ADOPTED RULES An agency may take final action on a section 30 days after a proposal has been published in the Texas Register. The section becomes effective 20 days after the agency files the correct document with the Texas Register, unless a later date is specified or unless a federal statute or regulation requires implementation of the action on shorter notice. If an agency adopts the section without any changes to the proposed text, only the preamble of the notice and statement of legal authority will be published. If an agency adopts the section with changes to the proposed text, the proposal will be republished with the changes. TITLE 1. ADMINISTRATION Part III. Office of the Attorney General Chapter 61. Crime Victims Compensation 1 TAC sec.61.10 The Office of the Attorney General adopts an amendment to sec.61.10, concerning crime victims compensation with changes to the proposed text as published in the July 4, 1995, issue of the Texas Register (20 TexReg 4895). The amendment is necessary to articulate administrative limits on new benefits as a result of legislative changes to the Act effective September 1, 1995. The adopted rule will set administrative limits on the dollar amount victims and claimants may receive for reimbursement of certain losses. No substantive comments were received regarding adoption of the amendment. Only comments on form were submitted by the Office of the Attorney General and such comments were agreed with and have been incorporated in this adoption. The amended section is adopted under the Crime Victims' Compensation Act, Texas Code of Criminal Procedure, Article 56.33 which provides the Office of the Attorney General with the authority to promulgate and adopt rules relating to the method of filing claims and the proof of entitlement to compensation. sec.61.10. Limits on Compensation. In addition to the rates established under the Act, the following limits for compensation are deemed to be an amount reasonably incurred under the Act, Article 56.32(9) of the Act: (1) ground ambulance transportation rates are limited to $250 for each ambulance response and transport; (2) air ambulance transportation rates are limited to $1,500 for each air ambulance response and transport; (3) funeral and burial expenses are limited to $4,500; (4) loss of earnings and loss of support to a dependent are limited to $400 per week; (5) care of dependents or minor children is limited to $100 per week per dependent or child; (6) costs of crime scene cleanup are limited to $750 in the aggregate; and (7) costs for replacement of clothing, bedding or other property is limited to $750 in the aggregate. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on August 9, 1995. TRD-9509935 Jerry Benedict Assistant Attorney General Office of the Attorney General Effective date: September 1, 1995 Proposal publication date: July 4, 1995 For further information, please call: (512) 475-4291 TITLE 10. COMMUNITY DEVELOPMENT Part I. Texas Department of Housing and Community Affairs Chapter 80. Manufactured Housing (Editor's Note: House Bill 785, 74th Legislature transferred the administration and enforcement of Texas Civil Statutes, Article 5221f, Texas Manufactured Housing Standards Act from the Texas Department of Licensing and Regulation, Title 16, Part IV, Chapter 69, to the Texas Department of Housing and Community Affairs, Title 10, Part I, Chapter 80. The transfer is effective September 1, 1995. The Texas Register is administratively transferring the following rules listed in the conversion chart published in this issue under the Tables and Graphics section on page 6212-6213. The table lists the old section number and the new section number that corresponds to them.) TITLE 16. ECONOMIC REGULATION Part I. Railroad Commission of Texas Chapter 15. Alternative Fuels Research and Education Division Media Rebate Program 16 TAC sec.sec.15.205, 15.210, 15.215 The Railroad Commission of Texas adopts amendments to sec. sec.15.205, 15.210, and 15.215, relating to the Alternative Fuels Research and Education Division's media rebate program, without changes to the proposed text as published in the July 4, 1995, issue of the Texas Register (20 TexReg 4896). The amended rules broaden certain media rebate program eligibility requirements and continue the program in effect past August 21, 1995. Changing the definitions of "commission advertising," "eligible media outlet," and "eligible media purchase" extends eligibility to new classes of advertising (e.g., billboards) and to advertising that is not commission-produced but that has been approved in writing by the commission prior to use. Changing sec.15.215 makes more advertising eligible for rebates. Deleting the definition of "program year" and the last sentence of sec.15.210 continues the rule and the program in effect past August 21, 1995. No comments were received regarding adoption of the amendments. The amendments are adopted under the Texas Natural Resources Code, sec.113. 241, which authorizes the commission to adopt rules relating to educating the public regarding the use of LPG and other environmentally beneficial alternative fuels that are or have the potential to be effective in improving the quality of air in this state; Texas Natural Resources Code, sec.113.243(c) (2), which authorizes the commission to implement marketing and advertising programs relating to alternative fuels to make alternative fuels more understandable and readily available to consumers; and Texas Natural Resources Code, sec.113.243(c)(6), which authorizes the commission to use money in the Alternative Fuels Research and Education Fund to implement programs necessary to promote the use of LPG or other environmentally beneficial alternative fuels. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on August 8, 1995. TRD-9509907 Mary Ross McDonald Assistant Director, Legal Division, Gas Utilities/LP Gas Railroad Commission of Texas Effective date: August 29, 1995 Proposal publication date: July 4, 1995 For further information, please call: (512) 463-7008 TITLE 16. ECONOMIC REGULATION Part IV. Texas Department of Licensing and Regulation Chapter 69. Manufactured Housing (Editor's Note: House Bill 785, 74th Legislature transferred the administration and enforcement of Texas Civil Statutes, Article 5221f, Texas Manufactured Housing Standards Act from Title 16, Part IV, Chapter 69, the Texas Department of Licensing and Regulation to Title 10, Part I, Chapter 80, the Texas Department of Housing and Community Affairs. The transfer is effective September 1, 1995. The Texas Register is administratively transferring the following rules listed in the conversion chart published in this issue under the Tables and Graphics section on page 6212-6213. The table lists the old section number and the new section number that correspond to them.) TITLE 22. EXAMINING BOARDS Part VIII. Texas Appraiser Licensing and Certification Board Chapter 153. Provisions of the Texas Appraiser Licensing and Certification Act 22 TAC sec.sec.153.1, 153.7, 153.13, 153.15-153.17, 153.25, 153. 