TITLE 1.ADMINISTRATION

Part 3. OFFICE OF THE ATTORNEY GENERAL

Chapter 55. CHILD SUPPORT ENFORCEMENT

Subchapter D. FORMS FOR CHILD SUPPORT ENFORCEMENT

1 TAC §55.120

The Office of the Attorney General adopts new revised Subchapter D, Forms For Child Support Enforcement by adding §55.120, concerning the National Medical Support Notice Forms, with minor grammatical changes to the proposed text as published in the November 21, 2003, issue of the Texas Register (28 TexReg 10363). Texas Family Code §154.186(c) authorizes the State's Title IV-D agency to prescribe forms for the efficient use of the Notice.

The National Medical Support Notice is federally mandated for use in IV-D cases. It may also be used in any other Suit Affecting the Parent Child Relationship order to enforce medical child support. The Request for Review of National Medical Support Notice may be used by an obligor to contest the National Medical Support Notice sent to the employer. The Termination of National Medical Support Notice may be used in any Suit Affecting the Parent Child Relationship order to terminate medical child support.

Section 55.120 adds three forms for use of the National Medical Support Notice by the Office of the Attorney General on all IV-D cases.

No comments have been received regarding adoption of this new section.

The new section is adopted under the authority of Texas Family Code §154.186.

The new section affects Texas Family Code §154.86.

§55.120.National Medical Support Notice, Request for Review of National Medical Support Notice, Termination of National Medical Support Notice.

(a) The National Medical Support Notice is federally mandated for use in IV-D cases. It may also be used in any other Suit Affecting the Parent Child Relationship order to enforce medical child support.

Figure: 1 TAC §55.120(a) (.pdf)

(b) The Request for Review of National Medical Support Notice may be used by an obligor to contest the National Medical Support Notice sent to the employer.

Figure: 1 TAC §55.120(b)

(c) The Termination of National Medical Support Notice may be used in any Suit Affecting the Parent Child Relationship order to terminate medical child support.

Figure: 1 TAC §55.120(c)

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 December 29, 2003.

TRD-200308892

Nancy S. Fuller

Assistant Attorney General

Office of the Attorney General

Effective date: January 18, 2004

Proposal publication date: November 21, 2003

For information regarding this publication, you may contact A.G. Younger, Agency Liaison, at (512) 463-2110.


Subchapter N. NATIONAL MEDICAL SUPPORT NOTICE

1 TAC §§55.701 - 55.707

The Office of the Attorney General adopts new Subchapter N, National Medical Support Notice, §§55.701 - 55.707, without changes to the proposed text as published in the November 21, 2003, issue of the Texas Register (28 TexReg 10363). Texas Family Code §154.186 authorizes the State's Title IV-D agency to establish procedures by rule for the use of the National Medical Support Notice.

The new sections provide a standardized means of communication between State child support enforcement agencies, employers, and parents. The Notice will facilitate the process of enrolling children in the group health plans for which their parents are eligible and create a uniform and streamlined process for enforcement of medical child support to ensure that all children receive the health care coverage for which they are eligible and to which they are entitled.

No comments have been received regarding adoption of these new sections.

The new sections are adopted under the authority of Texas Family Code §154.186.

The new sections affect Texas Family Code §154.86.

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 December 29, 2003.

TRD-200308893

Nancy S. Fuller

Assistant Attorney General

Office of the Attorney General

Effective date: January 18, 2004

Proposal publication date: November 21, 2003

For information regarding this publication, you may contact A.G. Younger, Agency Liaison, at (512) 463-2110.


Part 5. TEXAS BUILDING AND PROCUREMENT COMMISSION

Chapter 126. SURPLUS AND SALVAGE PROPERTY PROGRAMS

Subchapter A. STATE SURPLUS AND SALVAGE PROPERTY

1 TAC §126.1

The Texas Building and Procurement Commission adopts amendments to §126.1 with a correction to the text as published in the September 12, 2003, issue of the Texas Register (28 TexReg 7903).

