PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 351. COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
The Texas Health and Human Services Commission (HHSC) adopts amendments to §351.4, concerning Health and Human Services Commission Executive Council; §351.11, concerning Reports on Efforts to Streamline and Simplify Delivery of Services; §351.504, concerning Caseload Reduction Plan for Adult Protective Services; §351.507, concerning Adverse Licensing, Listing, or Registration Decisions by Health and Human Services Agencies; §351.701, concerning Unrelated Donor Umbilical Cord Blood Bank Program; §351.751, concerning Integrated eligibility services call centers; §351.801, concerning Authority and General Provisions; §351.807, concerning Behavioral Health Advisory Committee; §351.809, concerning Drug Utilization Review Board; §351.811, concerning Intellectual and Developmental Disability System Redesign Advisory Committee; and §351.841, concerning Joint Committee on Access and Forensic Services.
The amendments to §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751, 351.801, 351.807, 351.809, 351.811, and 351.841 are adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9087). These rules will not be republished.
HHSC withdraws the proposed amendments to §351.821, concerning Value-Based Payment and Quality Improvement Advisory Committee; §351.823, concerning e-Health Advisory Committee; §351.825, concerning Texas Brain Injury Advisory Council; and §351.827, concerning Palliative Care Interdisciplinary Advisory Council.
BACKGROUND AND JUSTIFICATION
House Bill (H.B.) 4611, 88th Legislature, Regular Session, 2023, made certain non-substantive revisions to Subtitle I, Title 4, Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the Texas Legislature's ongoing statutory revision program. These adopted amendments update citations in the rules to the Texas Government Code sections that become effective on April 1, 2025.
COMMENTS
The 31-day comment period ended December 16, 2024. During this period, HHSC did not receive any comments regarding the proposed rules.
SUBCHAPTER A. GENERAL PROVISIONS
1 TAC §§351.4, 351.11, 351.504, 351.507, 351.701, 351.751
STATUTORY AUTHORITY
The amendments are 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, and Chapters 521, 523, 525, 542, 546, and 549.
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 4, 2025.
TRD-202500374
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
DIVISION 1. COMMITTEES
1 TAC §§351.801, 351.807, 351.809, 351.811, 351.841
STATUTORY AUTHORITY
The amendments are 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, and Chapters 521, 523, 525, 542, 546, and 549.
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 4, 2025.
TRD-202500375
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: April 1, 2025
Proposal publication date: November 15, 2024
For further information, please call: (512) 221-9021
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §353.1309, concerning Texas Incentives for Physicians and Professional Services.
The amendment to §353.1309 is adopted without changes to the proposed text as published in the November 15, 2024, issue of the Texas Register (49 TexReg 9110). The rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment makes modifications to the Texas Incentives for Physicians and Professional Services (TIPPS) program to provide additional details concerning the pay-for-performance model established for Component Two of the program, beginning in State Fiscal Year (SFY) 2026. The rule amendment changes how certain TIPPS funds will be redistributed to certain physician groups participating in TIPPS if a physician group fails to earn those funds due to a failure to achieve performance requirements for Component Two of TIPPS.
HHSC sought and received authorization from the Centers for Medicare and Medicaid Services (CMS) to create TIPPS as part of the financial and quality transition from the Delivery System Reform Incentive Payment (DSRIP) program. Directed payment programs authorized under 42 Code of Federal Regulations (C.F.R.) §438.6(c), including TIPPS, are expected to continue to evolve over time to advance quality goals or objectives the program is intended to impact. HHSC previously amended the TIPPS rule to shift the program structure in SFY 2026 to provide that Component Two will be paid to physician groups based on a pay-for-performance model using achievement of quality measures and paid through a scorecard. Health Related Institution (HRI) and Indirect Medical Education (IME) physician groups are eligible for Component Two payments.
HHSC amends the program rule to allow for the redistribution of Component Two funds if a physician group does not meet the performance requirements. Under this rule amendment, if a physician group does not meet the performance requirements for Component Two, the funds that are not earned by that physician group will be redistributed among other physician groups in the same Service Delivery Area (SDA) and class (HRI or IME), based on how much those physician groups have already earned for Component Two. If no physician group in the same SDA and class earned funds under Component 2, the funds will be distributed across all physician groups in that SDA, based on how much those physician groups have already earned for Component Two. If there are no physician groups in that SDA that earned Component Two funds, the unearned funds will be distributed across all HRI and IME physician groups participating in TIPPS, based on how much those physician groups have already earned for Component Two.
Multiple providers requested that HHSC amend the rule to allow the redistribution of unearned funds in the manner set forth in the amendment.
