PART 8. TEXAS JUDICIAL COUNCIL
CHAPTER 171. REPORTING REQUIREMENTS
The Texas Judicial Council (Council) adopts amendments to 1 Texas Administrative Code §171.9, concerning judicial statistics, and new §171.11 regarding the new performance measures reporting requirements for the Office of Court Administration (OCA). The amendments to §171.9 and new §171.11 are adopted without changes to the proposed text as published in the November 24, 2023, issue of the Texas Register (48 TexReg 6811). These rules will not be republished.
The adopted rules comply with the requirements of HB 1182 and HB 2384, enacted during the 88th Regular Session of the Texas Legislature (2023). HB 1182 requires that the Council gather monthly court activity statistics and case-level information on the amount and character of business transacted by each trial court in the state. For trial courts with counties with a population of at least one million, the Council must gather information including, but not limited to: (1) the number of cases assigned to the court; (2) the case clearance rate for the court; (3) the number of cases disposed of by the court; (4) the number of jury panels empaneled by the court; (5) the number of orders of continuance for an attorney before the court or by the court; (6) the number of pleas accepted by the court; (7) the number of cases tried by the judge of the court or before a jury; and (8) the number of cases tried before a visiting or associate judge of the court. The trial courts must provide the information in the form and manner prescribed by OCA, and OCA must publish the information for each court on OCA's website in a searchable format. For counties in excess of a population of one million, the court official for each court in the county must submit, to the appropriate county official, a copy of each required monthly report for publication on the county's public Internet website within a certain prescribed timeframe and in searchable format. HB 2384 requires that OCA annually report, as performance measures, the following information with respect to each district court, statutory county court, statutory probate court, and county court in Texas: (1) the court's clearance rate; (2) the average time a case is before the court from filing to disposition; and (3) the age of the court's active pending caseload.
Pursuant to §2001.029 of the Texas Government Code, the Council gave all interested persons a reasonable opportunity to provide oral and/or written commentary concerning the adoption of these rules.
The comments received from seven clerks did not address the proposed rules but were questions about general implementation issues or about the proposed forms and instructions.
Four clerks asked whether the reporting requirements are in addition to reporting requirements the Council now requires. The Council responds that the new reporting requirements are in addition to existing reporting requirements in Chapter 171 of its administrative rules.
One clerk asked whether the new reports will be generated through their case management system, Local Government Solutions (LGS). The clerk asked whether LGS is aware of the changes or if the clerk's office must notify LGS. The Council responds that OCA has met with and notified case management system vendors in writing about the new reporting requirements and has provided them with reporting templates and reporting instructions. OCA also encourages counties to work with their vendors to ensure successful implementation.
One clerk asked if OCA is creating a new form for the annual performance measure reporting and whether OCA is working with case management system vendors to add the available reports. The Council responds that this is a new report that will collect court level data and will be submitted once a year. The submission method will be an Excel spreadsheet that must be emailed to OCA. OCA has met with and notified case management system vendors in writing about the new reporting requirements and has provided them with reporting templates and reporting instructions. OCA also encourages counties to work with their vendors to ensure successful implementation.
In reference to OCA's instructions for reporting requirements for counties with a population of one million and over concerning the number of cases tried before a visiting judge on long-term assignment, one judge asked how the activity of specialty courts and specialty dockets staffed by visiting judges should be reported. The Council responds that the data element in question captures information only on bench or jury trials held by a visiting judge working on cases for a specific district or county court. It does not capture any activity associated with specialty courts or dockets other than a trial. If a trial is held by the visiting judge and the case is associated with a specific district or county court, the trial would be reported for that district or county court. If a trial is held by the visiting judge and the case is not associated with a specific district or county court, the trial would not be reported.
One county's information technology employee asked about the process of facilitating implementation by Tyler Technologies and how counties will be able to ensure that their specific situations and needs are addressed to make implementation successful. The employee also asked whether each reporting rule will require a separate report. The Council responds that OCA has met with and notified case management system vendors in writing about the new reporting requirements and has provided them with reporting templates and reporting instructions. OCA also encourages counties to work with their vendors to ensure successful implementation. Because each rule requires different reporting requirements, separate reports are necessary.