SB 912, enacted by the 78th Regular Session of the Legislature, effective June 20, 2003, amended the definition of "assistance organization," to include a nonprofit computer bank that solicits, stores, refurbishes and redistributes used computer equipment to public school students and their families. The proposed amendment to §126.1 brings the definitions in the rules into compliance with the statute.

The amended rule will assist the Texas Building and Procurement Commission and state agencies in correctly identifying appropriate recipients of surplus and salvage property.

One letter of comment was received from the Texas Department of Transportation (TxDOT) which said, "The proposed wording of §126.1 directly conflicts with the plain language of §2175.001(A)."

Response: TxDOT is correct. The erroneous language has been corrected.

The amendment is adopted under the authority of the Texas Government Code, Title 10, Subtitle D, §§2152.003, 2175.002 and 2175.061(c).

The following code is affected by these rules: Texas Government Code, Title 10, Subtitle D, §2175.001, §2175.061, §2175.124, §2175.125, §2175.128, §2175.183, §2175.184, §2175.304 and §2175.306.

§126.1.Definitions.

The following words and terms, when used in this chapter, shall have the following meaning, unless the context clearly indicates otherwise.

(1) Assistance organization--

(A) a nonprofit organization that provides educational, health, or human services or assistance to homeless individuals; or

(B) a nonprofit food bank that solicits, warehouses, and distributes edible but unmarketable food to agencies that feed needy families and individuals; or

(C) Texas Partners of the Americas, a registered agency with the Advisory Committee on Voluntary Foreign Aid, with the approval of the Partners of the Alliance office of the Agency for International Development; or

(D) a group, including a faith-based group, that enters into a financial or non-financial agreement with a health or human services agency to provide services to that agency's clients; or

(E) a non profit organization approved by the Supreme Court of Texas that provides free legal services for low-income households in civil matters; or

(F) The Texas Boll Weevil Eradication Foundation Inc., or an entity designated by the commissioner of agriculture as the foundation's successor entity under §74.1011, Agriculture Code; or

(G) a local workforce development board created under §2308.253 of the Texas Government Code; or

(H) a nonprofit computer bank that solicits, stores, refurbishes, and redistributes used computer equipment to public school students and their families.

(2) Certificate of Acquisition--A form prescribed by the commission that verifies the qualifications of a qualified assistance organization or political subdivision as an entity entitled to receive state surplus or salvage property.

(3) Data processing equipment--Equipment as defined by Texas Government Code, §2054.003 to be information technology equipment and related services designed for the automated storage, manipulation, and retrieval of data by electronic or mechanical means to include:

(A) central processing units, front-end processing units, miniprocessors, microprocessors, and related peripheral equipment such as data storage devices, document scanners, data entry equipment, terminal controllers, data terminal equipment, computer-based word processing systems other than memory typewriters, and equipment and systems for computer networks;

(B) all related services, including feasibility studies, systems design, software development, and time-sharing services, provided by state employees or others; and

(C) the programs and routines used to employ and control the capabilities of data processing hardware, including operating systems, compilers, assemblers, utilities, library routines, maintenance routines, applications, and computer networking programs.

(4) Personal property--property that is lawfully confiscated and subject to disposal by a state agency. Personal property affixed to real property may be sold as surplus or salvage property if its removal and disposition is for a lawful purpose under Texas Government Code, Chapter 2175, Subchapter C or another law.

(5) Method of payment--A cashier's check, certified check, a money order, or any other approved method of purchase at the time of sale is acceptable payment under this section.

(6) Political subdivision--Each political subdivision of the state and volunteer fire departments.

(7) Salvage property--Any personal property which through use, time, or accident is so depleted, worn out, damaged, used, or consumed that it has no value for the purpose for which it was originally intended.

(8) State agency--

(A) a department, commission, board, office, or other agency in the executive branch of state government created by the state constitution or a state statute;

(B) the supreme court, the court of criminal appeals, a court of appeals, or the Texas Judicial Council;

(C) the Texas Civil Air Patrol; and

(D) excluding those entities in Texas Government Code, §§2175.301, 2175.302, 2175.304.

(9) Surplus property--Personal property that exceeds a state agency's needs and is not required for the agency's foreseeable needs; including used or new property that retains some usefulness for the purpose for which it was intended or for another purpose.

