TITLE 25.HEALTH SERVICES

Part 1. DEPARTMENT OF STATE HEALTH SERVICES

Chapter 37. MATERNAL AND INFANT HEALTH SERVICES

The Executive Commissioner of the Health and Human Services Commission, on behalf of the Department of State Health Services (department), proposes amendments to §§37.211 - 37.218 and the repeal of §§37.219 - 37.222, concerning the provision of epilepsy services in this state.

BACKGROUND AND PURPOSE

The repeals and amended sections are necessary to comply with Health and Safety Code, Chapter 40, which allows the department to establish a program to provide epilepsy diagnostic, treatment, and support services to eligible individuals. Epilepsy Services provides access to seizure-related services for individuals whose incomes do not exceed 200% of the Federal Poverty Level residing in Texas who are unable to access the same care through other funding sources or programs.

Government Code, §2001.039, requires that each state agency review and consider for re-adoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act). Sections 37.211 - 37.222 have been reviewed, and the department has determined that reasons for adopting §§37.211 - 37.218 continue to exist because rules on this subject are needed. The department also has determined that §§37.219 - 37.222 are no longer needed, and that the sections should be repealed.

SECTION-BY-SECTION SUMMARY

Sections 37.211 - 37.218 are amended to incorporate the current department and program names to be consistent with current terminology used by the department.

Amendments to §37.211 delete definitions no longer relevant to the subchapter.

An amendment to §37.212 clarifies language regarding client eligibility for services in coordination with the department's Children With Special Health Care Needs Program (CSHCN). The amendment does not extend benefits to additional clients, but clarifies that Epilepsy Services eligibility will not be denied if a client has been determined eligible for CSHCN services, but has been placed on the waiting list to receive CSHCN services. Further amendments to §37.212 delete language regarding fair hearings in order to better organize all language on this subject in one place in the subchapter.

Amendments to §37.213 and proposed repeal of §§37.220 - 37.222 delete detailed provisions concerning program contractors that are more appropriate for inclusion in a policy manual.

Amendments to §37.217 delete language concerning administration of contracts with providers of program services that need not be adopted as rules. Additionally, §37.217 has been amended to clarify and simplify the process for suspension and termination of contracts.

Amendments to §37.218 replace language describing a procedure for reconsideration of a notice of intent with new language concerning fair hearings in order to clarify and simplify the process.

Section 37.219 has been repealed because the subject of Notice and Fair Hearings is now included in §§37.217 - 37.218 to improve clarity.

FISCAL NOTE

Cindy Jones, Ph.D., R.N., Manager, Preventive and Primary Care Unit, has determined that for each year of the first five years the sections are in effect, there will be no fiscal implications to state or local governments as a result of administering the sections as proposed. The amended sections and repeals are not anticipated to have significant fiscal impact because the proposed rules do not change current program structure and implementation.

SMALL AND MICRO-BUSINESS IMPACT ANALYSIS

Dr. Jones has also determined that there will be no effect on small businesses or micro-businesses required to comply with the sections as proposed, because neither small businesses nor micro-businesses that are providers of epilepsy services will be required to alter their business practices in order to comply with the sections. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated negative impact on local employment.

PUBLIC BENEFIT

Dr. Jones has also determined that for each year of the first five years the sections are in effect, the public benefit anticipated as a result of administering the sections will be continued access to seizure-related care services for eligible, low-income Texas residents.

REGULATORY ANALYSIS

The department has determined that this proposal is not a "major environmental rule" as defined by Government Code, §2001.0225. "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. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.

TAKINGS IMPACT ASSESSMENT

The department has determined that the proposed sections do not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, do not constitute a taking under Government Code, §2007.043.

PUBLIC COMMENT

Comments on the proposal may be submitted to Kim Roberts, Mail Code 1923, Community Health Services Section, Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756-3189 or by email to kim.roberts@dshs.state.tx.us. Comments will be accepted for 30 days following publication of the proposal in the Texas Register .

LEGAL CERTIFICATION

The Department of State Health Services General Counsel, Cathy Campbell, certifies that the proposed rules have been reviewed by legal counsel and found to be within the state agencies' authority to adopt.

Subchapter K. EPILEPSY SERVICES

25 TAC §§37.211 - 37.218

STATUTORY AUTHORITY

The proposed amendments are authorized by Health and Safety Code, §40.003, which allows the department to adopt rules necessary to administer epilepsy services; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The proposed amendments affect Health and Safety Code, Chapter 40.

§37.211.General.

(a) Purpose. The purpose of this chapter is to establish rules for [ the ] Epilepsy Services [ Program ]. The authority for these rules is granted in the Texas Health and Safety Code, Chapter 40.

