, a description of how money is to be allocated within the region, projected financial operating information for the two state fiscal years following the submission of the regional plan, strategic planning information for the five state fiscal years following the submission of the regional plan, and a detailed description of the equipment, network, and database services as required by Health and Safety Code, Chapter 771, §771.055, Strategic Planning.

(f) All regional plans for 9-1-1 service must include the following equipment and service:

(1) Automatic Number Identification (ANI) level of service;

(2) Automatic Location Identification (ALI) level of service;

(3) Wireless Phase I E9-1-1 level of service;

(4) One P-PSAP per RPC. If there is more than one PSAP, the system may be arranged for two or more PSAPs to share the 24-hour duty requirement;

(5) TDD/TTY or TDD/TTY compatible equipment in compliance with the Americans with Disabilities Act (ADA) and in compliance with Commission [ CSEC ] §251.4 of this title (relating to Guidelines for the Provisioning of Accessibility Equipment);

(6) A standby power supply for the 9-1-1 equipment;

(7) Forced disconnect feature to allow the PSAP to clear incoming circuits when necessary;

(8) The following redundant crucial service items at each PSAP:

(A) Network connections between each telephone central office or mobile switch and the SR;

(B) Network connections from the SR to the PSAP;

(C) Network connections from the ALI database to the PSAP;

(D) Database routers;

(E) Telephone sets and/or integrated ANI and ALI display call taking positions;

(F) Stand-alone TDD units as applicable; and

(G) Any other equipment essential to the 9-1-1 call-taking function;.

(9) A published ten-digit emergency telephone number that can accept emergency calls;

(10) A positive response to each 9-1-1 call to include an audible ringing tone connecting to a PSAP where either the call is answered by personnel at the PSAP or a recorded announcement provides further information; and

(11) The following required elements to insure the reliability of the 9-1-1 equipment and service:

(A) Contingency routing plan [ Routing Plan ];

(B) Network testing plan [ Testing Plan ];

(C) Local monitoring plan [ Monitoring Plan ];

(D) Capital asset plan [ Asset Plan ];

(E) Network diagrams [ Diagrams ];

(F) Database maintenance plan [ Maintenance Plan ]; and

(G) Equipment maintenance plan [ Maintenance Plan ].

(g) Amendments to Regional Plan. A regional plan may be amended according to procedure established in accordance with Commission [ CSEC ] §251.6 of this title (relating to Guidelines for Strategic Plans, Amendments, and Revenue Allocation).

(h) Call Taking Positions. Requests for an increase in the number of positions within a PSAP should be submitted for approval in the regional strategic plan along with justification for the increase. If an increase in the number of positions is required after the regional plan has been approved and the addition of the position(s) will require no additional funding, the RPC shall follow the requirements for amendment in accordance with §251.6 of this title. If additional funding is required for the additional position(s), the request shall be submitted to the Commission [ CSEC ] for consideration and approval in accordance with §251.6 of this title. Each PSAP shall be equipped with adequate call taking positions to meet anticipated call volume. Factors that may be considered in determining the proper number of positions include:

(1) Historical 9-1-1 call volume and growth;

(2) Call duration information;

(3) Anticipated area population growth; and

(4) Peak 9-1-1 call volume patterns.

(i) Adding a PSAP. Should there be a need to add a new PSAP within the region, the RPC shall provide the Commission [ CSEC ] written justification supporting the request. Appropriate justification shall include statistical information such as call volume and growth rates, or jurisdictional changes within the region. All requests for a new PSAP must include specific costs for equipment and services, as well as a complete written description and schematic illustrating the relationship of the proposed PSAP to the balance of the region's network. If additional funding is required to facilitate the addition of a PSAP, the request must be accompanied by a plan amendment, which will require Commission approval. These requirements apply to the addition of a remote or mobile PSAP, as well as, Primary and Secondary PSAPs.

(j) Mobile PSAP Procedures. When a RPC is approved to add a mobile PSAP, they must submit a Standard Operating Procedure (SOP) for that PSAP that includes, at a minimum:

(1) Designation of responsible local agency;

(2) Proposed hours of operation;

(3) Primary location of operation;

(4) Procedure for notification of relocation of PSAP;

(5) Asset management plan or insurance coverage to safeguard the equipment;

(6) Security plan for control of the equipment and data;

(7) Revised Interlocal Agreement to include the mobile PSAP; and

(8) Plan for equipment disposal upon termination of the use of the mobile PSAP.

