Emergency Sections An agency may adopt a new or amended section or repeal an existing section on an emergency basis if it determines that such action is necessary for the public health, safety, or welfare of this state. The section may become effective immediately upon filing with the Texas Register, or on a stated date less than 20 days after filing, for no more than 120 days. The emergency action is renewable once for no more than 60 days. Symbology in amended emergency sections. New language added to an existing section is indicated by the use of bold text. [Brackets] indicate deletion of existing material within a section. TITLE 40. Social Services and Assistance Part I. Texas Department of Human Services Chapter 29. Purchased Health Services Subchapter L. General Administration 40 TAC sec.sec.29.1104, 29.1126, 27.1127 The Texas Department of Human Services (DHS) adopts on an emergency basis amendments to sec.29.1104 concerning the Texas Medicaid Reimbursement Methodology, sec.29.1126 concerning reimbursement for in-home total parenteral hyperalimentation services, and sec.29.1127 concerning reimbursement for in-home respiratory therapy services for ventilator-dependent persons. These emergency rules are required to eliminate any cost-of-living adjustment for these services for the 1994-1995 biennium as mandated in the appropriations act effective September 1, 1993. These amendments were proposed in the August 10, 1993, issue of the Texas Register. The amendments are adopted on an emergency basis under the Human Resources Code, Title 2, Chapters 22 and 32, which provides the department with the authority to administer public and medical assistance programs and under Texas Civil Statutes, Article 4413 (502), sec.16, which provides the Health and Human Services Commission with the authority to administer federal medical assistance funds. sec.29.1104. Texas Medicaid Reimbursement Methodology (TMRM). (a) Reimbursement for physicians and certain other practitioners. (1) (No change.) (2) Definitions. The following words and terms, when used in this section shall have the following meanings, unless the context clearly indicates otherwise. (A)-(C) (No change.) (D) Conversion Factor-The dollar amount by which the sum of the three cost component RVUs is multiplied in order to obtain a reimbursement fee for each individual service. The initial value of the conversion factor is $26.873 for fiscal year 1992 and 1993. The conversion factor will be updated based on the adjustments described in subparagraph (E) of this paragraph at the beginning of each state fiscal year biennium. Unless the cost savings specified in the Appropriations Act for the 1994-1995 biennium are realized, there will be no adjustment of the conversion factor for the 1994-1995 biennium.
    DHS may, at its discretion, develop and apply multiple conversion factors for various classes of service such as obstetrics, pediatrics, general surgeries, and/or primary care services. (E) (No change.) (3) (No change.) (b)-(c) (No change.) sec.29.1126. In-Home Total Parenteral Hyperalimentation Services. (a)-(d) (No change.) (e) The Texas Department of Human Services (DHS) or its designee reimburses each provider on a monthly basis. Reimbursement is based on one-twelfth of the maximum yearly fee established by DHS. DHS will adjust the allowable fees or rates each state fiscal year by applying the projected rate of change of the implicit price deflator for personal consumption expenditures (IPD-PCE). DHS uses the lowest feasible IPD-PCE forecast consistent with the forecasts of nationally-recognized sources available to DHS at the time rates are prepared. The first adjustment will be effective January 1, 1993. Unless the cost savings specified in the Appropriations Act for the 1994-1995 biennium are realized, there will be no adjustment for the 1994 and 1995 fiscal years.
      Subsequent adjustments will occur at the beginning of each state fiscal year. DHS or its designee does not reimburse more than a one-week supply of solutions and additives if the solutions and additives are shipped and not used because of the recipient's loss of eligibility, change in treatment, or inpatient hospitalization. The provider must exclude from its monthly billing any days that the recipient is an inpatient in a hospital or other medical facility or institution. Payment for partial months will be prorated based upon actual days of administration. Hospital outpatient departments furnishing in- home total parenteral nutrition must be separately enrolled as a provider meeting all requirements stipulated in subsection (d) of this section. Reimbursement to hospital outpatient departments furnishing in-home total parenteral nutrition may not exceed the maximum yearly fee established by DHS. sec.29.1127. In-Home Respiratory Therapy Services for Ventilator-Dependent Persons. (a)-(e) (No change.) (f) The department or its designee reimburses each respiratory therapy provider on a per-visit basis. Reimbursement for the visit is based on the lesser of the provider's customary charge or the maximum allowable fee or rate established by the department or its designee. Reimbursement for supplies furnished by the respiratory care practitioner is the lesser of the provider's customary charges or the maximum allowable fees or rates established by the department or its designee. The department updates its allowable fees or rates each state fiscal year by applying the implicit price deflator for personal consumption expenditures. Unless the cost savings specified in the Appropriations Act for the 1994-1995 biennium are realized, there will be no adjustment for the 1994 and 1995 state fiscal years. Issued in Austin, Texas, on August 16, 1993. TRD-9327385 Nancy Murphy Section Manager, Policy and Document Support Texas Department of Human Services Effective date: September 1, 1993 Expiration date: October 17, 1993 For further information, please call:(512) 450-3765