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 16. ECONOMIC REGULATION PART I. Railroad Commission of Texas CHAPTER 9. Liquefied Petroleum Gas Division SUBCHAPTER A. General Applicability and Requirements 16 TAC sec.9.34 The Railroad Commission of Texas adopts new sec.9.34, concerning the LP-gas (welding) advisory committee, with changes to the version published in the July 26, 1996, Texas Register (21 TexReg 6932). The new section establishes a new advisory committee to examine the uses of LP-gas in welding and other similar applications. It also establishes the committee's duration; sets forth the purpose and duties of the committee; prescribes the composition of the committee, the appointment process, and the membership terms of the committee; and sets forth the mechanisms by which the committee will meet, perform its work, and be evaluated. The only adopted change is in subsection (e), in which the date to submit written nominations has been changed from September 1, 1996, to October 15, 1996. The commission received no comments on the proposed new section. The new section is proposed under Texas Natural Resources Code, sec.113.051, which authorizes the commission to adopt rules relating to any and all aspects or phases of the LP-gas industry that will protect or tend to protect the health, welfare, and safety of the general public, and Texas Revised Statutes, Article 6252-33, sec.sec.5 and 8. The following is the statute, article, or code affected by the proposed new section: sec.9.34 -- Texas Natural Resources Code, sec.113.051 and Texas Revised Statutes, Article 6252-33, sec.sec.5 and 8. sec.9.34. LP-Gas (Welding) Advisory Committee. (a) Definitions. The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise. (1) Commission--The Railroad Commission of Texas. (2) Committee--The LP-Gas (Welding) Advisory Committee of the Railroad Commission of Texas. (3) Consumer representative--A member of the committee who is not engaged in the business of producing, distributing or retailing LP-gas and who is not engaged in the business of designing, manufacturing, distributing or retailing LP-gas equipment or performing LP-gas-related research or other services, but who is a user of LP-gas in a welding application. (4) Division--The Gas Services Division of the Railroad Commission of Texas. (5) Fiscal year--September 1 of a year through August 31 of the following year. (6) Industry representative--A member of the committee who is engaged in the business of producing, distributing or retailing LP-gas or who is engaged in the business of designing, manufacturing, distributing or retailing LP-gas equipment or performing LP-gas-related research or other services and who sells LP-gas for welding applications. (7) Local government representative--A member of the committee who is a fire chief, fire marshal, or other similar position for a city or county. (8) LP-gas--Liquefied petroleum gas (LPG), as that term is defined in Texas Natural Resources Code, Chapter 113. (9) Member--An industry representative, a consumer representative, or a representative of local government who serves on the LP-Gas (Welding) Advisory Committee of the Railroad Commission of Texas. (10) Presiding officer--The chairman of the LP-Gas (Welding) Advisory Committee of the Railroad Commission of Texas. (11) Section--The LP-Gas Section of the Gas Services Division. (b) Establishment; Duration. The LP-Gas (Welding) Advisory Committee of the Railroad Commission of Texas is hereby established effective October 1, 1996. The committee is abolished on August 31, 1998, unless the commission amends this subsection to establish a different date. (c) Purpose and Duties. The purpose of the committee is to give the commission the benefit of the members' collective business, environmental, and technical expertise and experience to help the commission regulate the safe use of LP-gas in welding applications. The committee's sole duty is to advise the commission. The committee has no executive or administrative powers or duties with respect to the operation of the section. All such powers and duties rest solely with the commission. (d) Composition of Committee; Membership Terms. The committee shall be composed of six members, five of whom shall be voting members. The five voting members shall include two LP-gas consumers, two members of the LP-gas (welding) industry, and one representative from local government, all of whom serve at the pleasure of the commission, for a period of two years. The assistant director of the LP-Gas Section shall serve as an ex officio, non-voting member of the committee. (e) Nominations for Committee Membership. Any person may nominate a candidate or candidates for membership on the committee. Nominations shall be made in writing and submitted by October 15, 1996, for the initial committee, and by January 1 of each odd-numbered year thereafter. Nominations may be submitted to the commission, a commissioner, or the assistant director of the LP-Gas Section for transmission to the commission. (f) Appointment of Members. All members of the committee are appointed by and serve at the pleasure of the commission. The commission shall appoint members of the first committee by October 15, 1996, and by August 31 of each odd-numbered year thereafter, such that the composition of the committee meets the requirements of subsection (d) of this section. If a member resigns or otherwise vacates his or her position prior to the end of his or her term, the commission shall appoint a replacement who shall serve the remainder of the unexpired term. (g) Reimbursement of Members' Expenses. The commission shall not reimburse members for travel or other expenses related to service on the committee. (h) Presiding Officer; Other Officers. The committee shall elect from its members a presiding officer who shall report the committee's advice and attendance in writing to the commission. The committee may elect other officers at its pleasure. (i) Subcommittees. The committee may organize itself into subcommittees. One member of each subcommittee shall serve as the chair of that subcommittee. The subcommittee chairs shall make written reports regarding their subcommittee's work to the presiding officer. (j) Meetings. The committee shall meet at the call of the presiding officer or the commission. Committee and subcommittee meetings are open to the public. (k) Committee Records. The LP-Gas Section staff shall record and maintain the originals of the minutes of each committee and subcommittee meeting. The section shall maintain a record of actions taken by the committee and shall distribute copies of approved minutes and other committee documents to the commission and the committee members. (l) Evaluation of Committee Costs and Benefits. By October 1 of each year, the assistant director of the Gas Services Division shall evaluate for the previous fiscal year and report to the commission: (1) the committee's work; (2) the committee's usefulness; and (3) the costs related to the committee's existence, including the cost of commission staff time spent in support of the committee's activities. (m) Report to Legislative Budget Board. The commission shall biennially report to the Legislative Budget Board the information developed under subsection (l) of this section in evaluating the committee's costs and benefits. 