(k) [ (j) ] Contracts. The RPC shall execute interlocal agreements between itself and its local governments responsible for PSAPs relating to the planning, development, operation and provision of 9-1-1 service, the use of 9-1-1 funds and adherence to applicable law in accordance with Commission [ CSEC ] §251.12 of this title (relating to Contracts for 9-1-1 Services).

(l) [ (k) ] Procurement. The RPC shall use competitive procurement practices and procedures similar to those required by state law for cities or counties, as well as any additional Commission [ CSEC ] policies, in conjunction with the procurement of 9-1-1 Customer Premises Equipment, 9-1-1 Network, and 9-1-1 Database Services, and any other items to be obtained with 9-1-1 funds in accordance with Commission [ CSEC ] §251.8 of this title (relating to Guidelines for the Procurement of Equipment and Services with 9-1-1 funds).

(m) [ (l) ] Equipment Management. The RPC is responsible for the 9-1-1 equipment in accordance with Commission [ CSEC ] §251.5 of this title (relating to Guidelines for 9-1-1 Equipment Management and Disposition). Any integration of expanded third-party applications onto a call taking position must be in accordance with Commission [ CSEC ] §251.7 of this title (relating to Guidelines for Implementing Integrated Services). If changes or extensions of 9-1-1 service occur, the RPC is to administer and report them in accordance with Commission [ CSEC ] §251.2 of this title (relating to Guidelines for Changing or Extending 9-1-1 Service Arrangements).

(n) [ (m) ] Testing. The RPC shall test all 9-1-1 Customer Premises Equipment (including TDD/TTY), 9-1-1 Network, and 9-1-1 Database services. Testing shall occur when new service or equipment is installed, service or equipment is modified, and on a regular basis to ensure system reliability and compliance with ADA. A schedule for ongoing testing shall be developed by the RPC and shall be available to the Commission [ CSEC ] for monitoring.

(o) [ (n) ] Monitoring. The Commission [ CSEC ] reserves the right to perform on-site monitoring of the RPC and/or its performing local governments or PSAPs, including mobile PSAPs , for compliance with applicable law in accordance with Commission [ CSEC ] §251.11 of this title (relating to Monitoring Policies and Procedures).

(p) [ (o) ] Performance Reporting. A RPC shall submit financial and performance reports to the Commission [ CSEC ] at least quarterly on a schedule to be established by the Commission [ CSEC ]. The financial report shall identify actual implementation costs by county, strategic plan priority level, and component. The performance report shall reflect the progress of implementing the region's strategic plan including, but not limited to, the status of equipment, services, and program deliverables in a format to be determined by the Commission [ CSEC ].

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 May 19, 2003.

TRD-200303103

Paul Mallett

Executive Director

Commission on State Emergency Communications

Earliest possible date of adoption: June 29, 2003

For further information, please call: (512) 305-6933


1 TAC §251.6

The Commission on State Emergency Communications (CSEC) proposes an amendment to §251.6, concerning guidelines for submission requests from councils of governments on strategic plans, amendments and allocation of equalization surcharge funds.

Current §251.6 provides a description of the formats and processes for regional strategic planning, plan amendments, and funding of plans. Modifications are necessary for the preparation of the regional strategic plans for fiscal years 2004-2005. The proposed changes only impact the sections that define the line-item components of the financial budgeting portion of the plans.

Paul Mallett, Executive Director, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Mallett also has determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be improved system for funds allocation and implementation levels for the 9-1-1 program statewide. No historical data is available, however, there appears to be no direct impact on small or large businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. There is no anticipated local employment impact as a result of enforcing the section.

Comments on the amendment may be submitted in writing within 30 days after publication of the proposal in the Texas Register to Paul Mallett, Executive Director, Commission on State Emergency Communications, 333 Guadalupe Street, Suite 2-212, Austin, Texas 78701-3942.

The amendment is proposed pursuant to the Texas Health and Safety Code, Chapter 771, §§771.051, 771.055, 771.056, 771.057, 771.071, 771.0711, 771.072, and 771.075, which authorize the Commission to adopt policies and procedures prescribing the distribution and use of 9-1-1 funds for providing 9-1-1 service.

No other statutes, articles or codes are affected by the proposed amendment.

§251.6.Guidelines for Strategic Plans, Amendments, and Revenue Allocation.

(a) (No change.)