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 December 22, 2003.

TRD-200308857

Cynthia de Roch

General Counsel

Texas Building and Procurement Commission

Effective date: January 11, 2004

Proposal publication date: September 12, 2003

For further information, please call: (512) 463-4257


1 TAC §126.5

The Texas Building and Procurement Commission adopts amendments to §126.5 as published in the September 12, 2003, issue of the Texas Register (28 TexReg 7905) with nonsubstantive changes in the text.

HB 3042, effective June 18, 2003, amended the Texas Government Code, §2175.134 to require that the proceeds and fees collected from the sale of state surplus or salvage property be deposited into the general revenue fund; however, the proceeds of sales for the State Aircraft Pooling Board (APB) shall be deposited to the credit of the APB. The amendment brings the language of §126.5 into compliance with the amended statute.

The amended rule will enable state agencies to correctly identify where to deposit proceeds and fees collected from the sale of state surplus or salvage property.

TBPC received the following comment from Texas Department of Transportation: "In reference to the proposed changes in 1 TAC §126.5, TxDOT is currently seeking an Attorney General opinion on the constitutionality of diverting dedicated funds to the general revenue fund. In regard to the proceeds from the sale of surplus and salvage property of the APB being deposited to the credit of the board, legislation is currently making its way through the 3rd called special session which may redirect those proceeds."

Response: The language of the statute is clear and went into effect June 13, 2003 and has not been subsequently amended.

The adopted amendment is made under the authority of the Texas Government Code, Title 10, Subtitle D, §2175.002 and §2175.061(a) and (c).

The following code is affected by these rules: Texas Government Code, Title 10, Subtitle D, §2175.134 and §2175.191.

§126.5.Proceeds.

The proceeds from the sale of any surplus or salvage property, less the costs of advertising, selling, auctioneer services, if any, and any fee collected under §126.2(5) of this title (relating to Purchaser's fees), shall be deposited to the credit of the general revenue fund of the state treasury. Proceeds from the sale of surplus or salvage property of the State Aircraft Pooling Board shall be deposited to the credit of the board. The portion of the proceeds from the sale of any surplus or salvage property equal to the costs of advertising, the sale and the costs of auctioneer services, if any, shall be deposited with the Comptroller of Public Accounts to the credit of the item of appropriation to the commission from which such costs were expended. The fee collected under §126.2(5) of this title shall be deposited with the Comptroller of Public Accounts to the credit of the general revenue fund.

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 December 22, 2003.

TRD-200308858

Cynthia de Roch

General Counsel

Texas Building and Procurement Commission

Effective date: January 11, 2004

Proposal publication date: September 12, 2003

For further information, please call: (512) 463-4257


Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 371. MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY

Subchapter C. UTILIZATION REVIEW

1 TAC §§371.203, 371.204, 371.206, 371.210

The Health and Human Services Commission (HHSC) adopts amendments to §§371.203, 371.204, 371.206, and 371.210, concerning possible denial and recoupment of admitting physicians' claims related to hospital inpatient claim denials. The amended sections are adopted without changes to the proposed text as published in the October 3, 2003, issue of the Texas Register (28 TexReg 8476). The text of the adopted rules will not be republished.

The adopted amendment language, which is the same for §§371.203, 371.204, 371.206, and 371.210, was developed in conjunction with discussions held during previous Medicaid Utilization Review Workgroup meetings in 2000 and 2001 with Texas Hospital Association (THA) and various workgroup participants, as well as in response to comments received from THA related to proposed rules revisions published in the Texas Register, October 4, 2002, issue. The adopted rule amendments reflect updated utilization review processes and procedures. The adopted rule amendments allow HHSC to consider for denial and recoupment physician claims related to hospital claims that are denied for lack of medical necessity or for being provided in an inappropriate setting, when such claims can be identified and are deemed to be the result of inappropriate admission orders.

HHSC received comments from the Texas Hospital Association (THA), Texas Medical Association (TMA), Texas Osteopathic Medical Association (TOMA), and the Coalition For Nurses In Advanced Practice (CNAP).