27 The Texas Appraiser Licensing and Certification Board adopts amendments to sec.sec.153.1, 153.7, 153.13, 153.15, 153.17, 153.25, 153.27, and new sec.153.16, without changes to the proposed text as published in the June 23, 1995, issue of the Texas Register (20 TexReg 4531). The adopted amendment to sec.153.1 conforms the definitions in the rules to those of Texas Appraiser Licensing and Certification Act, sec.3 (Texas Civil Statutes, Article 6572a.2) as amended by Senate Bill 634, 74th Legislature, regular session, 1995. The amendments also include the definition of provisional license, as created as follows. Adopted amendment to sec.153.7 notes the categories of state licensed real estate appraiser and appraiser trainee. It also establishes the new category of a provisional license as per the new Act, sec.9A as amended by Senate Bill 634. The Act, sec.9A provides for an alternate method of licensing and sec.153.7 clarifies what licensees licensed under sec.9A will be called. Adopted amendment to sec.153.13 provides for the provisional license applicant to meet all of the same requirements as the state licensed real estate appraiser except the experience requirement, as per the Act, sec.9A as amended by Senate Bill 634. It further provides that correspondence courses are acceptable under certain circumstances as provided in the Appraiser Qualifications Board (AQB) of the Appraisal Foundation educational criteria for qualifying education, and disallows "in-house" training from being acceptable qualifying education. Adopted amendment to sec.153.15 provides for a random sampling to verify experience claimed for certification or licensure, as per the Act, sec.9(f),(g), and (h) as amended by Senate Bill 634. New adopted sec.153.16 concerns the provisional license, as per new sec.9A of the Act as amended by Senate Bill 634. Adopted amendment to sec.153.17 allows correspondence courses to be acceptable for appraiser continuing education (ACE) under the AQB criteria for continuing education, and disallows "in-house" training from being acceptable for ACE. Adopted amendment to sec.153.25 removes the requirement that a person registered with the Board as a temporary non-resident appraiser may only appraise in federally related transactions, as per the Act, sec.15(c) as amended by Senate Bill 634. Adopted amendment to sec.153.27 changes the language concerning reciprocity with states having "substantially equivalent" requirements to those "that have not been disapproved by the Appraisal Subcommittee" as per the Act, sec.(d) as amended by Senate Bill 634. No comments were received regarding adoption of the amendments and new rule. No comments were presented at the public hearing on Friday, August 4, 1995. The amendments and new rule are adopted under the Texas Appraiser Licensing and Certification Act, sec.5 (Texas Civil Statutes, Article 6573a.2), which provides the Texas Appraiser Licensing and Certification Board with authority to adopt rules for the licensing and certification of real estate appraisers. The sections of the Act discussed provide further authority. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509837 Renil C. Liner Commissioner Texas Appraiser Licensing and Certification Board Effective date: September 1, 1995 Proposal publication date: June 23, 1995 For further information, please call: (512) 465-3950 Part XXIII. Texas Real Estate Commission Chapter 535. Provisions of the Real Estate License Act Fees 22 TAC sec.535.101 The Texas Real Estate Commission adopts an amendment to sec.535.101, concerning fees charged by the commission, without changes to the proposed text as published in the July 4, 1995, issue of the Texas Register (20 TexReg 4902). The amendment adjusts the fees paid under the section by real estate brokers and salesmen for annual renewal of their licenses, reducing the fee for both licenses from $36 to $28 per year. Adoption of the amendment is necessary to conform the commission's fee schedule with an amendment to Texas Civil Statutes, Article 6573a (the Act), sec.11, passed by the 74th Legislature, Regular Session, which separates the fees collected under the section by the commission for the Texas Real Estate Research Center (the Research Center) from the licensing fees collected from applicants and licensees. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 6573a, sec.5(h), which authorize the Texas Real Estate Commission to make and enforce all rules and regulations necessary for the performance of its duties. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509853 Mark A. Moseley General Counsel Texas Real Estate Commission Effective date: September 1, 1995 Proposal publication date: July 4, 1995 For further information, please call: (512) 465-3900 TITLE 25. HEALTH SERVICES Part I. Texas Department of Health Chapter 29. Purchased Health Services Subchapter G. Hospital Services 25 TAC sec.29.609 On behalf of the State Medicaid Director, the Texas Department of Health (department) submits an adopted amendment to sec.29.609, concerning disproportionate share hospitals, with changes to the proposed text as published in the May 12, 1995, issue of the Texas Register (20 TexReg 3549). The section is amended to conform to requirements of the Omnibus Budget Reconciliation Act of 1993 (OBRA '93). After September 1, 1995, all disproportionate share hospitals must have Medicaid inpatient utilization rates, at a minimum, of 1.0%. Disproportionate share hospitals reimbursed after September 1, 1995, also must have limits to how much hospitals can be reimbursed during a state fiscal year. The limit is the sum of two numbers. The first number is a hospital's Medicaid shortfall (the difference between reimbursement and Medicaid allowed costs). The second number is the cost of providing care to patients who have no health insurance or source of third party payments for services provided during the year, less the amount of payments made by these patients. The changes relating to hospital specific limits include definitions of "cost of service," "hospital overall ratios of cost to charges," Medicaid "shortfall," and "payments received" by a hospital from patients without health insurance or source of third party payment for services. Additional changes allow the department to pay a hospital its projected reimbursement, plus its percentage of any additional available funds. Finally, the amendments to the trauma condition of participation to allow disproportionate share hospitals additional time become designated trauma centers. This section provides for reimbursement to hospitals that provide a disproportionate share of indigent care. The following comments were received on the proposal. COMMENT: A commenter stated that the department should clarify its rules so that the Medicaid shortfall would not be reduced by the amount a hospital's Medicaid payments exceed its Medicaid allowable costs. RESPONSE: The department must and will operate its Medicaid disproportionate share program within the context of the Omnibus Budget Reconciliation Act of 1993 (OBRA '93), and any directives issued by the Health Care Financing Administration (HCFA). No changes were made to the section as a result of this comment. COMMENT: A commenter further commented that the department should clarify that the Medicaid shortfall should include Medicaid costs in excess of the inpatient Tax Equity and Fiscal Responsibility Act (TEFRA) cost per discharge limitation. The commenter contends that the rule should clarify that the Medicaid shortfall for outpatient services should be completed using allowable Medicaid costs irrespective of prospectively determined rates or fee screens. RESPONSE: At the direction of HCFA, the department considers the Medicaid shortfall to be the allowable cost, using Medicare principles of cost reimbursement, of services furnished to Medicaid patients, less the amount paid under the non-Medicaid disproportionate share payment method under the state plan. No changes were made to the section as a result of this comment. COMMENT: A commenter also stated that the Medicaid shortfall should be based on the latest available Medicare/Medicaid cost report on file with the department, and that it would not be subject to retroactive adjustment. RESPONSE: The department has not applied retroactive cost settlement procedures to its disproportionate share programs. The department cannot deviate from this policy, unless required to do so by federal regulations or statutes. No changes were made to the section as a result of this comment. COMMENT: A commenter commented that the section should include a provision whereby Medicaid providers would be permitted to submit a cost report that computes the actual cost of providing charity care during the hospital's fiscal year. RESPONSE: OBRA 1993 does not recognize the cost of charity care as such; rather, OBRA 1993 requires states to determine the cost of services hospitals provide to patients without health insurance or source of third party payments made by these patients. The department will obtain these data through its annual survey of Medicaid hospitals for the disproportionate share program. No changes were made to the section as a result of this comment. COMMENT: A commenter asked whether state teaching hospitals and non-state teaching hospitals were paid from the same pools of money. RESPONSE: State