(b) Strategic Plan Levels. Regional strategic plans developed in accordance with Chapter 771, along with the commensurate allocation of the above described funds, shall reflect implementation consistent with the following three major strategic plan levels (in order of priority) through state fiscal year 2003 [ 2001 ].

(1) Level I: The equipment, network and database equipment and/or services that provide the essential elements of 9-1-1 service, including the maintenance and replacement of equipment.

(A) Network;

(B) Wireless Phase I;

(C) Database;

(D) Equipment;

(E) Language Line;

(F) Equipment maintenance.

(2) Level II: The activities, equipment, and/or services that directly support and enhance 9-1-1 call delivery and data maintenance for the level of service provided to the region.

(A) Addressing Maintenance;

(B) Graphic MSAG;

(C) MIS;

(D) Mapped ALI;

(E) PSAP Room Prep;

(F) PSAP Training/Public Education; and

(G) Wireless Phase II.

(3) Level III: The activities, equipment, and/or services that provide auxiliary enhancements to the delivery of 9-1-1 calls and the level of service provided to the region.

(A) Network Diversity;

(B) Training Positions;

(C) Emergency Power;

(D) Recorders;

(E) Pagers;

(F) Ancillary Maintenance & Repair; and

(G) Other.

[(1) Level I: 9-1-1 service generally associated with Automatic Number Identification (ANI), to include the following components and associated costs:]

[(A) ANI (equipment and network);]

[(B) Public Safety Answering Point (PSAP) Room Preparation;]

[(C) Language Line;]

[(D) PSAP Supplies;]

[(E) Telecommunications Device for the Deaf (TDD);]

[(F) Maintenance/Repair (ANI/TDD); and]

[(G) Capital Recovery (ANI/TDD).]

[(2) Level II: 9-1-1 service generally associated with ANI, Selective Routing (SR), Automatic Location Identification (ALI) and any other network and/or database system enhancement, to include the following components and associated costs:]

[(A) ANI/ALI/SR (equipment and network);]

[(B) PSAP Room Preparation;]

[(C) Addressing;]

[(D) Addressing Maintenance;]

[(E) PSAP Training;]

[(F) Maintenance/Repair (CPE);]

[(G) Capital Recovery (telephone equipment); and]

[(H) Capital Recovery (addressing).]

[(3) Level III: Other 9-1-1 equipment, services and enhancements to same, to include, but not limited to the following components and associated costs:]

[(A) Additional Trunk Diversity;]

[(B) Other Redundancy;]

[(C) Wireless Access;]

[(D) Training Positions;]

[(E) Emergency Power;]

[(F) Recorders;]

[(G) Pagers;]

[(H) Detectors/Diverters;]

[(I) External Ringers;]

[(J) Mapped ALI;]

[(K) Maintenance/Repair (ancillary equipment);]

[(L) Capital Recovery (ancillary equipment); and]

[(M) Other.]

(c) New Strategic Plan Levels. Regional strategic plans developed in accordance with Chapter 771, along with the commensurate allocation of the above described funds, shall reflect implementation consistent with the following three major strategic plan levels (in order of priority) beginning state fiscal year 2004 [ 2002 ].

(1) Level I: The equipment, network and database equipment and/or services that provide the essential elements of 9-1-1 service, including the maintenance and replacement of equipment.

(A) - (C) (No change.)

(D) Equipment Lease ;

(E) Equipment Purchase [ Language Line ];

(F) Language Line; [ Equipment maintenance. ]

(G) Equipment Maintenance.

(2) Level II: The activities, equipment, and/or services that directly support and enhance 9-1-1 call delivery and data maintenance for the level of service provided to the region.

(A) (No change.)

(B) MIS [ Graphic MSAG ];

(C) Mapped ALI [ MIS ];

(D) PSAP Room Prep [ Mapped ALI ];

(E) PSAP Training [ PSAP Room Prep ];

(F) [ PSAP Training/ ]Public Education; and

(G) (No change.)

(3) (No change.)

(d) - (e) (No change.)

(f) Allocation of Revenue.

(1) (No change.)

(2) Equalization Surcharge Funds--

(A) Within the context of §771.056(d) [ Section 771.056(d) ], the Commission shall consider any revenue insufficiencies to represent need for equalization surcharge funding support.

(B) - (F) (No change.)

(g) - (i) (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 May 19, 2003.