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. Issued in Austin, Texas, on September 24, 1996. TRD-9614019 Mary Ross McDonald Deputy General Counsel, Office of General Counsel Railroad Commission ofTexas Effective date: October 15, 1996 Proposal publication date: July 26, 1996 For further information, please call: (512) 463-7008 PART XX. Texas Board of Private Investigators & Private Security Agencies CHAPTER 433. Handgun; Security Officer Commission 22 TAC sec.433.4 The Texas Board of Private Investigators & Private Security Agencies adopts the amendment of sec.433.4, concerning Application for a Security Officer Commission, with changes to the proposed text as published in the June 18, 1996, issue of the Texas Register (21 TexReg 5518). The Board has determined that this amendment is necessary in order to comply with House Bill 713 of the 74th Texas Legislature. A minor change was made to clarify that the required fingerprint cards must be purchased from the Board rather that furnished by the Board. This amendment eliminates the requirement that photographs of each applicant be submitted to the Board and requires that photographs be kept in the employee's personnel file instead. No comments were submitted to the Board. The amendment is adopted under the authority of Texas Civil Statutes, Article 4413(29bb), sec.11.(a)(3) which provides the Texas Board of Private Investigators & Private Security Agencies with the authority "to promulgate all rules and regulations necessary in carrying out the provisions of this Act." sec.433.4. Application for a Security Officer Commission. Applicant shall submit a completed application to the board for a security officer commission on a form provided by the board. To be complete, the application shall include: (1) the required fee which is nonrefundable for any cause; (2) at least two sets of fingerprints on a card purchased from the board. No security officer commission shall be issued prior to classification of fingerprints and receipt of concurrence from the Texas Department of Public Safety; (3) The employer shall retain two color photographs, one inch by one inch and affix one to the employee's pocket card when received from the board and shall retain the other photograph in the employee's personnel file for inspection by the board; and (4) a copy of the certificate of completion awarded to the employee from a board approved security officer training school. 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. Issued in Austin, Texas, on September 24, 1996. TRD-9613961 Clema D. Sanders Executive Director Texas Board of Private Investigators & Private Security Agencies Effective date: October 15, 1996 Proposal publication date: June 18, 1996 For further information, please call: (512) 463-5545 PART XXI. Texas State Board of Examiners of Psychologists CHAPTER 22.General Rulings 22 TAC sec.461.3 The Texas State Board of Examiners of Psychologists adopts the repeal of sec.461.3, concerning Violation of the Code of Ethics, without changes to the proposed text as published in the August 9, 1996, issue of the Texas Register (21 TexReg 7521). The rule is being repealed because the Board is consolidating the rules dealing with violations of board rules and law. The repealed rule will make the rules easier for licensees/certificands and the general public to follow and understand. No comments were received regarding adoption of the repeal. The repeal is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613972 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 9, 1996 For further information, please call: (512) 305-7700 22 TAC sec.461.15 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.461.15, concerning Failure to Comply with Board Directives, without changes to the proposed text as published in the August 6, 1996, issue of the Texas Register (21 TexReg 7313). The rule is being amended to consolidate rules regarding compliance with and violations of Board directives, rules and statutes by licensees/certificands. The amendment will ensure that the rules are easier to understand and follow and will better inform the public of the Board's requirements. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613973 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.461.18 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.461.18, concerning Complaint Procedure Notification, without changes to the proposed text as published in the August 6, 1996, issue of the Texas Register (21 TexReg 7313). The rule is being amended to include the toll free 800 number for complaints in the notification statements to the public required by all licensees/certificands of the board in all rooms where psychological services are conducted. The amendment will ensure that the public is provided with the most current information on contacting the Board regarding complaints and questions concerning the practice of psychology. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613974 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.sec.461.23-461.27 The Texas State Board of Examiners of Psychologists adopts new sec.sec.461.23- 461.27, concerning General Rulings, without changes to the proposed text as published in the August 6, 1996, issue of the Texas Register (21 TexReg 7314). The rules are being adopted to reorganize the rules of the Board. The new rules will make the rules easier for licensees/certificands and the general public to follow and understand. No comments were received regarding adoption of the new rules. The new rules are adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613975 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 CHAPTER 463.Applications 22 TAC sec.463.6 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.463.6, concerning Experience, without changes to the proposed text as published in the August 6, 1996, issue of the Texas Register (21 TexReg 7316). The rule is being amended to clarify the qualifications of the supervisors during the formal experience phase of training and to include all academic settings as possible areas of internship employment/experience. The amendment will provide clarification on the qualifications of the supervisors administering the required internship of applicants for licensure as a psychologist, which will make the rule easier to understand and follow, and to better inform the public of the Board's requirements. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613976 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.463.23 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.463.23, concerning Oral Exam Requirement, without changes to the proposed text published in the August 6, 1996, issue of the Texas Register (21 TexReg 7317). The rule is being amended to clarify that a person may not take the oral exam unless they are a certified psychologist and to correct the name of the American Board of Professional Psychology. The amendment will ensure that only those qualified to do so may take the exam thereby ensuring that consumers will receive quality psychological services. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613977 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.463.32 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.463.32, concerning Licensed Specialist in School Psychology, without changes to the proposed text published in the August 6, 1996, issue of the Texas Register (21 TexReg 7317). The rule is being amended to include legal issues within the course requirements, as well as realigning other course requirements to include two areas rather than one or the other. The amendment will ensure that the children in the public schools of Texas receive psychological services from the most qualified individuals. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613978 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 CHAPTER 465.Rules of Practice 22 TAC sec.465.7 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.465.7, concerning Providers of Psychological Services, without changes to the proposed text published in the August 6, 1996, issue of the Texas Register (21 TexReg 7318). The rule is being amended to consolidate rules regarding the provision of psychological services in independent practice. The amendment will make the rules easier to understand and follow and to better inform the public of the Board's requirements for the provision of psychological services in independent practice. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examines of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613979 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.sec.465.19, 465.20, 465.25, 465.32, 465.34 The Texas State Board of Examiners of Psychologists adopts the repeal of sec.sec.465.19, 465.20, 465.25, 465.32, and 465.34 concerning Rules of Practice, without changes to the proposed texts published in the August 6, 1996, issue of the Texas Register (21 TexReg 7318). The rules are being repealed to reorganize the rules of the Board. The repealed rules will make the rules easier for licensees/certificands and the general public to follow and understand. No comments were received regarding adoption of the repeals. The repeals are adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613980 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.465.37 The Texas State Board of Examiners of Psychologists adopts the repeal of sec.465.37, concerning Rules of Practice, without changes to the proposed texts published in the August 6, 1996, issue of the Texas Register (21 TexReg 7319). The rule is being repealed because the Board is consolidating the rules dealing with the provision of psychological services. The repealed rule will make the rules easier for licensees/certificands and the general public to follow and understand and to better inform the public of the Board's requirements for the provision of psychological services. No comments were received regarding adoption of the repeal. The repeal is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613981 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 22 TAC sec.465.38 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.465.38, concerning Psychological Services in the Schools, without changes to the proposed text as published in the August 6, 1996, issue of the Texas Register (21 TexReg 7319). The rule is being amended to include those individuals who have met the training criteria and taken the required national exam but are waiting to take and pass the Board's Jurisprudence exam and to clarify that the requirements of supervision. The amendment will ensure that the children in the public schools of Texas receive psychological services from the most qualified individuals. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613982 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 CHAPTER 467.Announcements and Listings 22 TAC sec.467.2 The Texas State board of Examiners of Psychologists adopts an amendment to sec.467.2, concerning Use of Specialty Titles, without changes to the proposed text as published in the August 6, 1996, issue of the Texas Register (21 TexReg 7320). The rule is being amended to clarify the diplomate recognized by the Board's statute and to include proficiency certification from the American Psychological Association's College of Professional Psychology. The amendment will ensure that the consumers of Texas receive the best possible services from the most qualified individuals. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613983 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 CHAPTER 473.Fees 22 TAC sec.473.5 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.473.5, concerning Miscellaneous Fees, without changes to the proposed text published in the August 6, 1996, issue of the Texas Register (21 TexReg 7321). The rule is being amended to reflect that the fee for inactive status covers the two-year period allowed for inactive status. The amendment will better inform the public of the time period allowed for individuals to place their licenses/certificates on inactive status. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, 4512c, which provide the Texas State Board of Examiners of Psychologists with the authority to promulgate rules consistent with the Statute. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613984 Sherry L. Lee Executive Director Texas State Board of Examiners of Psychologists Effective date: October 15, 1996 Proposal publication date: August 6, 1996 For further information, please call: (512) 305-7700 TITLE 25. HEALTH SERVICES PART I. Texas Department of Health CHAPTER 29. Purchased Health Services SUBCHAPTER A. Medicaid Procedures for Providers 25 TAC sec.29.3 On behalf of the State Medicaid Director, the Texas Department of Health (department) submits an adopted amendment to sec.29.3, concerning the time limits for filing claims. Section 29.3 is adopted with changes to the proposed text published in the June 25, 1996, issue of the Texas Register (21 TexReg 5829). The amendment provides the department with a clear and precise application of the department's rule concerning the filing of Medicaid claims. The amendment provides for an extension for filing Medicaid claims if the deadline falls on a weekend or holiday. The amendment also provides the department with the authority to make exceptions to the 95-day claims filing deadline when specific situations exist. The amendment describes these situations and establishes procedures providers must follow to obtain approval for the exceptions. The following is a summary of comments received during the 30-day comment period. COMMENTS: Several individuals expressed support of the amendment as it was proposed. RESPONSE: The department appreciates the support. COMMENT: A commenter requested that existing situations be "grandfathered" by retroactive application of the amendment to process claims that specifically fit the requirements of the newly adopted amendment. RESPONSE: The department disagrees with the commenter. The