teaching hospitals and non-state teaching hospitals are reimbursed from separate and distinct pools of money. COMMENT: Concerning sec.29.609(a)(2), department staff suggested that the definition of "bad debt" be clarified. RESPONSE: The department changed the definition to read the same as in the Annual Survey of Hospitals, rather than a citation to the definition. COMMENT: A commenter noted that although subsection (d) which showed the "(No change.)" designation as proposed, the subsection contained an error to a citation. RESPONSE: The department corrected the citation. Editorial changes were made throughout the section for clarification purposes. The department received written comments from the Universal Health Services, Inc. regarding the proposed section. The department also received oral comments from a representative of the Texas Hospital Association at the May 31, 1995, public hearing. The commenters were generally in favor of the amendments however, they asked questions, requested clarification, and offered suggestions as previously discussed. The amendment is adopted under the Human Resources Code, sec.32.021 and Texas Civil Statutes, Article 4413 (502), sec.16, which provides the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program and is submitted to the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program and as authorized under Chapter 15, sec.1.07, Acts of the 72nd Legislature, First Called Session (1991). sec.29.609. Additional Reimbursement to Disproportionate Share Hospitals. (a) Introduction. Hospitals participating in the Texas Medical Assistance (Medicaid) program that meet the conditions of participation and that serve a disproportionate share of low-income patients are eligible for additional reimbursement from the disproportionate share hospital fund. The single state agency or its designee shall establish each hospital's eligibility for and amount of reimbursement as specified in this section. For purposes of Medicaid disproportionate share eligibility determination, a multi-site hospital is considered as one provider unless it has separate Medicare cost reports for each site. To verify data referred to in this section, hospitals must allow state personnel access to the hospital and its records. (b) Definitions. For purposes of this section, the following words and terms, shall have the following meanings, unless the context clearly indicates otherwise. (1) Adjusted hospital specific limit-A hospital specific limit trended forward to account for inflation update factor since the base year. (2) Bad debt charges-Charges resulting from extensions of credit. (3) Charity care-The unreimbursed cost to a hospital of providing, funding, or otherwise financially supporting health care services on an inpatient or outpatient basis to a person classified by the hospital as financially or medically indigent or providing, funding, or otherwise financially supporting health care services provided to financially indigent patients through other nonprofit or public outpatient clinics, hospitals, or health care organizations. (4) Charity charges (excluding bad debt charges)-Total amount of hospital charges for inpatient and outpatient services attributed to charity care in a cost reporting period. The total inpatient and outpatient charity charges attributable to charity care do not include contractual allowances and discounts (other than for indigent patients not eligible for medical assistance under an approved Medicaid State Plan); that is, reduction or discounts, in charges given to other third-party payers such as, but not limited to, Health Maintenance Organizations (HMOs), Medicare, or Blue Cross. The amount of total charity charges must be consistent with the amount reported on the Texas Department of Health's (department) annual hospital survey. (5) Cost of services-The cost of services provided by a hospital to patients who have no health insurance or source of third party payment for services provided during the hospital's latest fiscal year, less the amount of payments made by these patients. (6) Cost-to-charge ratio (inpatient only)-Hospital's overall inpatient cost- to-charge ratio, as determined from its Medicare cost report it submitted for its fiscal year ending in the previous calendar year. The latest available Medicare cost report will be used in the absence of the cost report for the hospital fiscal year ending in the previous calendar year. (7) Cost-to-charge ratio (inpatient and outpatient) -Hospital's overall cost- to-charge ratio, as determined from its Medicare cost report it submitted for its fiscal year ending in the previous calendar year. The latest available Medicare cost report will be used in the absence of the cost report for the hospital fiscal year ending in the previous calendar year. (8) Financially indigent-An uninsured or underinsured person who is accepted for care with no obligation or a discounted obligation to pay for the services rendered based on the hospital's eligibility system. (9) Gross inpatient revenue-Amount of gross inpatient revenue (charges) reported by the hospital in the appropriate part of the Medicare cost report it submitted for its fiscal year ending in the previous calendar year. Gross inpatient revenue excludes revenue related to the professional services of hospital-based physicians, swing bed facilities, skilled nursing facilities, intermediate care facilities, and other revenue that is unidentified. The latest available Medicare cost report will be used in the absence of the cost report for the hospital fiscal year ending in the previous calendar year. (10) Hospital eligibility criteria-The financial criteria used by a hospital to determine if a patient is eligible for charity care. The system includes income levels and means testing indexed to the federal poverty guidelines; provided, however that a hospital may not establish an eligibility system that sets the income level eligible for charity care lower than that required by counties under the Texas Health and Safety Code, sec.61.023 or higher, in the case of the financially indigent, than 200% of the federal poverty guidelines. A hospital may determine that a person is financially or medically indigent pursuant to the hospital's eligibility system after health care services are provided. (11) Hospital specific limit-The sum of the following two measurements: (A) the Medicaid shortfall; and (B) cost of services. (12) Inflation update factor-A general increase in prices as determined by the guidelines in sec.29.606 of this title (relating to Reimbursement Methodology for Inpatient Hospital Services). (13) Low-income days-Number of days derived by multiplying a hospital's total inpatient census days by its low-income utilization rate. (14) Low-income utilization rate-The result of the following computation: ((Title XIX inpatient hospital payments plus total state and local revenue) divided by (gross inpatient revenue multiplied by cost-to-charge ratio)) plus ((total inpatient charity charges minus total state and local revenue) divided by (gross inpatient revenue)). (15) Medicaid inpatient utilization rate-A hospital's number of inpatient days attributable to patients who for these days were eligible for Medical Assistance under the State Plan divided by a hospital's total inpatient days. (16) Medicaid shortfall-The cost of services (inpatient and outpatient) furnished to Medicaid patients, less the amount paid under the nondisproportionate share hospital payment method under the state plan. (17) Medically indigent-A person whose medical or hospital bills after payment by third-party payers exceed a specified percentage of the patient's annual gross income, determined in accordance with the hospital's eligibility system, and the person is financially unable to pay the remaining bill. (18) Medicare inpatient utilization rate-Medicare inpatient days divided by total inpatient census days. (19) Payments received-Payments received by a hospital from patients who have no health insurance or source of third party payment for services provided during the hospital's latest fiscal year. (20) Rural area-Area outside a Metropolitan Statistical Area (MSA) or a Primary Metropolitan