[ (b) Delegation of Authority. Under the Texas Health and Safety Code, Chapter 11, §11.013, the Board of Health (board) delegates to the Commissioner of Health (commissioner), or to the person acting as commissioner in the commissioner's absence, the authority to administer the Epilepsy Program, exclusive of rulemaking authority. ]

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

(1) Action--A denial, termination, suspension or reduction of Epilepsy Services benefits [ Program services ] or eligibility.

(2) Applicant--An individual whose application for Epilepsy Services [ Program ] benefits has been submitted to a contracted provider and has not received a final determination of eligibility. This definition includes an individual whose application is submitted by a representative or person with legal authority to act for the individual.

[ (3) Board--The Texas Board of Health. ]

[ (4) Commissioner--The commissioner of the Texas Department of Health. ]

(3) [ (5) ] Contracted Provider--Any individual or entity with department [ Epilepsy Program ] approval to furnish covered services to Epilepsy Services [ Program ] recipients.

(4) [ (6) ] Department--The [ Texas ] Department of State Health Services .

(5) [ (7) ] Epilepsy--A chronic neurological condition characterized by abnormal electrical discharges in the brain manifested by two or more seizures. It is characterized by sudden, brief attacks of altered consciousness, motor activity, or sensory phenomena. Convulsive seizures are the most common form of attacks, but any recurrent seizure pattern is considered epilepsy.

[ (8) Fair hearing--The informal hearing process the department follows under §37.219 of this title (relating to Notice and Fair Hearing). ]

[ (9) Final decision--A decision that is reached by a decision maker after conducting a fair hearing under this title. ]

(6) [ (10) ] Recipient--An individual who is eligible to receive Epilepsy Services [ Program ] benefits.

[ (11) Reconsideration--The administrative process the Epilepsy Program follows under §37.218 of this title (relating to Notice of Intent to Take Action and Reconsideration). ]

(7) [ (12) ] Request for Proposal (RFP)--A document intended to solicit proposals from interested parties that [ which ] details qualifications and plans for provision of a specific service or range of services. Services may be targeted to a selected geographic area and/or special population group, or statewide coverage.

§37.212.Recipient Requirements.

(a) A person shall meet all of the following requirements to be eligible for Epilepsy Services [ Program ] benefits:

(1) (No change.)

(2) if younger than 21 years of age, be determined not eligible [ not be eligible ] for benefits from the Children With Special Health Care Needs Program (CSHCN) or be currently on the CSHCN waiting list for services ;

(3) - (5) (No change.)

(b) (No change.)

(c) A recipient may have all Epilepsy Services [ Program ] benefits modified, suspended, or terminated for any of the following reasons:

(1) (No change.)

(2) failure to provide income data as requested by the contracted provider to determine continued Epilepsy Services [ Program ] eligibility;

(3) - (5) (No change.)

(6) failure to continue premium payments on individual or group insurance, prepaid medical plan, and health insurance plans under the Social Security Act, Title XVIII, as amended, where such plans provide benefits for the care and treatment of persons who have epilepsy and the person's eligibility for benefits under the plan(s) was effective prior to eligibility for [ the ] Epilepsy Services [ Program ], or provide a statement on the application form outlining the reason(s) why such insurance cannot be maintained; or

(7) (No change.)

(d) In order to requalify for [ the ] Epilepsy Services benefits [ Program ], an applicant shall reapply and requalify for Epilepsy Services [ Program ] benefits when eligibility for program benefits is terminated.

[ (e) A recipient whose benefits are modified, suspended or terminated may appeal the Epilepsy Program's decision under the procedure contained in §37.218 of this title (relating to Notice of Intent to Take Action and Reconsideration) and §37.219 of this title (relating to Notice and Fair Hearing). ]

[ (f) The Epilepsy Program may not terminate program participation until a final decision is rendered under the department's reconsideration and fair hearings process, if a reconsideration or hearing is requested by the recipient. ]

§37.213.Residency and Residency Documentation Requirements.

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

[ (d) All documents submitted to establish the residency of an applicant shall be in English, or if required by the contracted provider, accompanied by an accurate English translation. ]

[ (1) An applicant who is currently a Texas resident and has been currently approved to receive Texas Medicaid benefits is not required to provide additional residency verification. ]

[ (2) An applicant, or person establishing residency for the applicant under subsections (b) and (c) of this section, may submit a copy of any one of the following documents as evidence of residency. All documents shall be in the applicant's name, or in the name of the person establishing residency for the applicant, and provide some verification of a Texas address or domicile: ]

[ (A) a valid Texas driver's license, or an identification card issued by the Texas Department of Public Safety; ]

[ (B) a valid Texas voter's registration card, or a copy of a validated (at the county clerk's office) application for a voter's registration card; ]

[ (C) a current Texas motor vehicle registration or automobile license plate registration renewal form; ]

[ (D) a mortgage payment receipt from any of the three months immediately preceding the date of the application; ]