COMMENTS
The 21-day comment period ended on December 6, 2024.
During this period, HHSC did not receive any comments regarding this proposed rule.
STATUTORY AUTHORITY
The adoption of the amendment is authorized by 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 provides the Executive Commissioner 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 and to administer federal Medicaid funds in Texas; 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 Medicaid payments; and 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 February 7, 2025.
TRD-202500450
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 27, 2025
Proposal publication date: November 15, 2024
For further information, please call: (737) 230-0550
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 33. ADVANCED TELECOMMUNICATIONS SERVICES
The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §354.1430, concerning Definitions, and §354.1434, concerning Home Telemonitoring Benefits and Limitations.
The amendment to §354.1430 is adopted with changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8509). This rule will be republished.
The amendment to §354.1434 is adopted without changes to the proposed text as published in the October 25, 2024, issue of the Texas Register (49 TexReg 8509) and will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments implement Texas Government Code §531.001(4-a) and §531.02164, amended by House Bill 2727, 88th Legislature, Regular Session, 2023.
To implement Texas Government Code §531.02164, the amendments add federally qualified health centers and rural health clinics as Medicaid providers of home telemonitoring services. To implement Texas Government Code §531.001(4-a), the amendment to §354.1430 clarifies the term "home telemonitoring services" is synonymous with "remote patient monitoring." Texas Government Code §531.02164(c)(5) requires home telemonitoring providers to establish a plan of care with outcome measures for each recipient, and to share the plan and outcome measures with the recipient's physician. Texas Government Code §531.02164(2)(B) also reduces the eligibility criteria for the service from two or more risk factors to at least one risk factor.
COMMENTS
The 31-day comment period ended November 25, 2024.
During this period, HHSC received comments regarding the proposed rules from one commenter, the American Telemedicine Association Action. A summary of the comment relating to the rules and HHSC's response follows.
Comment: The commenter expressed support of the amendments to §354.1430 and §354.1434, noting that the amendments are a "rational step forward for telehealth policy in Texas." The commenter further noted their strong support for the change as it "eases access to high quality and affordable healthcare." The commenter also encourages reimbursement rates that are fair to providers and reflect the cost savings to the health care system using telehealth technologies.
Response: HHSC thanks the commenter for the letter of support and acknowledges the recommendation regarding reimbursement. HHSC did not make any changes to the rules as a result of these comments.
HHSC updated a reference to the Texas Government Code in §354.1430(9) from §531.001(4-d) to §521.0001. The update implements H.B. 4611, 88th Legislature, Regular Session, 2023, which makes non-substantive revisions to the Texas Government Code that make the statute more accessible, understandable, and usable.
STATUTORY AUTHORITY
The amendments are 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 requires the executive commissioner of HHSC to adopt rules necessary to carry out the commission's duties under Chapter 531; Texas Human Resources Code §32.021(c), which requires the executive commissioner to adopt rules necessary for the proper and efficient operation of the medical assistance program; and Texas Government Code §531.02164(b), which requires the executive commissioner to adopt rules for the provision and reimbursement of home telemonitoring services under Medicaid as provided under §531.02164.
§354.1430.Definitions.
The following words and terms, when used in this division, have the following meanings unless the context clearly indicates otherwise.
(1) Audio-only--An interactive, two-way audio communication that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act. Audio-only includes the use of telephonic communication.
(2) Behavioral health services--This term includes mental health and substance use disorder services.
(3) Declaration of state of disaster--An executive order or proclamation by the governor declaring a state of disaster in accordance with Texas Government Code §418.014.
(4) Federally qualified health center--This term has the meaning assigned by Texas Government Code §531.02164.
(5) Home telemonitoring service--This term has the meaning assigned by Texas Government Code §531.001 and is synonymous with "remote patient monitoring."
(6) Hospital--This term has the meaning assigned by Texas Government Code §531.02164.
(7) In-Person--Within the physical presence of another person. In-person does not include interacting with a client via a telemedicine medical service or a telehealth service.
(8) Non-behavioral health service--Any health service that is not a behavioral health service.
(9) Platform--This term has the meaning assigned by Texas Government Code §521.0001.
(10) Rural health clinic--This term has the meaning assigned by Texas Government Code §531.02164.
(11) Telehealth service--This term has the meaning assigned by Texas Occupations Code §111.001.
(12) Telemedicine medical service--This term has the meaning assigned by Texas Occupations Code §111.001.
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 7, 2025.
TRD-202500449
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 27, 2025
Proposal publication date: October 25, 2024
For further information, please call: (512) 438-2910