exceptions will not be applied to any claim submitted for dates of service before the effective date of this amendment. Retroactive review of claims would create a substantial burden, financially and administratively, on the Medicaid program. Columbia Medical Center, El Paso, TX, commented on and agreed with the proposal but requested modification of the application of the rule as addressed in the summary of comments. The department made minor editorial changes to the amendment for consistency and clarification. The department deleted the word "personal" from subparagraph (a)(1)(A) to avoid confusion between personal and business related catastrophic events that could affect submittal of claims. This 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 are 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.29.3. Time Limits for Submitted Claims. (a)-(c) (No change.) (d) Extension. If a filing deadline falls on a weekend or holiday, the filing deadline shall be extended to the next business day following the weekend or holiday. (e) Exceptions to the 95-day deadline. The department shall consider exceptions only when at least one of the situations included in this subsection exists. The final decision of whether a claim falls within one of the exceptions will be made by the department's Medical Appeals office. (1) Exceptions to the filing deadline are considered when one of the following situations exists: (A) catastrophic event that substantially interferes with normal business operations of the provider, or damage or destruction of the provider's business office or records by a natural disaster, including but not limited to fire, flood, or earthquake; or damage or destruction of the provider's business office or records by circumstances that are clearly beyond the control of the provider, including but not limited to criminal activity. The damage or destruction of business records or criminal activity exception does not apply to any negligent or intentional act of an employee or agent of the provider because these persons are presumed to be within the control of the provider. The presumption can only be rebutted when the intentional acts of the employee or agent leads to termination of employment and filing of criminal charges against the employee or agent; (B) delay or error in the eligibility determination of a recipient, or delay due to erroneous written information from the department, another state agency, or health insuring agent; (C) delay due to electronic claim or system implementation problems; or (D) submission of claims within the 365-day federal filing deadline when services are authorized retroactively. (2) Under the conditions and circumstances included in paragraph (1) of this subsection, providers must submit the following documentation, if appropriate, and any additional requested information to substantiate approval of an exception. (A) All exception requests. The provider must submit an affidavit or statement from the provider stating the details of the cause for the delay, the exception being requested, and verification that the delay was not caused by neglect, indifference, or lack of diligence of the provider or the provider's employee or agent. This affidavit or statement must be made by the person with personal knowledge of the facts. (B) Exception requests within paragraph (1)(A) of this subsection. The provider must submit independent evidence of insurable loss; medical, accident, or death records; or police or fire report substantiating the exception of damage, destruction, or criminal activity. (C) Exception requests within paragraph (1)(B) of this subsection. The provider must submit the written document from the department or its designee that contains the erroneous information or explanation of the delayed information. (D) Exception requests within paragraph (1)(C) of this subsection. The provider must submit the written repair statement, invoice, computer or modem generated error report (indicating attempts to transmit the data failed for reasons outside the control of the provider), or the explanation for the system implementation problems. The documentation must include a detailed explanation made by the person making the repairs or installing the system, specifically indicating the relationship and impact of the computer problem or system implementation to claims submission, and a detailed statement explaining why alternative billing procedures were not initiated after the delay in repairs or system implementation was known. 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. Issued in Austin, Texas, on September 24, 1996. TRD-9614043 Susan K. Steeg General Counsel Texas Department of Health Effective date: October 16, 1996 Proposal publication date: June 25, 1996 For further information, please call: (512) 458-7236 SUBCHAPTER G. Hospital Services On behalf of the State Medicaid Director, the Texas Department of Health (department) submits adopted amendment to sec.29.609, repeal of sec.29.610, and new sec.29.610, concerning disproportionate share hospitals. Sections 29.609- 29.610 are being adopted with changes to the proposed text published in the June 28, 1996, issue of the Texas Register (21 TexReg 5917). The repeal of sec.29.610 is adopted without change and will not be republished. The amendments continue, according to federal directives, reimbursing hospitals that provide a disproportionate share of indigent care. The amendments also provide for a more accurate department administrative rule base. The amendments comply further with requirements established in the Omnibus Budget Reconciliation Act of 1993 (OBRA '93) and with the approved state plan amendment, which covers OBRA '93. The amendments also revise the reimbursement methodology for state mental and chest hospitals. The department specified when and how the state determines the available funds and added definitions for the available funds. These definitions clarify that there are three available funds in the disproportionate share hospital program. Although the department did not receive public comments during the 30-day comment period, the department initiated changes to clarify the language for consistency and to correct an incorrect reference in sec.29.610(e)(2). 25 TAC sec.29.609 These amendments are 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 are 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.29.609. Additional Reimbursement to Disproportionate Share Hospitals. (a) (No change.) (b) Definitions. For purposes of this section, the following words and terms, shall have the following meanings, unless the context clearly indicates otherwise. (1) (No change.) (2) Bad debt charges - Uncollectible inpatient and outpatient charges that result from the extension of credit. Bad debt charges are used in the calculation of charges attributed to uninsured patients as defined in paragraph (5) of this subsection, and are used only in the limited circumstances described in subsection (f)(2)(D)(iv) of this section. (3) (No change.) (4) Charity charges - Total amount of hospital charges for inpatient and outpatient services attributed to charity care in a cost reporting period. These charges do not include bad debt charges, contractual allowances or discounts (other than for indigent patients not eligible for medical assistance under the approved Medicaid state plan); that is, reductions or discounts in charges given to other third party payers such as, but not limited to, health maintenance organizations, Medicare, or Blue Cross. Charity charges are used in the calculation of charges attributed to uninsured patients as defined in paragraph (5) of this subsection, only in the limited circumstances described in subsection (f)(2)(D)(iv) of this section. 