TITLE 1. ADMINISTRATION
PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER
C.
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §355.312, concerning Reimbursement Setting Methodology--Liability Insurance Costs.
BACKGROUND AND PURPOSE
The purpose of this proposal is to revise the methodology for liability insurance add-on rates for nursing facility providers. The proposed amendment clarifies HHSC will pay the same add-on rate for providers who purchase general liability insurance without professional liability insurance, providers who purchase professional liability insurance without general liability insurance, and providers who purchase both general and professional liability insurance. This change ensures that HHSC is applying the appropriation uniformly across all nursing facility providers that carry liability insurance.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §355.112(d) clarifies the calculation of the rate add-ons before and after September 1, 2025, due to the anticipated implementation of Patient Driven Payment Model Long-Term Care. The amendment also clarifies the same add-on reimbursement rate will apply for providers who purchase general liability insurance without professional liability insurance, providers who purchase professional liability insurance without general liability insurance, and providers who purchase both general and professional liability insurance. The proposed amendment deletes text that is no longer applicable.
FISCAL NOTE
Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.
GOVERNMENT GROWTH IMPACT STATEMENT
HHSC has determined that during the first five years that the rule will be in effect:
(1) the proposed rule will not create or eliminate a government program;
(2) implementation of the proposed rule will not affect the number of HHSC employee positions;
(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;
(4) the proposed rule will not affect fees paid to HHSC;
(5) the proposed rule will not create a new regulation;
(6) the proposed rule will not expand, limit, or repeal existing regulation;
(7) the proposed rule will not change the number of individuals subject to the rule; and
(8) the proposed rule will not affect the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities.
The rule does not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.
LOCAL EMPLOYMENT IMPACT
The proposed rule will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons.
PUBLIC BENEFIT AND COSTS
Victoria Grady has determined for each year of the first five years the rule is in effect, the public benefit will be improved transparency in the payment of rate add-ons.
Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the proposed amendment does not result in a rate change for regulated persons.
TAKINGS IMPACT ASSESSMENT
HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
PUBLIC COMMENT
Written comments on the proposal may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.
To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register . Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R002" in the subject line.
STATUTORY AUTHORITY
The amendment is authorized by Texas Government Code §524.0151, 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, and Texas Human Resources Code §32.021 and Texas Government Code §532.0051(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; Texas Government Code §532.0057(a), 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 Texas Government Code §540.0051, which authorizes HHSC to implement the Medicaid managed care program.
The amendment affects Texas Government Code §524.0151, Chapter 532 and 540. The amendment also affects Texas Human Resources Code Chapter 32.
§
355.312.
(a) - (c) (No change.)
(d) Payment rates. Payment rates for purchased general and professional liability insurance will be determined as follows.
(1)
Before September 1, 2025, determine
[
Determine
] the portion of the general and administration rate component from §355.307 of this subchapter (relating to Reimbursement Setting Methodology
before September 1, 2025
) attributable to allowable liability insurance costs.
After September 1, 2025, determine the portion of the Non-Case-Mix rate component from §355.318 of this subchapter (relating to Reimbursement Setting Methodology for Nursing Facilities on or after September 1, 2025) attributable to allowable liability insurance costs.
(2)
Determine the
total number of
[
amount of total
] dollars that would be expended if the liability rate component from paragraph (1) of this subsection were paid uniformly to all providers during the rate effective period.
(3) Estimate the number of days of service that will be covered by purchased liability insurance during the rate period.
(4)
Divide the total dollars available for liability insurance from paragraph (2) of this subsection by the estimated number of days of service that will be covered by purchased liability insurance during the rate period from paragraph (3) of this subsection. [
Estimate the proportion of this per diem amount accruing from general liability insurance and the proportion accruing from professional liability insurance to determine the payment rate for each day of purchased general liability insurance and the payment rate for each day of purchased professional liability insurance.
]
(5)
Payment rates for purchased [
general and professional
] liability insurance may be adjusted as often as HHSC determines is necessary to ensure that the total dollars expended during the rate period do not exceed the amount appropriated for this purpose.
(6) Since these payment rates are determined through an allocation of available appropriations among estimated units of service covered by purchased liability insurance, a public rate hearing is not required when adjustments are made to the payment rates.
(7) Providers will be notified, in a manner determined by HHSC, of adjustments to the payment rates for purchased general and professional liability insurance.
(8)
HHSC will pay the same add-on rate for providers who purchase general liability insurance without professional liability insurance, providers who purchase professional liability insurance without general liability insurance, and providers who purchase both general and professional liability insurance.
[
Providers who purchase general liability insurance without professional liability insurance are only eligible to receive payment of the rate for purchased general liability insurance. Providers who purchase professional liability insurance without general liability insurance are only eligible to receive payment of the rate for purchased professional liability insurance. Providers who purchase both general and professional liability insurance are eligible to receive payment of both rates.
]
(e) - (j) (No change.)
The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.
Filed with the Office of the Secretary of State on April 29, 2025.
TRD-202501412
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: June 15, 2025
For further information, please call: (737) 867-7817