TRD-200303104

Paul Mallett

Executive Director

Commission on State Emergency Communications

Earliest possible date of adoption: June 29, 2003

For further information, please call: (512) 305-6933


1 TAC §251.12

The Commission on State Emergency Communications (CSEC) proposes an amendment a to §251.12, concerning contracts for 9-1-1 services. Such changes reflect the balance of recommendations made by the Management Advisory Services (MAS) of the State Auditor's Office and anticipated legislative requirements. The changes are being made only to the contract listed in Figure: 1 TAC §251.12(d), not to the text of §251.12.

Proposed revisions to the contract will clarify requirements and make the contract more reflective of current and pending legislation specific to monitoring compliance; standard interlocal agreement with local governments; service fee funding; surcharge allocation; strategic planning to include historically underutilized business plan with strategic plan; reporting requirements; and State Auditor's Office on-site monitoring and audits of Regional Planning Commissions.

Paul Mallett, Executive Director, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Mallett also has determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be better accountability of funds and program reporting requirements. No historical data is available, however, there is no direct impact on small or large businesses. There is no anticipated economic cost to persons who are required to comply with the section as proposed. There is no anticipated local employment impact as a result of enforcing the section.

Comments on the proposed rule may be submitted in writing within 30 days after publication of the proposal in the Texas Register to Paul Mallett, Executive Director, Commission on State Emergency Communications, 333 Guadalupe Street, Suite 2-212, Austin, Texas 78701-3942.

The amendment is proposed pursuant to the Health and Safety Code, Chapter 771, §§771.071, 771.0711, 771.072, 771.073, 771.075, 771.078, 771.055, 771.056, and Title 1 Texas Administrative Code, Part 12, which authorizes the Commission to adopt policies and procedures prescribing the distribution and use of 9-1-1 funds for providing 9-1-1 service.

No other statute, article or code is affected by the proposed amendment.

§251.12.Contracts for 9-1-1 Services.

(a) - (c) (No change.)

(d) The contract described in subsection (b) of this section shall substantially conform to the following standard contract form:

Figure: 1 TAC §251.12(d)

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 May 19, 2003.

TRD-200303105

Paul Mallett

Executive Director

Commission on State Emergency Communications

Earliest possible date of adoption: June 29, 2003

For further information, please call: (512) 305-6933


Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 355. MEDICAID REIMBURSEMENT RATES

The Texas Health and Human Services Commission (HHSC) proposes to repeal §355.501, concerning reimbursement methodology for Program for All-Inclusive Care for the Elderly (PACE); and proposes new §355.501, concerning reimbursement methodology for Programs of All-Inclusive Care for the Elderly (PACE), in its Medicaid Reimbursement Rates chapter. The purpose of the repeal and new section is to comply with new payment rate determination guidelines instituted by the Centers for Medicare and Medicaid (CMS) for PACE sites. CMS recently converted PACE from a Medicaid research and demonstration project to a Medicaid State Plan program. As a result of this change, CMS instituted new payment rate guidelines. The major change instituted by CMS is that upper payment limits per member month must be calculated for each PACE geographic site based on the historical claims of the geographic site. CMS also requires that historical claims for both nursing facility and Community Based Alternatives recipients be based on the population served by the Texas Department of Human Services that meets nursing facility eligibility. Historical claims include all costs to the Medicaid program needed to serve these recipients, including acute care services, long-term care services, medical transportation, prescriptions, and other services. CMS also requires that the payment rates be lower than the calculated upper payment limit. This is achieved by determining the payment rate at 95% of the upper payment limit. The upper payment limits and reimbursement rates are determined coincident with the state's biennium. The proposal also includes two reimbursement rates calculated for each PACE contract: one for clients eligible only for Medicaid services and one for clients eligible for both Medicare and Medicaid services. The proposal ensures that HHSC is in compliance with these requirements.

Tom Suehs, Deputy Commissioner for Financial Services, has determined that, for the first five-year period the proposed section is in effect, there are fiscal implications for state government as a result of enforcing or administering the section. There are no fiscal implications for local government as a result of enforcing or administering the section.

The effect on state government for the first five-year period the section is in effect is an estimated additional cost of $1,256 in fiscal year (FY) 2003; $67,818 in FY 2004; $124,463 in FY 2005; $129,917 in FY 2006; and $130,002 in FY 2007.