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 to uninsured patients - Inpatient and outpatient charges to patients who have no health insurance or other source of third party payment for services provided during the year, multiplied by the hospital's ratio of costs to charges (inpatient and outpatient), less the amount of payments made by or on behalf of those patients. Uninsured patients are patients who have no health insurance or other source of third party payments for services provided during the year. Uninsured patients include those patients who do not possess health insurance that would apply to the service for which the individual sought treatment. (6)-(10) (No change.) (11) Hospital specific limit - The sum of the following two measurements: (A) (No change.) (B) cost of services to uninsured patients. (12)-(14) (No change.) (15) Medicaid inpatient utilization rate - Fraction expressed as a percentage, the numerator of which is the hospital's number of inpatient days attributable to patients who (for these days) were eligible for medical assistance under a state plan, and the denominator of which is the total number of the hospital's inpatient days in that period. The term "inpatient day" includes each day in which an individual (including a newborn) is an inpatient in the hospital, whether or not the individual is in a specialized ward and whether or not the individual remains in the hospital for lack of suitable placement elsewhere. (16)-(18) (No change.) (19) Payments received - Payments received from uninsured patients from or on behalf of uninsured patients as defined in paragraph (5) of this subsection. (20)-(21) (No change.) (22) Total inpatient charity charges - Total amount (excluding bad debt charges) 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 does 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 that were denied payment for reasons other than eligibility. Included are inpatient days of care provided to patients eligible for Medicaid at the time the service was provided, regardless of whether the claim was paid. These denied claims include, but are not limited to, claims for patients whose spell of illness limits are exhausted, or claims that were filed late. The terms excludes days attributable to Medicaid patients between the ages of 21 and 65 who live in an institution for mental diseases. The term includes days attributable to individuals eligible for Medicaid in other states. 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). (24)-(29) (No change.) (30) Available fund (state mental and chest hospitals) - Sum of 100 percent of their adjusted hospital specific limits. (31) Available fund (hospitals other than mental and chest hospitals) - Total federal fiscal year cap (state disproportionate share hospital allotment) minus the available fund for state teaching hospitals minus the available fund for state mental and chest hospitals. (c)-(e) (No change.) (f) Reimbursing Medicaid disproportionate share hospitals. The department 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. Before the start of the next state fiscal year, the department determines the size of the available funds to reimburse disproportionate share hospitals for the next state fiscal year, which begins each September 1. The funds available to reimburse the state chest hospitals and state mental hospitals equal the total of their adjusted hospital specific limits. The available fund for the remaining hospitals equals the lesser of the funds remaining in the state's annual disproportionate share hospital allotment or the sum of qualifying hospitals' adjusted hospital specific limits. Payments shall be made in the following manner, unless the department 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 receives annually 100 percent of its adjusted hospital specific limit. (2) For the remaining hospitals, payments will be based on both weighted inpatient Medicaid days and weighted low income days. The department weighs each hospital's total inpatient Medicaid days and low income days by the appropriate weighing factor. The department 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 determines the hospital specific limit for each disproportionate share hospital. This limit is the sum of a hospital's Medicaid shortfall, as defined in subsection (b)(16) of this section, and its cost of services to uninsured patients, as defined in subsection (b)(5) of this section, multiplied by the appropriate inflation update factor, as provided for in subsection (g)(2)(E) of this section. (i) The Medicaid shortfall includes total Medicaid billed charges and any Medicaid payment made for the corresponding inpatient and outpatient services delivered to Texas Medicaid clients, as determined from the hospital's fiscal year claims data, regardless of whether the claim was paid. These denied claims include, but are not limited to, patients whose spell of illness claims were exhausted, or payments were denied due to late filing. See subsection (b)(16) of this section for definition of "Medicaid shortfall." (ii) The total Medicaid billed charges for each hospital are converted to cost, utilizing a calculated cost-to-charge ratio (inpatient and outpatient). The department or its designee determines that ratio by using the hospital's Form HCFA 2552-92, Hospital and Hospital Health Care Complex Cost Report, that was submitted for the fiscal year ending in the previous calendar year. The department or its designee uses 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. To determine the cost-to-charge ratio (inpatient and outpatient) for each hospital, the department or its designee uses the total cost from the HCFA 2552-92, Worksheet B, Part I, Column 25, and total charges from the HCFA 2552-92, Worksheet C Part I, Column 6. The ratio is the total cost divided by the total gross patient charges. (iii) The department or its designee determines the cost of services to patients who have no health insurance or source of third party payments for services provided during the fiscal year for each hospital. Hospitals are surveyed each year to determine charges that can be attributed to patients without insurance or other third party resources. The charges from reporting hospitals are multiplied by each hospital's cost-to-charge ratio (inpatient and outpatient) to determine the cost. (iv) 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 charges as defined in subsection (b)(2) of this section, and their