[ (E) a rent payment receipt from any of the three months immediately preceding the date of the application; ]

[ (F) a notarized statement reflecting that the applicant is currently receiving rent-free housing. The statement must be signed by the individual providing the rent-free housing and must include the address and phone number of the individual providing the rent-free housing; ]

[ (G) a utility payment receipt from any of the three months immediately preceding the date of the application; ]

[ (H) a Texas property tax receipt for the most recently completed tax year; ]

[ (I) a payroll or retirement check dated within the three months immediately preceding the date of the application; ]

[ (J) employment/unemployment records prepared within the three months immediately preceding the date of the application; ]

[ (K) a statement from a financial institution issued within the three months preceding the date of the application; or ]

[ (L) social security supplemental income or disability income records or social security retirement benefit records issued within the three months immediately preceding the date of the application. ]

[ (e) Applications submitted under subsections (b) and (c) of this section shall also include evidence of the legal relationship between the applicant and the resident, such as: ]

[ (1) a marriage license or declaration of non-ceremonial marriage to document the marriage of the applicant and spouse; ]

[ (2) a birth certificate establishing the parent/child relationship between the applicant and the resident; ]

[ (3) a final order showing the appointment of the resident as guardian for the minor; ]

[ (4) a final order naming the applicant's managing conservator; or ]

[ (5) an income tax return showing name and relationship of the applicant to the resident. ]

[ (f) Any difference between the name of the applicant and the name on any document must be explained by additional documentation (Example: marriage license, divorce decree, or adoption decree). ]

§37.214.Applications and Eligibility Date.

Persons meeting the eligibility requirements set forth in §37.212(a)(1), (2), (3) and (5) of this title (relating to Recipient Requirements) must make an application for benefits through an approved Epilepsy Services [ Program ] contracted provider.

(1) - (2) (No change.)

(3) Eligibility date for Epilepsy Services [ Program ] benefits. The date on which a person's eligibility will be determined will be the date upon which a properly completed application is received by the contracted provider. The Epilepsy Services [ Program ] eligibility date will be the later of:

(A) - (D) (No change.)

§37.215.Financial Criteria.

Financial need is established annually on the basis of income legally available to the applicant or the person(s) who have a legal obligation to support the applicant.

(1) - (2) (No change.)

(3) The income level for eligibility is established at 200% of the Federal Poverty Level Guidelines, currently published by the United States Department of [ U.S. ] Health and Human Services and adopted by the department [ Texas Department of Health (department) ].

§37.216.Limitations and Benefits Provided.

(a) Benefits provided by [ the ] Epilepsy Services [ Program ] are outlined in the contract with each provider and may include:

(1) - (3) (No change.)

(b) All Epilepsy Services [ Program ] benefits are limited to services received in Texas from [ at ] a contracted provider.

(c) Depending on the recipient's eligibility status, services will be provided based upon:

(1) (No change.)

(2) any contract between the department [ Texas Department of Health (department) ] and the recipient's service provider; and

(3) (No change.)

(d) [ The ] Epilepsy Services [ Program ] is the payor of last resort. Benefits are payable only after all third parties or government entities (e.g., private/group insurance or the Veterans Administration) have met their liability.

§37.217.Participating Providers.

(a) Selection of Service Providers. Providers are solicited and selected by a Request for Proposal (RFP) process. An organization may apply to become a contracted provider by responding to an RFP [ to participate in the Epilepsy Program ] that has been published in accordance with department [ Texas Department of Health (department) ] policy. [ The RFP must be accompanied by documentation which is acceptable to the department and which is sufficient to demonstrate that the organization: ]

[ (1) can provide the range of medical, non-medical and support activities outlined in the RFP and deemed necessary by the department to effectively serve eligible persons in the designated geographic area; ]

[ (2) agrees to comply with the department's Uniform Grant Management Standards as promulgated by the State of Texas Governor's Office; and ]

[ (3) agrees to cooperate with the department in accordance with Texas Health and Safety Code, Chapter 40; Title 25 Texas Administrative Code §§37.211 - 37.222; and the Texas Family Code, §231.006. ]

(b) An applicant and/or a current contractor that is aggrieved in connection with the award of a department contract to provide epilepsy services may file a protest in accordance with department policy.

[ (b) Provision of Services. Epilepsy Program services shall be furnished by providers under contract with the department. ]

(c) The department may deny, modify, suspend, or terminate the approval of providers for submitting false or fraudulent claims or failing to provide and maintain quality services according to acceptable standards. A provider's performance under its contract may subject the provider to review, fraud referral to the appropriate authority, and/or administrative sanctions.

