TITLE 1. ADMINISTRATION

PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 355. REIMBURSEMENT RATES

SUBCHAPTER J. PURCHASED HEALTH SERVICES

DIVISION 32. CLINICAL LABORATORY SERVICES

1 TAC §355.8610

The Texas Health and Human Services Commission (HHSC) adopts amended §355.8610, concerning Reimbursement for Clinical Laboratory Services. The amendment to §355.8610 is adopted without changes to the proposed text as published in the November 1, 2019, issue of the Texas Register (44 TexReg 6471). This rule will not be republished.

BACKGROUND AND JUSTIFICATION

HHSC adopts the amendment to the rule governing Clinical Laboratory Services reimbursement. The amendment updates the rule to allow HHSC to establish fees based on a percentage of the Medicare fee schedule and removes the limitation that would not allow payments to exceed the Medicare fee schedule. Currently, HHSC Medicaid fees for clinical laboratory services provided by the Department of State Health Services (DSHS) Laboratory are set at 100 percent of the Medicare fee. The Medicare fee schedule may adjust fees more frequently or in a manner that could negatively impact the DSHS Laboratory. Of particular concern is the series of tests that comprise the newborn screening, which are provided solely by the DSHS laboratory for all Texas newborns.

This amendment allows HHSC to reimburse for clinical laboratory services at a percentage of the Medicare fee schedule, which still permits flexibility for HHSC to maintain existing funding for the DSHS Laboratory and its ability to continue to provide newborn screenings for Medicaid newborns.

COMMENTS

The 31-day comment period ended December 2, 2019.

During this period, HHSC received one comment regarding the proposed rule from the American Clinical Laboratory Association. A summary of the comment relating to the Clinical Lab Services rule amendment and HHSC's response follow.

Comment: The commenter agrees with the flexibility the amendment affords HHSC by removing the limitation that at present, does not allow payments to exceed the Medicare fee schedule.

Response: HHSC appreciates the support for the proposed amendment. No revision to the rule text is necessary.

STATUTORY AUTHORITY

The amendment is adopted under Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the Health and Human Services agencies; 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-1), 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 February 6, 2020.

TRD-202000437

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Effective date: February 26, 2020

Proposal publication date: November 1, 2019

For further information, please call: (512) 428-1962