charity charges as defined in subsection (b)(4) of this section, reduced by a percentage derived from a representative sample of hospitals to be determined annually by the department or its designee. The department derives the percentages using the following formula; for each specific category of hospitals listed in clause (v) of this subparagraph, the department sums the total amount of charges for patients without health insurance or other third party payments. For each specific category of hospitals listed in clause (v) of this subparagraph, the department sums the charity and bad debt charges. For each specific category of hospitals listed in clause (v) of this subparagraph, the department then divides the charges for patients without health insurance or other third party payments by the sum of charity and bad debt charges. The department then uses the resulting ratio for each specific category of hospitals listed in clause (v) of this subparagraph in the following manner. Individual hospitals that do not respond to the survey, or that are unable to accurately determine the charges attributed to patients without insurance have their hospital's individual sum of bad debt and charity charges multiplied by the appropriate ratio for the specific hospital category. After the department has calculated a value for the charges for patients without health insurance or other source of third party payment for each individual hospital, the department multiplies each hospital's calculated value by that hospital's cost-to-charge ratio (inpatient and outpatient) to obtain the proxy cost of services delivered to uninsured patients at each hospital. (v) The representative sample of hospitals is one of the following specific categories of hospitals: urban public, other urban, rural, state-operated psychiatric and nonstate psychiatric. In the event that less than 20 percent of the hospitals in a specific category provide data to the department, the department or its designee uses the overall ratio calculated for all responding hospitals. The department or its designee creates additional categories, by submitting a state plan amendment, as it deems appropriate for the economic and efficient operation of the Medicaid disproportionate share hospital program. (vi) 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 payments for services provided during the year, the department subtracts from each hospital's cost of services the amount of payments made by or on behalf of those patients who have no health insurance or source of third party payments for services provided during the year. (E) 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 department 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 months from the mid-point of the hospital's cost reporting period to the mid-point of the state 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." (F) The department or its designee compares the projected payment for each disproportionate share hospital, as determined by subsections (d) and (e) of this section, with its adjusted hospital specific limit, as determined by subparagraphs (D) and (E) of this paragraph. If the hospital's projected payment is greater than its adjusted hospital specific limit, the department or its designee reduces the hospital's payment to its adjusted hospital specific limit. (G) If there are disproportionate share hospital funds left in the available fund for the remaining hospitals, because some hospitals have had their disproportionate share hospital payments reduced to their adjusted hospital specific limits, the department distributes the excess funds according to the provisions in this section. For hospitals whose projected disproportionate share hospital payments are less than their adjusted hospital specific limits, the department or its designee does the following: (i) calculate the difference between its adjusted hospital specific limit and its projected disproportionate share hospital payment; (ii) add all of the differences from clause (i) of this subparagraph; (iii) calculate a ratio for each hospital by dividing the difference from clause (i) of this subparagraph by the sum for clause (ii) of this subparagraph; and (iv) multiply the ratio from clause (iii) of this subparagraph by the remaining available fund. Remaining Available Hospital's Adjusted Limit (minus) Hospital's Projected Fund X Disproportionate Share Payment Total (H) Only those hospitals that are below their adjusted hospital specific limits are eligible to participate in this distribution. The disproportionate share hospital funds remaining in the available fund are distributed to the hospitals that have not already reached their adjusted hospital specific limits. Each hospital's total disproportionate share payment (including the redistribution of excess funds) cannot exceed its adjusted hospital specific limit. (g)-(i) (No change.) 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. Issued in Austin, Texas, on September 24, 1996. TRD-9614044 Susan K. Steeg General Counsel Texas Department of Health Effective date: October 16, 1996 Proposal publication date: June 28, 1996 For further information, please call: (512) 458-7236 25 TAC sec.29.610 This repeal 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 are 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). 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. Issued in Austin, Texas, on September 24, 1996. TRD-9614046 Susan K. Steeg General Counsel Texas Department of Health Effective date: October 16, 1996 Proposal publication date: June 28, 1996 For further information, please call: (512) 458-7236 This 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 are 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.29.610. Disproportionate Share Hospital Reimbursement Methodology. (a) A hospital owned and operated by a state university or other agency of the state is eligible for disproportionate share reimbursement. A state-owned teaching hospital is a hospital owned and operated by a state university or other agency of the state. (b) Each hospital must have a Medicaid inpatient utilization rate defined at a minimum of one percent. (c) To qualify for disproportionate share payments, each hospital must have at least two physicians (M.D. or D.O.), with staff privileges at the hospital, who have agreed to provide nonemergency obstetrical services to Medicaid clients. The two-physician requirement does not apply to hospitals whose inpatients are predominantly under 18 years old or that did not offer nonemergency obstetrical services to the general population as of December 22, 1987. (d) For purposes of this section, the following words and terms, shall have the following meanings, unless the context clearly indicates otherwise. (1) Total Medicaid inpatient days - Total Medicaid inpatient days means the 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 that were denied payment for reasons other than eligibility. Included are inpatient days of care provided to patients eligible for Medicaid at the time the service was provided, regardless of whether the claim was paid. These