[ (c) Suspension or Termination of Service Providers. Any contracted provider may be terminated or suspended from participation in the Epilepsy Program for any of the following reasons: ]

[ (1) providing false or misleading information regarding any participation criteria; ]

[ (2) a material breach of any contract or agreement with the Epilepsy Program; ]

[ (3) failure to maintain the participation criteria contained in subsection (a) of this section. ]

[ (d) Appeal of Termination or Suspension. A contracted provider may appeal a termination or a suspension through the department's reconsideration and fair hearings process, as contained in §37.218 of this title (relating to Notice of Intent to Take Action and Reconsideration) and §37.219 of this title (relating to Notice and Fair Hearing). ]

[ (1) The Epilepsy Program may not terminate program participation until a final decision is rendered under the department's reconsideration and fair hearing process. ]

[ (2) The Epilepsy Program shall not enter into, extend, or renew a contract or agreement with a contracted provider until a final decision is rendered under the department's reconsideration and fair hearings process. ]

[ (3) A contracted provider may not appeal a termination of a contract which results from limitations in appropriations or funding for covered services or benefits or which terminates under its own terms. ]

§37.218.Notice of Intent to Take Action and Fair Hearing [ Reconsideration ].

(a) When notice of intent to take action is required. An Epilepsy Services [ Program ] applicant or [ , ] recipient [ , or provider ] is entitled to [ a ] notice anytime Epilepsy Services intends [ of intent ] to take action under this section [ anytime the Epilepsy Program intends to take action ].

(b) Time of notice of intent to take action. Epilepsy Services shall provide a written [ A ] notice of intent to take action under this section [ shall be mailed ] to the applicant or [ , ] recipient [ , or provider ] not less than 20 days prior to the effective date of the [ time the Epilepsy Program intends to take an ] action.

(c) Content of notice of intent to take action. The notice shall contain the following information:

(1) a statement of the action [ the ] Epilepsy Services [ Program ] intends to take;

(2) an explanation of the reasons for the action [ the ] Epilepsy Services [ Program ] intends to take;

(3) an explanation of the applicant's or [ , ] recipient's [ , or provider's ] right to request a fair hearing regarding [ reconsideration before ] the action [ is taken ];

[ (4) the procedure by which the applicant, recipient, or provider may request a reconsideration from the Epilepsy Program, including the address where written requests shall be submitted and any phone number the applicant, recipient, or provider may call to request assistance or a reconsideration; and ]

[ (5) a statement that the applicant, recipient, or provider shall make a request for reconsideration within 20 days of the date on the notice and that if the applicant, recipient, or provider does not request a reconsideration, the applicant's, recipient's, or provider's right to a reconsideration and fair hearing will be waived and the action will become final. ]

(d) A recipient or applicant aggrieved by the intent to take action may appeal the decision according to the procedures in §§1.51-1.55 of this title (relating to Fair Hearing Procedures). If an aggrieved recipient requests a hearing, the department shall not terminate services to the recipient until a final decision has been rendered.

[ (d) No request. If a request for reconsideration is not received within the time allowed, the action shall become final 20 days after the date on the notice and the right to reconsideration or a fair hearing is waived. ]

[ (e) Reconsideration procedure. If an applicant, recipient, or provider contacts the Epilepsy Program requesting a reconsideration, the Epilepsy Program will conduct a review of the request and the action shall not become final until a decision is made as described in this subsection. ]

[ (1) The Epilepsy Program will conduct a comprehensive review of the request within 180 days of the Epilepsy Program's receipt of the request. The Epilepsy Program will: ]

[ (A) obtain any additional medical information or documentation required or available to support the request; and ]

[ (B) review the request along with all supporting documentation. ]

[ (2) If the Epilepsy Program determines that the request is approved based on the comprehensive review, the Epilepsy Program will notify the applicant, recipient, or provider that the request is approved. ]

[ (3) If the Epilepsy Program determines that the request is not approved and that an action will be taken, the Epilepsy Program will notify the applicant, recipient, or provider of their right to a fair hearing as described in §37.219 of this title (relating to Notice and Fair Hearing). ]

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 June 5, 2006.

TRD-200603039

Cathy Campbell

General Counsel

Department of State Health Services

Earliest possible date of adoption: July 16, 2006

For further information, please call: (512) 458-7111 x6972


Subchapter K. EPILEPSY PROGRAM

25 TAC §§37.219 - 37.222

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

STATUTORY AUTHORITY

The proposed repeals are authorized by Health and Safety Code, §40.003, which allows the department to adopt rules necessary to administer epilepsy services; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.

The proposed repeals affect Health and Safety Code, Chapter 40.

§37.219.Notice and Fair Hearing.

§37.220.Forms.

§37.221.Confidentiality of Information.

§37.222.Nondiscrimination Statement.

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 June 5, 2006.

TRD-200603040

Cathy Campbell

General Counsel

Department of State Health Services

Earliest possible date of adoption: July 16, 2006

For further information, please call: (512) 458-7111 x6972