Subchapter J. PURCHASED HEALTH SERVICES

The Texas Health and Human Services Commission (HHSC) adopts the amendments to the following reimbursement methodology rules: Division 9, Certified Nurse Midwives, §355.8161; Division 12, Certified Registered Nurse Anesthetists, §355.8221; and Division 15, Nurse Practitioners and Clinical Nurse Specialists, §355.8281. Sections 355.8161 and 355.8281 are adopted without changes to the proposed text as published in the April 21, 2006, issue of the Texas Register (31 TexReg 3339) and will not be republished. Minor changes have been made to §355.8221, so the text of the rules will be republished.

Background and Justification

The rule amendments were proposed pursuant to Rider 72, S.B. 1, 79th Legislature, Regular Session, 2005. Rider 72 requires, in part, that HHSC reimburse advanced practice nurses (APNs) for services billed under the APN's Medicaid provider number. According to the Texas Board of Nurse Examiners, the correct titles for APNs are nurse practitioners (NPs), clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), and certified nurse midwives (CNMs). The amendments revise the methodology by which these providers will be reimbursed.

Revisions to §355.8161, concerning certified nurse midwives (CNMs), increased the reimbursement percentage for covered professional services from 85 to 92 percent of the reimbursement for the same professional service paid to a physician (M.D. or D.O.). Certified nurse midwives will be reimbursed for other billing codes at the same reimbursement level as physicians. The amendments removed program policy language that was not appropriate for reimbursement methodology rules, changed the title of Division 9 from "Nurse-Midwife Services" to "Certified Nurse Midwives," and changed the title of the rule from "Reimbursement" to "Reimbursement Methodology."

Revisions to §355.8221, concerning Certified Registered Nurse Anesthetists (CRNAs), increased the reimbursement percentage for covered anesthesia services from 85 to 92 percent of the reimbursement for the same anesthesia service paid to a physician (M.D. or D.O.). The amendments removed program policy language that was not appropriate for reimbursement methodology rules, changed the title of Division 12 from "Certified Registered Nurse Anesthetists' Services" to "Certified Registered Nurse Anesthetists," and changed the title of the rule from "Reimbursement" to "Reimbursement Methodology."

Revisions to §355.8281, concerning Nurse Practitioners and Clinical Nurse Specialists (NPs and CNSs), increased the reimbursement percentage for covered professional services from 85 to 92 percent of the reimbursement for the same professional services paid to a physician (M.D. or D.O.). Nurse practitioners and clinical nurse specialists will be reimbursed for other billing codes at the same reimbursement level as physicians. The amendments changed the title of Division 15 from "Certified Family Nurse Practitioner and Pediatric Nurse Practitioner" to "Nurse Practitioners and Clinical Nurse Specialists," as well as changed the title of the rule from "Reimbursement" to "Reimbursement Methodology."

HHSC received comments during the 30-day comment period. Written comments were received from the Coalition for Nurses in Advanced Practice (CNAP) and the Texas Academy of Nurse Anesthetists (TANA). The rules at 1 TAC §355.8221 were modified in response to the comments. A summary of the comments and HHSC's response follows.

COMMENT: CNAP and TANA requested that the phrase "and billed under the CRNA's own provider number" be removed from 1 TAC §355.8221, since CRNAs are required to bill Medicaid under their own provider numbers by the proposed program rules at 1 TAC §354.1301(g).

RESPONSE: 1 TAC §355.8221 has been revised accordingly.

Subchapter I. MEDICAID BUY-IN PROGRAM