PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER D. REIMBURSEMENT METHODOLOGY FOR INTERMEDIATE CARE FACILITIES FOR PERSONS WITH MENTAL RETARDATION (ICF/MR)
The Texas Health and Human Services Commission (HHSC) proposes to amend §355.455, concerning Payments to Non-State Operated Facilities.
Background and Justification
The proposed amendment exempts augmentative communication devices (ACDs) from existing requirements that limit reimbursement to Intermediate Care Facilities for Persons with Mental Retardation (ICF/MRs) for durable medical equipment purchased for Medicaid-eligible residents to $5,000 per resident per year. Instead, the amendment will refer to new 40 TAC §9.228, regarding ACDs, that the Department of Aging and Disability Services (DADS) is proposing concurrently with this rule. Proposed new 40 TAC §9.228 was published in the April 17, 2009, issue of the Texas Register (34 TexReg 2499). New §9.228 describes requirements that an ICF/MR must follow to obtain DADS reimbursement for purchasing an ACD for a Medicaid recipient. Under the proposed amendment to §355.455 and new 40 TAC §9.228, ICF/MRs will be reimbursed at cost for the purchase of ACDs for Medicaid-eligible residents.
The proposed amendment to §355.455 also deletes repetitive language and replaces references to the legacy Texas Department of Mental Health and Mental Retardation (MHMR) with references to the Health and Human Services Commission (HHSC) or its designee. It also updates terminology by replacing references to "clients" with the term "residents."
Section-by-Section Summary
The proposed amendment to §355.455:
Revises subsections (a) and (c) to replace references to legacy "MHMR" with references to "HHSC or its designee."
Revises subsection (c) to exclude ACDs from reimbursement requirements associated with the purchase of durable medical equipment in ICF/MRs.
Revises subsection (d) to delete language stating that "there are modeled rates for each level of need for each class of non-state operated facilities;" this language merely repeats statements made in subsections (a) and (b).
Revises subsection (d) to add language stating that reimbursement for ACDs is governed by 40 TAC §9.228, regarding Augmentative Communication Device system.
Revises subsections (a) and (c) and subsection (c)(4) to replace references to clients with references to residents.
Fiscal Note
Gordon E. Taylor, Chief Financial Officer for the Department of Aging and Disability Services, has determined that, for the first five-year period the proposed amendment is in effect, there will be a fiscal impact to state government of $74,412 for state fiscal year (SFY) 2009; $74,412 for SFY 2010; $75,348 for SFY 2011; $75,348 for SFY 2012; and $75,348 for SFY 2013. 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 this 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 amendment. The implementation of the proposed rule amendment 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 amendment. The amendment will not affect local employment.
Public Benefit
Carolyn Pratt, Director of Rate Analysis, has determined that, for each of the first five years the amendment is in effect, the expected public benefit is that ICF/MRs will be reimbursed at appropriate amounts for ACDs, and it will be easier for Medicaid-eligible individuals receiving services in an ICF/MR to receive a medically-necessary ACD.
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 Cheryl Jablonski in the HHSC Rate Analysis Department by telephone at (512) 491-1764. Written comments on the proposal may be submitted to Ms. Jablonski by facsimile at (512) 491-1998, by e-mail to cheryl.jablonski@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 amendment is proposed under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and the Human Resource Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.
The proposed amendment affects the Human Resources Code Chapter 32, and the Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by this proposal.
§355.455.Payments to Non-State Operated Facilities.
(a) HHSC or its designee [TDMHMR]
will pay to non-state-operated facilities modeled rates that will
vary by class of facility and a resident's [client's]
level-of-need.
(b) The non-state operated facility modeled rates include
payment for both residential and day program services.
Residents [Individuals
] receive medical and dental services through the
Medicaid identification card. Any medical expenses other than
Medicaid-covered services are the responsibility of the
ICF/MR provider.
(c) With a limit of $5,000 per resident [client
] per year, HHSC or its designee [TDMHMR]
will pay a provider for the actual cost of a resident's [
client's] durable medical equipment, excluding augmentative
communication devices, if:
(1) the cost of the equipment exceeds $1,000;
(2) the facility receives approval from HHSC or
its designee [TDMHMR] to purchase the equipment;
(3) the provider submits a voucher to HHSC or
its designee [TDMHMR] for the cost of the equipment; and
(4) the resident [client] is
eligible for Medicare benefits and the provider has submitted a Medicare
claim and received a response to the claim prior to requesting payment
from HHSC or its designee [TDMHMR].
(d) Reimbursement for augmentative communication
devices is governed by 40 TAC §9.228, relating to Augmentative
Communication Device Systems. [There are modeled rates
for each level of need for each class of non-state operated facilities.]
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 April 29, 2009.
TRD-200901604
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: June 14, 2009
For further information, please call: (512) 424-6900