Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355. REIMBURSEMENT RATES
Subchapter C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
The Health and Human Services Commission (HHSC) proposes new §355.310, concerning the reimbursement methodology for customized power wheelchairs (CPWCs) and associated physical or occupational therapy evaluations for qualified Texas nursing facility residents.
Background and Justification
This rule describes the reimbursement methodology for CPWCs and associated physical or occupational therapy evaluations for qualified Texas nursing facility residents authorized under 40 Texas Administrative Code (TAC) §19.2614. Section 19.2614 relates to Nursing Facility Customized Power Wheelchairs and was proposed in the January 18, 2008, issue of the Texas Register (33 TexReg 521).
The Texas Department of Aging and Disability Services is adding CPWCs as an item reimbursable by Medicaid for qualified Texas nursing facility residents as part of the settlement agreement in the lawsuit filed in federal court against HHSC and DADS entitled LeCompte, et al. v. Hawkins, et al. This rule details how reimbursements will be calculated for these CPWCs and associated physical or occupational therapy evaluations.
Section-by-Section Summary
The proposal creates a new section in the HHSC rule base at 1 TAC §355.310 to:
Describe in paragraph (1) the reimbursement methodology for CPWCs.
Describe in paragraph (2) the reimbursement methodology for physical or occupational therapy evaluations associated with CPWCs.
Fiscal Note
Gordon E. Taylor, Chief Financial Officer for the Department of Aging and Disability Services, has determined that during the first five-year period the proposed rule is in effect there will be a fiscal impact to state government of $664,477 for state fiscal year (SFY) 2008, $672,910 for SFY 2009, $522,769 for SFY 2010, $535,838 for SFY 2011, and $549,234 for SFY 2012 as a result of adding this service to the nursing facility program. The proposed rule will not result in any fiscal implications for local health and human services agencies. There are no fiscal implications for local governments as a result of enforcing or administering the section.
Small Business and Micro-Business Impact Analysis
HHSC has determined that there is no adverse economic effect on small businesses or micro-businesses as a result of enforcing or administering the proposed rule. The implementation of this proposed rule does not require any changes in practice or any additional cost to the contracted provider.
HHSC does not anticipate that there will be any economic cost to persons who are required to comply with this proposed rule. The proposed rule will not affect local employment.
Public Benefit
Carolyn Pratt, Director of Rate Analysis, has determined that, for each of the first five years the proposed rule is in effect, the expected public benefit is that nursing facilities will be reimbursed at appropriate rates for CPWCs and associated physical or occupational therapy evaluations.
Takings Impact Assessment
HHSC has determined that this proposed rule does 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, does not constitute a taking under Texas Government Code §2007.043.
Regulatory Analysis
HHSC has determined that this proposed rule is not a "major environmental rule" as defined by §2001.0225 of the Texas Government Code. "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 proposed rule is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.
Public Comment
Questions about the content of this proposal may be directed to Pam McDonald in the HHSC Rate Analysis Department by telephone at (512) 491-1373. Written comments on the proposal may be submitted to Ms. McDonald by facsimile at (512) 491-1998, by e-mail to pam.mcdonald@hhsc.state.tx.us, or by mail to HHSC Rate Analysis, Mail Code H-400, P.O. Box 85200, Austin, Texas 78708-5200, within 30 days of publication of this proposal in the Texas Register.
Statutory Authority
The new rule is proposed under Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which authorize HHSC to administer the federal medical assistance (Medicaid) program in Texas.
The proposed rule affects Human Resources Code Chapter 32, and Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by this proposal.
§355.310.Reimbursement Setting Methodology--Customized Power Wheelchairs and Associated Evaluations.
Reimbursement rates for customized power wheelchairs (CPWCs) and associated physical or occupational therapy evaluations provided under 40 TAC §19.2614 (relating to Nursing Facility Customized Power Wheelchairs) are determined as follows:
(1) For CPWCs, rates are determined in accordance with §355.8021(c) of this title (relating to Reimbursement Methodology for Home Health Services).
(2) For evaluations required for CPWCs under 40 TAC §19.2614(c), rates are determined in accordance with §355.313 of this title (relating to Reimbursement Methodology for Specialized and Rehabilitative Services).
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 January 17, 2008.
TRD-200800197
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: March 2, 2008
For further information, please call: (512) 424-6900