The Council received a comment from a Criminal Manager for a district clerk's office concerning the definition of "disposition" with respect to probate cases. In the instructions prepared as a reference for the additional monthly reporting requirements under §171.9 for counties one million and over in population, OCA states that the dispositions to be reported for probate cases are those cases that were disposed of or in which a judgment or order was entered and states each order or judgment entered is counted as a disposition for each case or subsequent action filed. The instructions provide a link to an Excel file that lists different probate case subcategories and case types and provides more detailed information regarding when a case may be counted as a disposition.
The proposed rules are adopted pursuant to: (1) Texas Government Code § 71.019, the Council's general rulemaking authority; (2) section 71.031 of the Government Code, the Council's authority to study the procedures and practices, work accomplished, and results of state courts and methods for their improvement; (3) the Council's authority under Texas Government Code § 71.033 to design methods for simplifying judicial procedure, expediting the transaction of judicial business, and correcting faults in or improving the administration of justice; and (4) Texas Government Code § 71.035, the Council's authority to gather judicial statistics. The adopted rules implement the changes to Texas Government Code § 71.035 by HB 1182 and to Texas Government Code § 72.083 by HB 2384.
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 9, 2024.
TRD-202400510
Maria Elena Ramon
General Counsel
Texas Judicial Council
Effective date: February 29, 2024
Proposal publication date: November 24, 2023
For further information, please call: (512) 936-7553
CHAPTER 353. MEDICAID MANAGED CARE
SUBCHAPTER E. STANDARDS FOR MEDICAID MANAGED CARE
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) adopts new §353.425, concerning MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation, and new §353.427, concerning Accessibility of Information Regarding Medicaid Prior Authorization Requirements.
Section 353.425 is adopted with changes to the proposed text as published in the September 8, 2023, issue of the Texas Register (48 TexReg 4948). The rule will be republished.
Section 353.427 is adopted without changes to the proposed text as published in the September 8, 2023, issue of the Texas Register (48 TexReg 4948). The rule will not be republished.
BACKGROUND AND JUSTIFICATION
New §353.425 and §353.427 are necessary to comply with Texas Government Code §533.00282, §533.00284, §533.002841, and §531.024163 as added by Senate Bill 1207, 86th Legislature, Regular Session, 2019, which require HHSC to establish a uniform process and timeline for a prior authorization (PA) request submitted with incomplete or insufficient information or documentation and require Medicaid managed care organizations (MCOs) to improve website accessibility of information related to PA requirements.
COMMENTS
The 31-day comment period ended October 9, 2023.
During this period, HHSC received comments regarding the proposed rules from six commenters, including the American Clinical Laboratory Association, Driscoll Health Plan, Myriad Genetics, Texas Association of Health Plans, Texas Council of Community Centers, and Texas Rare Alliance. A summary of comments relating to the rules and HHSC's responses follows.
Comment: One commenter requested an amendment to new §353.425(c) regarding the reference to MCO compliance with Texas Insurance Code (TIC) Chapter 4201. The commenter noted that the authorizing legislation amends the Texas Government Code and does not amend the TIC. The commenter stated that TIC Chapter 4201 varies in applicability to Medicaid MCOs; therefore, HHSC should use the qualification "as applicable" or remove the reference to the TIC.
Response: HHSC agrees with the commenter that the authorizing statute requires HHSC to implement Texas Government Code §533.00282, §533.00284, §533.002841, and §531.024163. In response to this comment, HHSC revised §353.425(c) to remove the reference to Texas Insurance Code Chapter 4201.
Comment: Several commenters requested clarity as to whether the three-day deadline for an MCO to make a final determination in new §353.425(d)(4) is business days or calendar days.
Response: HHSC agrees with the commenters' request for clarity and amended new §353.425(d)(4) to specify that the deadline is three business days.
Comment: One commenter requested an amendment to new §353.425(d) to require an MCO to notify the requesting provider and member when the MCO has received documentation that completes the missing information and require the MCO to give the provider and member a timeline for the MCO's decision.
Response: HHSC declines to revise the rule in response to this comment. Section 353.425(d) already prescribes a timeline for the provider and member to produce missing documentation and prescribes a timeline for the MCO to respond with the MCO's final determination. The rule does not preclude an MCO from notifying the provider and member when missing documentation is received.
Comment: Several commenters requested HHSC amend new §353.425 to extend the number of business days for a provider to produce the incomplete information requested by an MCO to fulfill the MCO's PA documentation requirements.