Comment: THA commented that it was in support of the proposed rule amendments related to denial of physician services in conjunction with the hospital services, and acknowledged that the formulation of the proposed rule amendments was the product of participation by THA, HHSC, and various participants from the medical community in the Medicaid Utilization Review Workgroup meetings held during 2000 and 2001.

Response: HHSC agrees with the comments by THA in support of the proposed rule amendments.

Comment: TMA and TOMA commented that the proposed rule amendments would create confusion and reinforce discrepancies between hospitals and physicians pertaining to admission orders, would not accomplish hospitals' goals of reduction of facility payment denials stemming from what appear to be inappropriate physician admission orders, would not accomplish HHSC's goal of reduction of Medicaid costs associated with inappropriate utilization, and would further alienate physicians from Medicaid participation. TMA and TOMA commented that the core problems with the proposed rule amendments were clinically inaccurate or obsolete classifications of some procedures as appropriate in an outpatient setting as well as an inflexible notion of when observational status is appropriate for presenting patients. TMA and TOMA expressed concern that the proposed rule amendments were not sensitive to the nuances of patients with complex clinical presentations; at the time of a prospective admission, it may not be clear whether a patient should be admitted as an inpatient or placed on observation status. TMA and TOMA suggested changing the rules to allow up to forty-eight hours for observation of patients when that status is clinically appropriate.

Response: HHSC disagrees with TMA and TOMA regarding the proposed rule amendments. HHSC believes that the adoption of the proposed rule amendments will reduce hospital payment denials resulting from inappropriate admission orders by focusing attention on Medicaid policies concerning the use of outpatient observation as an admitting status. The fiscal impact associated with the recoupment of physician claim payments over a year's period of time is estimated to be $213,000. HHSC recognizes that some physicians may react negatively to the adoption of the proposed rule amendments. However, HHSC believes that, overall, the rule amendments provide an opportunity for further education of the medical community concerning inappropriate utilization of hospital services. If the clinical condition of a patient is such that it is unclear whether to admit the patient initially in outpatient observation status or as an inpatient, the physician may, under Texas Medicaid program policy, admit the patient in observation status and progress the admission to inpatient at or before the end of twenty-four hours, if the physician determines that further evaluation and/or treatment is required. Furthermore, when a patient is admitted to the hospital as an inpatient, and is discharged in less than twenty-four hours, the hospital may request that the physician change the admission order from inpatient status to outpatient observation status. This billing practice is acceptable under the Texas Medicaid Program when the physician makes the changes to the admitting order from inpatient status to outpatient observation status before the hospital submits the claim for reimbursement.

Comment: The Coalition For Nurses In Advanced Practice (CNAP) comments that, because other types of health care practitioners, such as advanced practice nurses, are authorized to order services in hospitals (laboratory tests, radiologic and other diagnostic tests, prescribing medication), language in §371.203(a)(6) and §371.206(a)(5) be amended to read "ordered by a physician or other appropriate health care practitioner" instead of the current language "ordered by a physician." CNAP also comments that, since many types of health care practitioners may write notes and orders in the "physician progress notes" section and "physician order" section of the hospital medical record, language in §371.203(b) be amended to refer to those sections of the medical record as "progress notes" and "orders."

Response: HHSC disagrees with the comments from CNAP as they relate to the proposed amendments. At this time, the only amendments to §§371.203(c), 371.204(a), 371.206(a) and (b), and 371.210c) that are under consideration are those noted, i.e. underlined language, in the October 3, 2003, issue of the Texas Register. HHSC will, however, keep CNAP's comments on file for reference should HHSC consider any revisions to those portions of the rules about which CNAP commented.

The amendments are adopted under authority granted to HHSC by §531.033, Texas Government Code, which provides the Executive Commissioner of HHSC with broad rulemaking authority, and under §531.021(a), Texas Government Code, which authorizes HHSC to administer the federal medical assistance (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 December 22, 2003.

TRD-200308829

Steve Aragón

General Counsel

Texas Health and Human Services Commission

Effective date: January 11, 2004

Proposal publication date: October 3, 2003

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