denied claims include, but are not limited to, claims for patients whose spell of illness limits are exhausted, or claims that were filed late. The term excludes days attributable to Medicaid patients between the ages of 21 and 65 who live in an institution for mental diseases. The term includes days attributable to individuals eligible for Medicaid in other states. (2) Total inpatient census days - Total inpatient census days means the total number of a hospital's inpatient census days during its fiscal year ending in the previous calendar year. (3) Cost of services - Cost of services to uninsured patients is the inpatient and outpatient charges to patients who have no health insurance or other source of third party payment for services provided during the year, multiplied by the hospital's ratio of costs to charges (inpatient and outpatient), less the amount of payments made by or on behalf of those patients. Uninsured patients are patients who have no health insurance or other source of third party payments for services provided during the year. Uninsured patients include those patients who do not possess health insurance that would apply to the service for which the individual sought treatment. Cost of services does not include any bad debt charges. (4) Hospital specific limit - Hospital specific limit is the sum of the following two measurements: Medicaid shortfall and cost of services to uninsured patients. (5) Medicaid shortfall - Medicaid shortfall is the cost of services (inpatient and outpatient) furnished to Medicaid patients, less the amount paid under the nondisproportionate share hospital payment method under this state plan. (6) Cost-to-charge ratio (inpatient and outpatient) - Cost-to-charge ratio is the hospital's overall cost-to-charge ratio, as determined from its Medicare cost report submitted for the fiscal year ending in the previous calendar year. The latest available Medicare cost report is used in the absence of the cost report for the hospital's fiscal year ending in the previous calendar year. (7) Adjusted hospital specific limit - Adjusted hospital specific limit is a hospital specific limit trended forward to account for the inflation update factor since the base year. (8) Inflation update factor - Inflation update factor is a general increase in prices as determined by the department. (9) Medicaid inpatient utilization rate - Medicaid inpatient utilization rate is the fraction expressed as a percentage, the numerator of which is the hospital's number of inpatient days attributable to patients who (for these days) were eligible for medical assistance under a state plan, and the denominator of which is the total number of the hospital's inpatient days in that period. The term "inpatient day" includes each day in which an individual (including a newborn) is an inpatient in the hospital, whether or not the individual is in a specialized ward and whether or not the individual remains in the hospital for lack of suitable placement elsewhere. (10) Payments received - Payments received from uninsured patients are those payments received from or on behalf of uninsured patients as defined in paragraph (3) of this subsection. (11) Charity charges - Charity charges are the total amount of hospital charges for inpatient and outpatient services attributed to charity care in a cost reporting period, as reported on the state teaching hospitals' annual financial reports, for use only in the calculation of the disproportionate share hospital payment under subsection (e)(1) of this section. (12) Allowable cost - Allowable cost is defined by the department using the rates that are reasonable and adequate to meet the costs that must be incurred by efficiently and economically operated providers when providing services in conformity with applicable state and federal laws, regulations, and quality and safety standards. (13) Available fund - The available fund for state teaching hospitals is the total amount of funds that may be reimbursed to the state teaching hospitals as determined below. (e) The department reimburses state-owned teaching hospitals on a monthly basis from the available fund for state teaching hospitals. Monthly payments equal one-twelfth of annual payments unless it is necessary to adjust the amount because payments are not 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. Prior to the start of the next federal fiscal year, the department determines the size of the fund to reimburse state-owned teaching hospitals for the next federal fiscal year. The available fund to reimburse the state teaching hospitals equals the total of their disproportionate share hospital payments, as follows: (1) A state teaching hospital will receive a monthly disproportionate share payment based on the following formula: Monthly Charity Charges of the State- Owned Teaching Hospital x Available Total Monthly Charity Charges of All State- Owned Teaching Hospitals Fund (2) If the adjusted hospital specific limit for a state teaching hospital is less than the formula in paragraph (1) of this subsection, a state teaching hospital will receive 100 percent of its adjusted hospital specific limit, instead of the amount determined under this subsection. (f) The department or its designee determines the hospital specific limit for each disproportionate share hospital. This limit is the sum of a hospital's Medicaid shortfall, as defined in subsection (d)(5) of this section, and its cost of services to uninsured patients as defined in subsection (d)(3) of this section, multiplied by the appropriate inflation update factor, as provided for in subsection (g) of this section. (1) The Medicaid shortfall includes total Medicaid billed charges and any Medicaid payments made for the corresponding inpatient and outpatient services delivered to Texas Medicaid clients, as determined from the hospital's fiscal year claims data, regardless of whether the claim was paid. These denied claims include, but are not limited to, patients whose spell of illness claims were exhausted, or payments were denied due to late filing. Refer to subsection (d)(5) of this section. (A) The total billed Medicaid charges for each hospital are converted to cost, utilizing a calculated cost-to-charge ratio (inpatient and outpatient). The department or its designee determines that ratio by using the hospital's HCFA 2552-92, Hospital and Hospital Health Care Complex Cost Report, that was submitted for the fiscal year ending in the previous calendar year. The department or its designee uses 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. To determine the cost-to-charge ratio (inpatient and outpatient) for each hospital, the department or its designee uses the total cost from the HCFA 2552-92, Worksheet B, Part 1, Column 25, and total charges from the HCFA 2552-92, Worksheet C, Part 1, Column 6. The ratio is the total cost divided by the total gross patient charges. (B) The department or its designee determines 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. Hospitals are surveyed each year to determine charges that can be attributed to patients without