Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354. MEDICAID HEALTH SERVICES
Subchapter A. PURCHASED HEALTH SERVICES
DIVISION 11. GENERAL ADMINISTRATION
The Health and Human Services Commission (HHSC) adopts new §354.1186, Requirements for the Health Passport, as required by Senate Bill 6, 79th Legislature, Regular Session, 2005, codified in the Texas Family Code §266.06. The new rule is adopted with a few technical, non-substantive corrections that were made for stylistic and grammatical purposes to the proposed text as published in the January 5, 2007, issue of the Texas Register (32 TexReg 8). The text of the rule will be republished.
New §354.1186 describes the minimum data requirements of the Health Passport, an electronic record of healthcare information required for children in foster care.
HHSC did not receive comments regarding the proposed rule during the 30-day comment period, which included a public hearing on January 24, 2007. However, a few technical, non-substantive corrections were made for stylistic and grammatical purposes. The intent of the new rule remains the same as originally proposed.
The new rule is adopted under the Texas Government Code §531.033, which provides the Executive 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 Family Code §266.06, which requires the Executive Commissioner to adopt rules specifying the information required to be included in the passport.
§354.1186.Requirements for the Health Passport.
(a) The Health Passport is an electronic medical record used to document healthcare services provided to clients who receive services through the comprehensive foster care healthcare delivery system, mandated by the Texas Family Code §266.003 and §266.006, and other Medicaid clients as may be designated by the Health and Human Services Commission (HHSC).
(b) The contents of the Health Passport must include, but are not limited to:
(1) Client's name, birthdate, address of record, and Medicaid ID number;
(2) Name and address of each of the client's physicians and health care providers;
(3) A record of each visit to a physician or other healthcare provider, including routine checkups conducted in accordance with the Texas Health Steps Program;
(4) A record of immunizations;
(5) Identification of the client's known health problems; and
(6) Information on all client prescriptions.
(c) The electronic Health Passport system must be secure and maintain the confidentiality of the client's health records in compliance with security and privacy rules adopted by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 C.F.R. §§164.302 - 164.318 and §§164.500 - 164.534.
(d) If the client is in foster care, the Health Passport information shall be available in printed and electronic formats to the following individuals when the client is discharged from foster care:
(1) The client's legal guardian, managing conservator, or parent; or
(2) The client, if the client is at least 18 years of age or has been awarded the legal rights of an adult through the removal of the disabilities of minority, as defined in the Texas Family Code, Title 2, Chapter 31.
(e) The administrator of the electronic Health Passport system shall be determined by HHSC. The administrator shall be responsible for meeting all requirements of the Health Passport.
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 March 19, 2007.
TRD-200701047
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 1, 2007
Proposal publication date: January 5, 2007
For further information, please call: (512) 424-6900
The Health and Human Services Commission (HHSC) adopts amendments to §354.1415, concerning Disease Management (DM) vendor requirements and conditions for participation; §354.1416, which outlines the eligibility criteria for the Disease Management Program; and §354.1417, which provides the definitions for Disease Management services. Section 354.1415 and §354.1416 are adopted without changes to the proposed text as published in the December 29, 2006, issue of the Texas Register (31 TexReg 10455) and will not be republished. Section 354.1417 is adopted with a minor change to the proposed text as published in the December 29, 2006, issue of the Texas Register (31 TexReg 10455) and will be republished.
The change to §354.1417 is minor. In the first sentence, the word "and" is extraneous and has been removed.
The amended rules satisfy requirements of Senate Bill 1188, 79th Legislature, Regular Session, 2005, related to standards of care and care coordination for the Medicaid DM program. In addition, the rules are being updated to reflect current eligibility requirements and exclusions for the program, including the inclusion of Primary Care Case Management (PCCM) recipients in the program.
HHSC did not receive any comments regarding the proposed amendments during the 30-day comment period, which included a public hearing on January 23, 2007.
The amendments are adopted under the Texas Government Code, §531.033, which provides the Executive 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.
§354.1417.Definitions for Disease Management Services.
The following terms are specific to the Disease Management (DM) Program, and when used in this chapter and, have the following meanings, unless the context clearly indicates otherwise.
(1) Care management--An approach or process for persons with chronic illness focused on preventing acute or urgent care utilization through the use of accepted clinical and non-clinical interventions. These interventions include services such as care coordination, telephone access to nurses skilled in monitoring disease symptoms, including answering medication questions, teaching patient education in self-management, and providing physician-coordinated treatment plans.
(2) Case management--A process whereby covered persons with specific health care needs are identified and a plan is formulated and implemented which efficiently utilizes health care resources to achieve the optimum outcome in the most cost-effective manner.
(3) Catastrophic condition--A health condition, such as AIDS, cancer, or end-stage renal disease requiring intensive and ongoing treatment. Clients diagnosed with these types of conditions are excluded from participation in the Texas DM Program.
(4) Claim--A request for payment for authorized benefits submitted on the applicable approved form that meets the established itemization requirements.
(5) Disease hierarchy--The classification of diseases (from highest to lowest) within the DM program that establishes severity and anticipated complexity of intervention and management.
(6) Disease Management Program--The Texas Medicaid DM Program is a holistic approach to health care delivery designed to identify and provide services to Medicaid Fee-for-Service (FFS) clients with, or who are at risk for developing a targeted chronic disease. Clients receive specific interventions from medical professionals for their disease based on nationally recognized evidence-based practice guidelines, support to follow their physician's plan of care, and education to practice healthy behaviors.
(7) Disease management targeted diseases--The DM Program provides services to Medicaid eligible clients with, or at risk for one or more of the following five chronic health conditions: Diabetes, Asthma, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and Coronary Artery Disease (CAD).
(8) Eligible client--An individual who has been designated by the State as eligible for medical care and services under the Medicaid State Plan and meets the requirements for the targeted diseases included in the DM Program.
(9) Fee-for-Service Reimbursement--The traditional health care payment system under which physicians and other providers receive a payment for each unit of service they provide or an insurance product in which clients are allowed total freedom to choose their health care providers.
(10) Health severity level--An assessment by the disease management vendor that determines the appropriate intervention level (low, medium, high) based on the progression of the disease and the DM enrollee's health status.
(11) Medical assistance program--The program implemented by the State of Texas under the provisions of Title XIX of the Social Security Act, as amended.
(12) Medical home--A community-based system of health care delivery that provides individual patients a known resource (primary care provider or clinic) for all primary and preventive care services. It also provides continuity of care for primary acute needs 24 hours a day, and is networked to any necessary consultative, specialty, and health-related services.
(13) Physician--A doctor of medicine or doctor of osteopathy (MD or DO) legally authorized to practice medicine or osteopathy at the time and place the service is provided.
(14) Preventive care--Comprehensive care emphasizing priorities for prevention, early detection, and early treatment of conditions, generally including routine physical examination, immunization, and well-person care.
(15) Primary Care Case Management (PCCM)--A managed care model allowed under federal regulations in which HHSC contracts with providers to form a managed care provider network.
(16) Primary care provider (PCP)--A physician or provider who has agreed to provide a medical home to Medicaid clients and who is responsible for providing initial and primary care to patients, maintaining the continuity of patient care and initiating referral for care.
(17) Stratify--A method used by the disease management vendor to organize interventions based on low, medium, and high categories.
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 March 19, 2007.
TRD-200701048
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: September 1, 2007
Proposal publication date: December 29, 2006
For further information, please call: (512) 424-6900