Steve Lorenzen, Director, Rate Analysis, has determined that, for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section is that by complying with new CMS payment rate guidelines, the PACE program will continue to operate. This will allow the PACE program to continue to serve recipients through a comprehensive service model that provides health-related services to elderly clients in their own communities as an alternative to nursing facility care. There is no adverse economic effect on small or micro businesses as a result of enforcing or administering the section, because the proposal ensures that the PACE program will continue to operate with similar reimbursement rates for the majority of clients eligible for Medicare and Medicaid. Providers will receive greater reimbursement for the few Medicaid-only clients they serve. There is no anticipated economic cost to persons who are required to comply with the proposed section. There is no anticipated effect on local employment in geographic areas affected by this section.

Questions about the content of this proposal may be directed to Nancy Kimble at (512) 338- 6496 in HHSC Rate Analysis. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-166, 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 Government Code, HHSC has determined that Chapter 2007 of the Government Code does not apply to this rule. Accordingly, HHSC is not required to complete a takings impact assessment regarding this rule.

Subchapter E. COMMUNITY CARE FOR AGED AND DISABLED

1 TAC §355.501

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Health and Human Services Commission or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

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

The repeal affects the Government Code, §§531.033 and 531.021(b).

§355.501.Reimbursement Methodology for Program for All-Inclusive Care for the Elderly (PACE).

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 May 14, 2003.

TRD-200303002

Steve Aragon

General Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: June 29, 2003

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


1 TAC §355.501

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

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

§355.501.Reimbursement Methodology for Programs of All-Inclusive Care for the Elderly (PACE).

(a) General specifications. The Texas Health and Human Services Commission (HHSC) determines the upper payment limits and reimbursement rates for each PACE contractor. HHSC applies the general principles of cost determination as specified in §355.101 of this title (relating to Introduction).

(b) Frequency of reimbursement determination. The upper payment limits and reimbursement rates are determined coincident with the state's biennium.

(c) Upper payment limit determination. There are two upper payment limits calculated for each PACE contract: one for clients eligible only for Medicaid services and one for clients eligible for both Medicare and Medicaid services. An average monthly historical cost per client receiving nursing facility and Community Based Alternatives (CBA) services under the fee-for-service payment system is calculated for the counties served by each PACE contract for each type of upper payment limit.

(1) The upper payment limits for the biennium are calculated for the base period using historical fee-for-service claims data and member-month data from the most recent state fiscal year of complete claims available prior to the state's biennium.

(2) The historical costs are derived from fee-for-service claims data for clients receiving nursing facility services or CBA services in the counties served by each PACE contract. This applies to clients who:

(A) are age 55 and older;

(B) have Medicare coverage and who do not have Medicare coverage; and

(C) are not receiving services under the STAR+PLUS managed care program.

(3) The historical costs include:

(A) acute care services, including inpatient, outpatient, professional, and other acute care services;

(B) prescriptions;

(C) medical transportation;

(D) nursing facility services;

(E) hospice services;

(F) long-term care specialized services, including physical therapy, occupational therapy, and speech therapy;

(G) CBA services;

(H) Primary Home Care (including Family Care) services; and

(I) Day Activity and Health Services.

(4) To determine an average monthly historical cost for the counties served by each PACE contract, the total historical fee-for-service claims data for the counties served by each PACE contract are divided by the number of member months for the counties served by each PACE contract.

(5) A per member month amount is added to the average monthly historical cost per client. The per member month amount is added for:

(A) processing claims, based on the state's cost to process claims under the fee-for-service payment system; and

(B) case management, based on the state's cost to provide case management under the fee- for service payment system for CBA clients.

(6) The sum of the average monthly historical cost per client for each PACE contract and the amounts from paragraph (5) of this subsection are projected from the claims data base period identified in paragraph (1) of this subsection to the rate period to account for anticipated changes in costs for each PACE contract.

(d) Payment rate determination. There are two reimbursement rates calculated for each PACE contract: one for clients eligible only for Medicaid services and one for clients eligible for both Medicare and Medicaid services. The payment rates for each PACE contract are determined by multiplying the upper payment limits calculated for each PACE contract by 0.95.

(e) Reporting of cost. HHSC may require the PACE contractor to submit financial and statistical information on a cost report or in a survey format designated by HHSC. Cost report completion is governed by the requirements specified in Subchapter A of this chapter (relating to Cost Determination Process). HHSC may also require the PACE contractor to submit audited financial statements.

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 May 14, 2003.

TRD-200303003

Steve Aragon

General Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: June 29, 2003

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