Statistical Area (PMSA). MSA and PMSA are defined by the Office of Management and Budget. (21) Total inpatient census days-Total number of a hospital's inpatient census days during its fiscal year ending in the previous calendar year. (22) Total inpatient charity charges (excluding bad debt charges) -Total amount of the hospital's charges for inpatient hospital services attributed to charity care (care provided to individuals who have no source of payment, third- party or personal resources) in a cost reporting period. The total inpatient charges attributable to charity care will not include contractual allowances and discounts (other than for indigent patients not eligible for medical assistance under an approved Medicaid State Plan); that is, reduction or discounts, in charges given to other third-party payers such as but not limited to HMOs, Medicare, or Blue Cross. The amount of total inpatient charity charges must be consistent with the amount reported on the department's annual hospital survey. (23) Total Medicaid inpatient days-Total number of billed Title XIX inpatient days based on the latest available state fiscal year data for patients eligible for Title XIX benefits. Total Medicaid inpatient days includes days with dates of admissions between September 1 and August 31 (state fiscal year) and dates of payments within the fiscal year and for nine months after the end of the fiscal year (May 31). Total Medicaid inpatient days include days that were denied for reasons other than eligibility. Total Medicaid inpatient days also include days attributable to individuals eligible for Medicaid in other states. (24) Total Medicaid inpatient hospital payments-Total amount of Title XIX funds, excluding Medicaid disproportionate share funds, a hospital received for admissions during the latest available state fiscal year for inpatient services. Total Medicaid inpatient hospital payments includes payments associated with dates of admissions between September 1 and August 31 (state fiscal year) and dates of payments within the fiscal year and for nine months after the end of the fiscal year (May 31). (25) Total operating costs-Total operating costs of a hospital during its fiscal year ending in the calendar year before the start of the current federal fiscal year, according to the hospital's Medicare cost report (tentative, or final audited cost report, if available). (26) Total state and local revenue-Total amount of state and local revenue a hospital received for inpatient care, excluding all Title XIX payments, during its fiscal year ending in the previous calendar year. Sources of state and local revenue include but are not limited to County Indigent Health Care, Chronically Ill and Disabled Children, Kidney Health Care, and tax funds. Sources of revenue that are not included in state and local inpatient revenue include but are not limited to Office of Substance Abuse Program, Ryan White Title II, Ryan White Title III, State Legalization Impact Assistance Grant, Civilian Health and Medical Program of the Uniformed Services, Medicare, and Medicare/Medicaid contractual funds and allowances. The department adjusts inpatient tax revenues for hospitals that report all of their tax revenues as inpatient revenue. To make adjustments, the department uses the appropriate parts of the Medicare cost report that the hospital submitted for its fiscal year ending in the previous calendar year. (27) Urban-Area inside an MSA or PMSA. (28) Weighted low-income days-Low-income days multiplied by an appropriate weighing factor. (29) Weighted Medicaid days-Medicaid days multiplied by an appropriate weighing factor. (c) Conditions of participation. Before the beginning of each state fiscal year, which begins September 1, the single state agency or its designee shall survey Medicaid hospitals to determine which hospitals meet the state's conditions of participation. Hospitals must allow state personnel access to the hospital and its records to ensure compliance with the conditions of participation. Failure to meet all of the conditions of participation shall result in ineligibility for participation in the program. These conditions of participation do not apply to state-owned teaching hospitals as specified in sec.29.610 of this title (relating to Disproportionate Share Hospital Reimbursement Methodology for State-Owned Teaching Hospitals). The conditions of participation are as follows. (1)-(6) (No change.) (7) Trauma system. Disproportionate share hospitals must actively participate in the development of a regional trauma system, which includes trauma facility designation as defined in the state trauma laws (Health and Safety Code, sec.sec.773.111-773.120) and department rules. This condition shall apply only if rules and procedures to designate facilities have been adopted. Exceptions: The following hospitals are exempt from the trauma system condition: State mental and state chest hospitals; psychiatric hospitals licensed by TXMHMR; and certain hospitals licensed as "special" by the department (i.e., long term care hospitals, ventilator hospitals, burn institutes, and alcohol-chemical dependency hospitals); rehabilitation hospitals; maternity hospitals; college infirmaries; contagious disease hospitals; and hospitals for the terminally ill. Pediatric and adolescent facilities are exempt from trauma facility designation requirements until the time that state law authorizes the designation of pediatric and/or adolescent trauma facilities. (A) Hospitals qualifying for the disproportionate share program for the first time must meet the regional trauma system development participation requirement in the first year of their participation in the disproportionate share program, regional trauma system development participation and application for trauma facility designation in the second year of their participation in the disproportionate share program, regional trauma system development participation and confirmation that a consultation survey has been scheduled or a complete designation application packet has been submitted to the Bureau of Emergency Management in the third year of their participation in the disproportionate share program, regional trauma system development participation and confirmation that a verification or designation survey has been scheduled in the fourth year of their participation in the disproportionate share program and regional trauma system development participation and trauma facility designation in subsequent years of their participation in the disproportionate share hospital program. (B) Hospitals shall be designated as trauma facilities under four levels that range from "basic" (stabilization and transfer of major and severe trauma patients) to "comprehensive" (care and management of all trauma patients, plus education and research). Hospitals identified as disproportionate share hospitals effective September 1, 1993, must be designated as trauma facilities or hospitals participating in regional trauma system development by March 1, 1994. Participation in regional trauma system development and application for designation as a trauma facility shall be required in the second year of participation in the disproportionate share program. Participation in regional trauma system development and confirmation that a consultation survey has been scheduled or a complete designation application packet has been submitted to the Bureau of Emergency Management shall be required in the third year of participation in the disproportionate share program. Participation in regional trauma system development and confirmation that a verification or designation survey has been scheduled are required in the fourth year of participation in the disproportionate share program. Participation in regional trauma system development and designation as a trauma facility shall be required in subsequent years of their development in the disproportionate share program. (C) (No change.) (8)-(9) (No change.) (d) Qualifying formulas for determining disproportionate share status. Each hospital must have a Medicaid inpatient utilization rate, at a minimum, of 1.0%. The single state agency or its designee shall identify the qualifying Medicaid