TITLE 1. ADMINISTRATION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 353. MEDICAID MANAGED CARE

SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES

1 TAC §353.1305

The Texas Health and Human Services Commission (HHSC) adopts an amendment to §353.1305, concerning Uniform Hospital Rate Increase Program. The amendment is adopted without changes to the proposed text as published in the August 25, 2017, issue of the Texas Register (42 TexReg 4199), and therefore will not be republished.

BACKGROUND AND JUSTIFICATION

In March of 2017, HHSC adopted rules governing a provider payment initiative through Medicaid managed care organizations (MCOs) called the Uniform Hospital Rate Increase Program (UHRIP) (42 TexReg 1748). Under the UHRIP initiative, a service delivery area (SDA) may apply to receive an increase in certain hospital rates which would vary by class of hospital. Although UHRIP was to begin in September 2017 and be available to any SDA, operational issues necessitated a delay. Such issues included lack of readiness by MCOs, lack of program understanding among providers, and incomplete approvals from the Centers for Medicare & Medicaid Services (CMS). HHSC amends the UHRIP rule in three ways.

First, HHSC amends §353.1305(b)(7) and (8), the definitions of "rural private hospital" and "rural public hospital," to be consistent with a revised definition of "rural hospital" that was adopted in §355.8052 (relating to Inpatient Hospital Reimbursement) to be effective September 1, 2017. The definitions in this rule now refer to the definition of "rural hospital" in §355.8052.

Second, HHSC adds §353.1305(k), which allows for a limited December 1, 2017, entry into UHRIP for a subset of SDAs. Specifically, if HHSC received an approval from CMS for any particular SDA by April 15, 2017, that SDA would be able to participate in UHRIP for dates of service beginning December 1, 2017.

Third, HHSC standardizes references to SDA throughout the section.

COMMENTS

The 30-day comment period ended September 25, 2017. During this period, HHSC received one comment regarding the proposed rule from the Texas Hospital Association. A summary of the comment and HHSC's response follows.

Comment:

One commenter encouraged HHSC to adopt the proposed rule to allow the Bexar and El Paso Service Delivery Areas (SDAs) to participate in UHRIP beginning on December 1, 2017.

Response:

HHSC thanks the commenter for their support of the rule.

STATUTORY AUTHORITY

The amendment is adopted under Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; Texas Government Code §531.021(b), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under the Texas Human Resources Code, Chapter 32; and with Texas Government Code §533.002, which authorizes HHSC to implement the Medicaid managed care program.

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 October 26, 2017.

TRD-201704344

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Effective date: December 1, 2017

Proposal publication date: August 25, 2017

For further information, please call: (512) 707-6068


CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES

1 TAC §355.315

The Texas Health and Human Services Commission (HHSC) adopts new §355.315, concerning Reimbursement Methodology for Preadmission Screening and Resident Review (PASRR) Specialized Services. The rule is adopted without changes to the proposed text published in the August 18, 2017, issue of the Texas Register (42 TexReg 4042) and therefore will not be republished.

Background and Justification

HHSC, under its authority and responsibility to administer and implement rates, adopts this new rule to establish the reimbursement methodology for PASRR Specialized Services. Effective December 1, 2017, HHSC will implement an array of PASRR Specialized Services for clients who reside in nursing facilities as required by the Centers for Medicare & Medicaid Services (CMS) under 42 CFR §483.100 through §483.138. This adopted rule is required to develop the rates for the above-referenced services.

Comments

The 30-day comment period ended September 18, 2017. During this period, HHSC did not receive any comments regarding the new rule.

Statutory Authority

The new rule is adopted under Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules necessary to carry out HHSC's duties; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §531.021(b), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under the Texas Human Resources Code Chapter 32.

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 October 26, 2017.

TRD-201704343

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Effective date: November 15, 2017

Proposal publication date: August 18, 2017

For further information, please call: (512) 462-6223