PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 98. TEXAS HIV MEDICATION PROGRAM
SUBCHAPTER A. TEXAS HIV STATE PHARMACY ASSISTANCE PROGRAM
25 TAC §§98.2, 98.6, 98.10
The Executive Commissioner of the Health and Human Services Commission, on behalf of the Department of State Health Services (department), adopts amendments to §§98.2, 98.6, and 98.10, concerning the Texas HIV State Pharmacy Assistance Program (SPAP), without changes to the proposed text as published in the December 23, 2016, issue of the Texas Register (41 TexReg 10062) and therefore, the sections will not be republished.
BACKGROUND AND PURPOSE
The SPAP is a part of the Texas HIV Medication Program (THMP), which provides medications for the treatment of HIV and its related complications for low-income Texans. SPAP provides medication copayments on behalf of eligible clients with Medicare Part D prescription drug coverage. Rebates are available to the THMP as a result of changes in federal law in 2011 that allowed Ryan White Part B participants (states) to invoice drug manufacturers for rebates on medication copayments paid on behalf of clients with prescription drug coverage, either through Medicare Part D or an insurance plan. The amendments align the rules with proposed new federal funding guidance. The amendments add language to allow the SPAP to pay prescription drug coverage insurance premiums in addition to copayments and coinsurance in order to be eligible to claim a rebate. The amendments have an added public health benefit by adding a new method to allow the THMP to assist individuals living with HIV with their prescription medications.
Amendments to §98.2, Definitions, add "premium" to the definition of "Out-of-Pocket Costs" to clarify that this expense is allowed.
Amendments to §98.6, Denial, Non-Renewal, and Termination of Benefits, delete paragraph "(7) failure to continue premium payments under Medicare" as a reason for terminating enrollment in the program. This language is no longer needed since the program is paying premiums. As a result, the remaining paragraphs are renumbered.
Amendments to §98.10, Limitations and Benefits Provided, add "Medicare Part D premium payments" as a benefit that the program is allowed to pay for those clients enrolled in the program.
The department, on behalf of the commission, did not receive any comments regarding the proposed rules during the comment period.
The Department of State Health Services General Counsel, Lisa Hernandez, certifies that the rules, as adopted, have been reviewed by legal counsel and found to be a valid exercise of the agencies' legal authority.
The amendments will be adopted under and are authorized by Texas Health and Safety Code, §85.003, which requires the department to act as lead agency and primary resource for AIDS and HIV policy; Health and Safety Code, §85.016, which allows for the adoption of rules; Health and Safety Code, §85.061, which establishes the Texas HIV Medication Program; Health and Safety Code, §85.063, which requires the department to establish procedures and eligibility guidelines for the HIV Medication Program; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 24, 2017.
Department of State Health Services
Effective date: April 13, 2017
Proposal publication date: December 23, 2016
For further information, please call: (512) 776-6972