disproportionate share providers from among the hospitals that meet the two- physician requirement and the state's conditions of participation, as specified in subsection (c)(1)-(9) of this section, by using the following formulas. In the case of hospitals that have merged to form a single Medicaid provider, the single state agency or its designee shall aggregate the data points from the individual hospitals that now make up the single provider to determine whether the single Medicaid provider qualifies as a Medicaid disproportionate share hospital. Medicaid disproportionate share hospitals shall receive payments if they merge with other hospitals during the fiscal year, if they continue to meet the two-physician requirement, and if they meet the other conditions of participation. Children's hospitals that do not otherwise qualify as disproportionate share hospitals shall be deemed disproportionate share hospitals. The formulas are as follows: (1)-(4) (No change.) (e) (No change.) (f) Reimbursing Medicaid disproportionate share hospitals. The single state agency shall reimburse Medicaid disproportionate share hospitals on a monthly basis. Monthly payments will equal one-twelfth of annual payments unless it is necessary to adjust the amount because payments will not be made for a full 12- month period, to comply with the annual state disproportionate share hospital allotment, or to comply with other state or federal disproportionate share hospital program requirements. Payments will be made in the following manner, unless the state determines the hospital's proposed reimbursement has exceeded its specific limit: (1) A state chest hospital (facility of the Texas Department of Health) or a state mental hospital (facility of the Texas Department of Mental Health and Mental Retardation) that meets the requirements for disproportionate share status and provides inpatient psychiatric care or inpatient hospital services will receive annually up to 100% of the hospital's net operating costs, which are the total operating costs, less Medicaid payments (other than disproportionate share adjustments), less all funding from nonstate and nonlocal government sources for services provided in the particular hospital's fiscal year. The percentage will be determined by the ratio of funds available under the annual state disproportionate share hospital allotment to the net operating costs (up to 100%), after annual payment amounts to all other disproportionate share hospitals are deducted from the total annual allotment. (2) For the remaining hospitals, payments will be based on both weighted inpatient Medicaid days and weighted low income days. The single state agency shall weigh each hospital's total inpatient Medicaid days and low income days by the appropriate weighing factor. The state defines a low income day as a day derived by multiplying a hospital's total inpatient census days from its fiscal year ending in the previous calendar year by its low income utilization rate. Hospital districts and city/county hospitals with greater than 250 licensed beds in the state's largest MSAs shall receive weights based proportionally on the MSA population according to the 1990 United States census. MSAs with populations greater than or equal to 150,000, according to the 1990 census, are considered as the "largest MSAs." Children's hospitals also shall receive weights because of the special nature of the services they provide. All other hospitals receive weighing factors of 1.0. The inpatient Medicaid days of each hospital shall be based on the latest available state fiscal year data for patients entitled to Title XIX benefits. The available fund shall be divided into two parts. Two- thirds of the available fund will reimburse each qualifying hospital on a monthly basis by its percent of the total inpatient Medicaid days. One-third of the available fund will reimburse each qualifying hospital by its percent of the total low income days. Reimbursement for the remaining hospitals is determined monthly as follows. (A)-(C) (No change.) (D) The department or its designee shall determine the adjusted hospital specific limit for each disproportionate share hospital. This limit is the sum of a hospital's Medicaid shortfall and its cost of services provided to patients who have no health insurance or source of third party payment for services provided during the year, multiplied by the appropriate inflation update factor. (i) The department or its designee shall determine the Medicaid shortfall for each hospital, using the appropriate part of the hospital's Medicare cost report submitted for the fiscal year ending in the previous calendar year. The department also shall use claims denied for reasons other than eligibility to determine the Medicaid shortfall. These denied claims are for the hospital's fiscal year ending in the previous calendar year. (ii) The department or its designee shall determine the cost of services to the uninsured for each hospital. Hospitals shall be surveyed each year to determine charges that can be attributed to patients without insurance or other third party resources. Hospitals that do not respond to the survey, or that are unable to determine accurately the charges attributed to patients without insurance, shall have their inpatient and outpatient bad debt and charity charges, as reported to the department in its Annual Hospital Survey, reduced by a percentage derived from a representative sample of similar hospitals to be determined annually by the department or its designee. The representative sample of hospitals shall be one of the following specific categories of hospitals: urban public, other urban, rural, and psychiatric. The state or its designee may create additional categories as it deems appropriate for the economic and efficient operation of the Medicaid disproportionate share hospital program. After the department has identified the charges for each hospital that can be attributed to patients without insurance, or other third party resources, the department shall multiply those charges by each hospital's cost-to-charge ratio. (iii) After the department or its designee determines each disproportionate share hospital's cost of services to patients who have no health insurance or source of third party payment for services provided during the year, the state shall subtract from each hospital's cost of these services the amount of payments made by those patients who have no health insurance or source of third party payment for services provided during the year. (iv) The department or its designee shall trend each hospital's "hospital specific limit" calculated from its historical base period cost report to the state's fiscal year disproportionate share program. For hospitals without a full 12-month fiscal year cost report, the state or its designee shall convert their costs to annualized hospital specific limits. The department or its designee shall use the inflation rates described in sec.29. 606(n)(2) of this title (relating to Reimbursement Methodology for Inpatient Hospital Services) to calculate the inflation update factor used in the adjusted hospital specific limit. The department or its designee shall calculate the number of the hospital's cost reporting period to the fiscal year disproportionate share program. The department or its designee shall then multiply the portion of the hospital's cost report year occurring in the state fiscal year by the inflation update factor used for each state fiscal year in the calculation of hospital reimbursement rates for each state fiscal year. The product of these calculations shall be multiplied by each hospital's "hospital specific limit" to obtain each hospital's "adjusted hospital specific limit." (E) The state compares the projected payment for each disproportionate share hospital with its hospital specific limit. If a hospital's calculated payment is less than its limit, the state will reimburse the calculated payment to the hospital, plus its percentage of any additional available funds, not to exceed the hospital's specific limit. If the calculated payment is greater than the limit, the state will reduce the hospital's payment to equal its limit. (g)-(i) (No