insurance or other third party resources. The charges are multiplied by each hospital's cost-to- charge ratio (inpatient and outpatient) to determine the cost. (2) 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 payments for services provided during the year, the department subtracts from each hospital's cost of services the amount of payments made by or on behalf of those patients who have no health insurance or source of third party payments for services provided during the year. (g) The department or its designee trends each hospital's "hospital specific limit" calculated from its historical base period cost report from subsection (f) of this section to the state's fiscal year disproportionate share program. For hospitals without full 12-month fiscal year cost reports, the department or its designee annualizes the cost to calculate the hospital specific limit. The department or its designee uses the inflation update factor, as defined in subsection (d)(8) of this section, in calculating the adjusted hospital specific limit. The department or its designee calculates the number of months from the mid-point of the hospital's cost reporting period to the mid-point of the state fiscal year disproportionate share program. The department or its designee then multiplies 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 is multiplied by each hospital's hospital specific limit to obtain each hospital's adjusted hospital specific limit. 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. Issued in Austin, Texas, on September 24, 1996. TRD-9614045 Susan K. Steeg General Counsel Texas Department of Health Effective date: October 16, 1996 Proposal publication date: June 28, 1996 For further information, please call: (512) 458-7236 TITLE 31. NATURAL RESOURCES AND CONSERVATION PART II. Texas Parks and Wildlife Department CHAPTER 51.Executive The Texas Parks and Wildlife Commission, in a regularly scheduled public hearing held August 29, 1996, adopted the repeal of sec.sec.51.91, 51.93-51.97, concerning Easement Requests and Unauthorized Easement Activities, without change to the proposed text as published in the June 7, 1996, issue of the Texas Register (21 TexReg 5144). The Commission also adopted the repeal and new sec.51.92. New sec.51.92 is adopted with changes to the proposed text as published in the July 26, 1996 issue of the Texas Register (21 TexReg 6990). The commission adopted amendment of sec.51.92(a)(3)(A) which will require a statement from entities requesting an easement on department lands which certifies that every reasonable attempt has been made to minimize adverse impacts on department property or its users. The repeals and new rule remove redundant sections of the Texas Administrative Code and are necessary to provide a procedure for evaluating easement requests and for forwarding staff recommendations to the commission for approval. The repeal and new rule will provide a mechanism for department, commission and public review of easement requests on department lands. Requirements for easement requests are clearly specified and the commission will review these requests. The department received no public comment concerning the proposed repeal and new rule. Easement Requests and Unauthorized Easement Activity 31 TAC sec.sec.51.91, 51.93-51.97 The repeal and new sections are adopted under Parks and Wildlife Code, Chapter 13, Subchapter B, which provides the Commission with the authority to establish regulations governing the conservation, preservation, and use of state property. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613914 William D. Harvey, Ph.D. Regulatory Coordinator Texas Parks and Wildlife Department Effective date: October 14, 1996 Proposal publication date: June 7, 1996 For further information, please call: 1-800-792-1112, extension 4642 or (512) 389-4642 31 TAC sec.51.92 The repeal is adopted under Parks and Wildlife Code, Chapter 13, Subchapter B, which provides the Commission with the authority to establish regulations governing the conservation, preservation, and use of state property. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613915 William D. Harvey, Ph.D. Regulatory Coordinator Texas Parks and Wildlife Department Effective date: October 14, 1996 Proposal publication date: June 7, 1996 For further information, please call: 1-800-792-1112, extension 4642 or (512) 389-4642 The new section is adopted under Parks and Wildlife Code, Chapter 13, Subchapter B, which provides the Commission with the authority to establish regulations governing the conservation, preservation, and use of state property. sec.51.92. Easement Requests. (a) An entity requesting an easement on property owned or managed by the department shall submit a written request that: (1) identifies the site of the proposed easement by a metes and bounds description; (2) describes the activity to take place on the site of the proposed easement; and (3) contains a statement that: (A) every reasonable attempt has been made to minimize adverse impacts to the property or its users; (B) no feasible and prudent alternative exists to the easement on state property; and (C) discusses alternatives to the location of the easement. (b) The department shall review requests fairly and expeditiously in accordance with the best available management guidelines. (c) Upon reaching a determination, the department shall present to the commission its findings and recommendations. 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. Issued in Austin, Texas, on September 23, 1996. TRD-9613916 William D. Harvey, Ph.D. Regulatory Coordinator Texas Parks and Wildlife Department Effective date: October 14, 1996 Proposal publication date: June 7, 1996 For further information, please call: 1-800-792-1112, extension 4642 or (512) 389-4642 TITLE 40. SOCIAL SERVICES AND ASSISTANCE PART I. Texas Department of Human Services CHAPTER 4.Medicaid Programs-Children and Pregnant Women Eligibility Requirements 40 TAC sec.4.1004 The Texas Department of Human Services (DHS) adopts an amendment to sec.4.1004 without changes to the proposed text as published in the Texas Register (21 TexReg 7228) and will not be republished. The justification for the amendment is to implement welfare reform policies as required by House Bill 1863. The amendment will function by ensuring that DHS will be in compliance with state legislation related to welfare reform. No comments were received regarding adoption of the amendments. The amendment is adopted under the Human Resources Code, Title 2, Chapters 22, 31, and 32, which provides the department with the authority to administer public, financial, and medical assistance programs and under Texas Government Code, sec.531.021, 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.22.001-22.030, 31.0325, and 32.001-32.042. 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. Issued in Austin, Texas, on September 10, 1996. TRD-9614248 Glenn Scott General Counsel, Legal Service Texas Department of Human Services Effective date: October 1, 1996 Proposal publication date: July 30, 1996 For further information, please call: (512) 438-3765