change.) This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509839 Susan K. Steeg General Counsel Texas Department of Health Effective date: September 1, 1995 Proposal publication date: May 12, 1995 For further information, please call: (512) 458-7236 Subchapter G. Hospital Services 25 TAC sec.29.610 On behalf of the State Medicaid Director, the Texas Department of Health (department) submits an adopted amendment to sec.29.610, concerning disproportionate share reimbursement methodology for state-owned teaching hospitals, with changes to the proposed text as published in the June 13, 1995, issue of the Texas Register (20 TexReg 4323). The amended section applies the requirements of the Omnibus Budget Reconciliation Act of 1993 (OBRA '93) to the reimbursement methodology for state-owned teaching hospitals. After September 1, 1995, all disproportionate share state-owned teaching hospitals must have Medicaid inpatient utilization rates, at a minimum, of one percent. Disproportionate share hospitals reimbursed after September 1, 1995, also must have limits to how much hospitals can be reimbursed during a state fiscal year. The limit is the sum of two numbers. The first number is a hospital's Medicaid shortfall (the difference between reimbursement and Medicaid allowed costs). The second number is the cost of providing care to patients who have no health insurance or source of third party payments for services provided during the year, less the amount of payments made by these patients. The changes relating to hospital specific limits include definitions of "cost of service," "hospital overall ratios of cost to charges," Medicaid "shortfall," and "payments received" by a hospital from patients without health insurance or source of third party payment for services. Additional changes allow the department to pay a hospital its projected reimbursement, plus its percentage of any additional available funds. The amendment implements the Omnibus Budget Reconciliation Act of 1993 (effective September 1, 1995), which requires Medicaid inpatient utilization of at least one percent. Although no public comments were received regarding the adoption of this amendment, the department made editorial changes for clarification purposes. The amendment is adopted under the Human Resources Code, sec.32.021 and Texas Civil Statutes, Article 4413 (502), sec.16, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program and is submitted to the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program and as authorized under Chapter 15, sec.1.07, Acts of the 72nd Legislature, First Called Session (1991). sec.29.610. Disproportionate Share Hospital Reimbursement Methodology for State-Owned Teaching Hospitals. (a) The single state agency or its designee shall provide additional disproportionate share reimbursement to state-owned teaching hospitals through a supplemental disproportionate share program. A state-owned teaching hospital is a hospital owned and operated by a state university or other agency of the state. Additional reimbursement shall be provided to each state-owned teaching hospital on a monthly basis using the following formula. Figure 1: 25 TAC sec.29.610(a) (b) Each hospital must have Medicaid inpatient utilization rate, at a minimum, of 1.0%. (c) The Texas Department of Health (department) or its designee shall determine the adjusted hospital specific limits for each disproportionate share hospital. These limits shall be the sum of a hospital's Medicaid shortfall and its cost of services to patients who have no health insurance or source of third party payments for services provided during the year, multiplied by the appropriate inflation update factor. (d) The department or its designee shall determine the Medicaid shortfall for each hospital by using the appropriate part of the hospital's Medicare cost report that was submitted for the fiscal year ending in the previous calendar year. The department or its designee shall use the latest available Medicare cost report in the absence of the Medicare cost report submitted in the fiscal year ending in the previous calendar year. The department also uses claims denied for reasons other than eligibility to determine the Medicaid shortfall. These denied claims are for the hospital's fiscal year ending in the previous calendar year. (1) The department or its designee shall determine the cost of services to patients who have no health insurance or source of third party payments for services provided during the year for each hospital. The department or its designee shall survey hospitals each year to determine charges that can be attributed to patients without insurance or other third party resources. Hospitals that do not respond to the survey, or that are unable to determine accurately the charges attributed to patients without insurance, shall have their bad debt and charity charges reduced by a percentage derived from a representative sample of hospitals that shall be determined annually by the department or its designee. (A) After the department or its designee has identified the charges for each hospital that can be attributed to patients without insurance, or other third party resources, the department or its designee shall multiply those charges by each hospital's cost-to-charge ratio. (B) After the department or its designee has determined each disproportionate share hospital's cost of services to patients who have no health insurance or source of third party payments for services provided during the year, the department shall subtract from each hospital's cost of services the amount of payments made by those patients who have no health insurance or source of third party payments for services provided during the year. (2) The department or its designee shall trend each hospital's "hospital specific limit" by calculating from the hospital's historical base period cost report to the state fiscal year disproportionate share program. (A) The department or its designee shall: (i) use the inflation rates described in sec.29.606(n)(2) of this title (relating to Reimbursement Methodology for Inpatient Hospital Services) to calculate the inflation update factor that the department will use to determine the adjusted hospital specific limit; (ii) calculate the number of the hospital's cost reporting period to the fiscal year disproportionate share program; and (iii) then multiply the portion of the hospital's cost report year occurring in the state fiscal year by the inflation update factor used for each state fiscal year in the calculation of hospital reimbursement rates for each state fiscal year; and (iv) then multiply the product of these calculations by the each hospital's "hospital specific limit" to obtain each hospital's "adjusted hospital specific limit." (B) For hospitals without a full 12-month fiscal year cost report, the department or its designee shall convert their costs to annualized hospital specific limits. (3) The department or its designee shall compare the projected payment for each disproportionate share hospital with its "hospital specific limit. (A) If a hospital's calculated payment is less than its limit, the department or its designee shall reimburse the calculated payment to the hospital, plus its percentage of any additional available funds, not to exceed the hospital's specific limit. (B) If the calculated payment is greater than the limit, the department or its designee will reduce the hospital's payment to equal its limit. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509842 Susan K. Steeg General Counsel Texas Department of Health Effective date: August 28, 1995 Proposal publication date: June 13, 1995 For further information, please call: (512) 458-7236 Subchapter P. Hearing Aid Services 25 TAC sec.29.1502 On behalf of the State Medicaid Director, the Texas Department of Health (department) submits an adopted amendment to sec.29.1502, with changes to the proposed text as published in the May 12, 1995, issue of the Texas Register (20 TexReg 3552). The amendment clarifies and streamlines existing rules governing hearing aid services. The amendment deletes prior authorization requirements for hearing aid services. The amended section allows for a more efficient use of state resources in providing medical assistance. The department received one public comment during the comment period. The comment is as follows. COMMENT: The State Board of Examiners for Speech-Language Pathology and Audiology (board) requested that licensed audiologists and interns in audiology who are registered with the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments be included in the amendment. RESPONSE: The department agrees with this comment and changed sec.29.1502(b) (4)(B)(i) to reflect the comment. While the commenter was generally in favor of the amendment, the board raised concerns and questions regarding the changes. The department also made minor editorial changes for clarification purposes. The amendment is adopted under the Human Resources Code, sec.32.021 and Texas Civil Statutes, Article 4413 (502), sec.16, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program and is submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program and as authorized under Chapter 15, sec.1.07, Acts of the 72nd Legislature, First Called Session (1991). sec.29.1502. Requirements for Hearing Aid Services. (a) Hearing aid evaluations. Providers of hearing aid evaluations must comply with all applicable federal and state laws and regulations, recognized professional standards, and the provisions cited at Subchapter A, Medicaid Procedures for Providers, and at Subchapter L, General Administration, of this chapter, in addition to the following conditions, specifications, and limitations established by the Texas Department of Health (department) or its designee. (1) Hearing aid evaluations must be recommended by a physician based upon his examination of the client. The client must have a medical necessity for a hearing aid and have no medical contraindications to his ability to use and/or wear a hearing aid. (A) A physician who recommends a hearing aid evaluation must be licensed to practice medicine in the state where and when the evaluation is conducted. (B) The physician must indicate on the Physician Examination Report form if the client needs a hearing aid evaluation based on his examination of the client. Medicaid reimbursement for a hearing aid evaluation is based on the physician's recommendation that the hearing aid evaluation is medically necessary. Medicaid reimbursement for hearing aids is limited to eligible clients whose air conduction puretone average in the better ear is 45dB or greater (PTA for 500, 1000, 2000 HZ). (C) Each client receiving a hearing aid through the Texas Medicaid Program must receive a hearing aid evaluation using the procedures specified under the provisions of paragraph (2)(A)-(G) and paragraph (3)(A)-(C) of this subsection and subsection (b) of this section. (D) Providers may conduct home visit hearing aid evaluations only if the client's physician has documented that the client's medical condition prohibits his traveling to the provider's place of business. (E) Only those providers having the necessary mobile testing equipment and sound level meter may conduct home visit hearing aid evaluations. (2) Providers must include in the hearing aid evaluation an audiometric assessment and a sound field test. (A) Masking for air-conduction, bone-conduction, speech discrimination testing, and speech audiometry must be conducted in accordance with the 45dB hearing loss evidenced by the client. (B) Providers must ensure that the testing environment does not have an ambient noise level exceeding 50dBA or 60dBC. (C) Audiometers must be equipped with air and bone conduction circuitry, masking and sound field capabilities, with calibrated speech circuit and VU meter. (D) Semi-annual audiometer calibration and sound level readings are required for equipment used for home visit hearing aid evaluations. (E) If conventional sound field speech discrimination testing cannot be done, providers may use aided versus unaided lipreading scores on appropriate standardized tests. (3) Providers of hearing aid evaluations must have a report in the client's record. Providers must include in the report audiometric test data, hearing aid evaluation test data, and a recommendation for the hearing aid most appropriate for the ear being amplified. (A) If appropriate, providers must include test data cited in paragraph (2)(F) and (G) of this subsection in the hearing aid evaluation report. (B) If any of the criteria cited in this section cannot be met, providers must specify in the evaluation report the factors influencing or preventing assessments, and justify the recommendation for a hearing aid. (C) Recommendations including poor ear fittings resulting in problems with speech discrimination ability must be accompanied by supporting rationale. (b) Hearing aids. Providers must offer each client eligible for a hearing aid a new instrument that meets his hearing need and that is within the allowable fee paid by the Texas Medicaid Program. (1) Hearing aids above the maximum allowable fee. The department shall pay the maximum allowable fee paid by the Texas Medicaid Program toward hearing aids for clients who meet the requirements cited at sec.29.1504(b)(2) of this title (relating to Reimbursement for Hearing Aid Services). (2) Warranty. Providers must ensure that each hearing aid purchased through the Texas Medicaid Program is a new and current model which meets the performance specifications of the manufacturer and the hearing needs of the client. Providers must also ensure that each hearing aid is covered by a full 12-month manufacturer's warranty, effective from the dispensing date. (3) Required package. Providers must dispense each hearing aid purchased through the Texas Medicaid Program with a receiver or oscillator, if needed; all necessary tubing, cords, and connectors; instructions for care and use; and a one-month supply of batteries. (4) Thirty-day trial period. Providers must allow each eligible client 30 days to determine his satisfaction with a hearing aid purchased through the Texas Medicaid Program. The trial period consists of 30 consecutive days from the dispensing date. Providers must inform clients of the trial period and of the beginning and ending dates. (A) During the trial period, providers may dispense additional hearing aids, as medically necessary, until the client is satisfied with the results of the aid or the provider determines that the client cannot benefit from the dispensing of an additional hearing aid. A new trial period begins with the dispensing date of each hearing aid. (B) Providers may charge a rental fee for hearing aids returned during the trial period. (i) If a rental fee is charged, providers must assess the rental fee according to the rules and regulations established by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments and the State Board of Examiners for Speech-Language Pathology and Audiology. (ii) If there is no signed agreement between the client and the provider specifying a greater amount, the maximum rental for eligible Medicaid clients is $2.00 per day. This fee is not a covered benefit of the Texas Medicaid Program. Clients are responsible for paying any rental fee assessed them for instruments returned during the 30-day period. Providers must keep in the client's file the client's signed certification acknowledging his responsibility to pay hearing aid rental fees. (iii) Providers must comply with all procedures and directions provided by the department or its designee regarding forms and certifications required during the 30-day trial period. Providers must allow 30 days to elapse from the hearing aid dispensing date before completing a "30-day trial period certification statement," which is kept in the client's file. (5) Post-fitting checks. The fitter and dispenser must perform a post-fitting check of the hearing aid within five weeks of the initial fitting. The post- fitting check is part of the dispensing procedure. (6) First revisit. The first revisit includes a hearing aid check and/or counseling and is conducted as needed within six months of the post-fitting check. (7) Second revisit. The second revisit is conducted as needed. The purpose of the second revisit is to assess hearing acuity and includes an aided sound field test according to the hearing aid evaluation guidelines established by the department or its designee. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509840 Susan K. Steeg General Counsel Texas Department of Health Effective date: September 1, 1995 Proposal publication date: May 12, 1995 For further information, please call: (512) 458-7236 Subchapter AA. School Health and Related Services 25 TAC sec.29.2603 On behalf of the State Medicaid Director, the Texas Department of Health (department) submits an adopted amendment to sec.29.2603, concerning reimbursement for School Health and Related Services (SHARS), without changes to the proposed text as published in the June 9, 1995, issue of the Texas Register (20 TexReg 4198). Specifically, the amendment covers SHARS reimbursement methods and procedures which will apply to the rate setting process. The purpose of this amendment is to modify the sampling methodology and reduce the reporting burden previously imposed on the school districts. No comments were received regarding adoption of the amendment. The amendment is adopted under the Human Resources Code, sec.32.021 and Texas Civil Statutes, Article 4413 (502), sec.16, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program and is submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program and as authorized under Chapter 15, sec.1.07, Acts of the 72 Legislature, First Called Session (1991). This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509841 Susan K. Steeg General Counsel Texas Department of Health Effective date: September 1, 1995 Proposal publication date: June 9, 1995 For further information, please call: (512) 458-7236 Title 40. SOCIAL SERVICES AND ASSISTANCE Part I. Texas Department of Human Services Chapter 12. Special Nutrition Programs The Texas Department of Human Services (DHS) adopts amendments to sec.sec.12. 203, 12.207, 12.211, 12.307, 12.407, 12.410, and 12.413-12.415, without changes to the proposed text as published in the June 30, 1995, issue of the Texas Register (20 TexReg 4676). The justification for the amendments are public access to accurate rules. The amendments will function by correcting references to federal citations that were reorganized, correcting typographical errors, and reflecting the name change of Food and Nutrition Service to Food and Consumer Service. The department received no comments regarding adoption of the amendments. The amendments are adopted under the Human Resources Code, Title 2, Chapters 22 and 33, which authorizes the department to administer public and nutritional assistance programs. Special Milk Program 40 TAC sec.sec.12.203, 12.207, 12.211 The amendments implement the Human Resources Code, sec. sec.22.001-22.024 and sec.sec.33.001-33.024. This agency hereby certifies that the sections as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on August 8, 1995. TRD-9509871 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Effective date: September 1, 1995 Proposal publication date: June 30, 1995 For further information, please call: 450-3765 School Breakfast Program 40 TAC sec.12.307 The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 and 33, which authorizes the department to administer public and nutritional assistance programs. The amendment implements the Human Resources Code, sec. sec.22.001-22.024 and sec.sec.33.001-33.024. This agency hereby certifies that the section as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on August 8, 1995. TRD-9509872 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Servcies Effective date: September 1, 1995 Proposal effective date: June 30, 1995 For further information, please call: 450-3765 National School Lunch Program 40 TAC sec.sec.12.407, 12.410, 12.413-12.415 The amendments are adopted under the Human Resources Code, Title 2, Chapters 22 and 33, which authorizes the department to administer public and nutritional assistance programs. The amendments implement the Human Resources Code, sec. sec.22.001-22.024 and sec.sec.33.001-33.024. This agency hereby certifies that the sections as adopted have been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on August 8, 1995. TRD-9509873 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Effective date: September 1, 1995 Proposal publication date: June 30, 1995 For further information, please call: 450-3765 Chapter 15. Medicaid Eligibility Subchapter B. Medicare and Third-party Resources 40 TAC sec.15.204 The Texas Department of Human Services (DHS) adopts an amendment to sec.15. 204, concerning qualified Medicare beneficiaries (QMB) and specified low-income Medicare beneficiaries (SLMB) in its Medicaid Eligibility rule chapter, with changes to the proposed text as published in the June 27, 1995, issue of the Texas Register (20 TexReg 4622). The justification for the amendment is to provide a clarification of which persons are not eligible for QMB/SLMB coverage. The amendment will function by ensuring that eligibility policy will be consistently applied statewide. The department received no comments regarding adoption of the amendment; however, DHS has initiated a minor editorial change to sec.15.204(3)(C). The term QMB is changed to QMB/SLMB to clarify that individuals age 65 or older residing in institutions for mental diseases may be certified for QMB/SLMB if all eligibility criteria are met. The amendment is adopted 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. The amendment implements the Human Resources Code sec. sec.22.001-22.024 and sec.sec.32.001-32.042. sec.15.204. Specified Low-Income Medicare Beneficiaries (SLMB). The Omnibus Budget Reconciliation Act of 1990 created the Specified Low-income Medicare Beneficiary program as an extension of Qualified Medicare Beneficiaries (QMB). For SLMB-eligible clients, the Texas Medical Assistance (Medicaid) Program pays only Medicare Part B premiums. A client can be eligible for both Medicaid and SLMB. The eligibility criteria for SLMB are the same as the criteria for QMB in sec.15.201 of this title (relating to Qualified Medicare Beneficiaries). Except for the specifications in paragraphs (1) and (2) of this section, the policies for the QMB program apply. (1)-(2) (No change.) (3) Persons not eligible for QMB/SLMB coverage. Persons not eligible for QMB/SLMB coverage are: (A) residents of state schools who are eligible under Type Program 14, Base Plan 16, except when the client's income is not sufficient to pay the Medicare premium; (B) inmates of jails and reformatories; and (C) individuals under age 65 who are residing in institutions for mental diseases. Individuals age 65 or older residing in institutions for mental diseases may be certified for QMB/SLMB, if all eligibility criteria are met. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority. Issued in Austin, Texas, on August 7, 1995. TRD-9509851 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Effective date: September 1, 1995 Proposal publication date: June 27, 1995 For further information, please call: (512) 450-3765 Chapter 50. Day Activity and Health Services Service Requirements 40 TAC sec.50.406 The Texas Department of Human Services (DHS) adopts the repeal of sec.50. 406, without changes to the proposed text as published in the June 27, 1995, issue of the Texas Register (20 TexReg 4623). The justification for the repeal is to avoid duplication of information contained in Chapter 98, Licensing Standards for Adult Day Care Facilities. The repeal will function by providing public access to correct information located in only one rule chapter. No comments were received regarding adoption of the repeal. The repeal is adopted 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 provide the Health and Human Services Commission with the authority to administer federal medical assistance funds. The repeal implements the Human Resources Code, sec.sec.22.001-22.024 and sec.sec.32.001-32.041. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on August 9, 1995. TRD-9509939 Nancy Murphy Section Manager, Media and Policy Services Texas Department of Human Services Effective date: September 1, 1995 Proposal publication date: June 27, 1995 For further information, please call: (512) 450-3765