Response: HHSC declines to revise the rule in response to this comment. Texas Government Code §533.002841 states that the combined timeframe for a PA determination may not exceed the timeframe for a decision under federally-prescribed timeframes, which is a maximum of 14 calendar days. HHSC carefully considered the allocation of days for each activity to stay within the 14 calendar days.
Comment: Multiple commenters requested that new §353.425 be amended to include an "ordering physician" and "requesting entity" as parties required to be notified by an MCO when a PA request is received with incomplete or insufficient documentation.
Response: HHSC declines to revise the rule in response to this comment. The statutory requirements apply to a requesting provider. However, the rule does not prevent an MCO from notifying the ordering physician or requesting entity in addition to the requesting provider.
Comment: Several commenters shared positive feedback on new §353.427, stating that transparency regarding MCO requirements for documentation will facilitate providers' understanding of which items or services need PA and what documentation must be provided.
Response: HHSC appreciates the commenters' support for the rule.
Comment: One commenter requested that §353.427 be amended to require an MCO's website to include the process and contact information for a provider or member to contact the MCO to appeal a determination on a PA request and file a complaint on a PA determination.
Response: HHSC declines to revise the rule in response to this comment because this information is already available online. The Code of Federal Regulations (CFR) Title 42 §438.10(g)(2)(XI) requires the member handbook to include information about the process to appeal a determination or file a complaint. 42 CFR §438.10(g)(1) requires an MCO to make the handbook available to each enrollee, which may include print or electronic posting. 42 CFR §438.10(c) requires the state to operate a website that includes this information, either directly or by linking to an MCO's website.
Comment: One commenter asked for clarification on whether §353.427(c)(1)(B) requires an MCO to post a copy of the template used for an MCO's notice.
Response: Section 353.427(c)(1)(B) requires an MCO's website to maintain a description of the notice the MCO provides to a provider or member regarding the documentation required to complete a PA determination. This rule does not require an MCO to post the template for the notice. However, the rule does not prevent an MCO from posting the template. HHSC declines to revise the rule in response to this comment.
Comment: One commenter conveyed concerns that PA requests create an administrative burden for patients and caregivers and delay access to care. The commenter noted that transparency about additional MCO requirements for patients would be helpful.
Response: HHSC agrees with the commenter that greater transparency about an MCO's PA documentation requirements will benefit the public by reducing PA requests denied solely because of incomplete information. However, HHSC declines to revise the rules in response to this comment because PA reviews play an important role in confirming service requests are up to date with standards of care, meet the member's needs, and are medically necessary.
STATUTORY AUTHORITY
The new sections 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 Texas Human Resources Code §32.021(a) and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas. The new sections are also authorized by Texas Government Code §533.00282, §533.00284, §533.002841 and §531.024163.
§353.425.MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation.
(a) The rules in this section apply when a prior authorization (PA) request is submitted with incomplete or insufficient information or documentation on behalf of a member who is not hospitalized at the time of the request.
(b) In this section, "incomplete PA request" means a request for service that is missing information or documentation necessary to establish medical necessity as listed in the PA requirements on the managed care organization's (MCO's) website.
(c) An MCO must comply with Title 42 Code of Federal Regulations §438.210, applicable provisions of Texas Government Code Chapter 533, and the PA process and timeline requirements included in an MCO's contract with the Texas Health and Human Services Commission (HHSC).
(d) If an MCO or an entity reviewing a request on behalf of an MCO receives a PA request with incomplete or insufficient information or documentation, the MCO or reviewing entity must comply with the following HHSC requirements.
(1) An MCO reviewing the request must notify the requesting provider and the member, in writing, of the missing information no later than three business days after the MCO receives an incomplete PA request.
(2) If an MCO does not receive the information requested within three business days after the MCO notifies the requesting provider and the PA request will result in an adverse benefit determination, the MCO must refer the PA request to the MCO medical director for review.
(3) The MCO must offer to the requesting physician an opportunity for a peer-to-peer consultation with a physician no less than one business day before the MCO issues an adverse benefit determination.
(4) The MCO must make a final determination as expeditiously as the member's condition requires but no later than three business days after the date the missing information is provided to an MCO.
(e) The HHSC requirements for MCO reconsideration of an incomplete PA request do not affect any related timeline for:
(1) an MCO's internal appeal process;
(2) a Medicaid state fair hearing;
(3) a review conducted by an external medical reviewer; or
(4) any rights of a member to appeal a determination on a PA request.
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 8, 2024.
TRD-202400505
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 28, 2024
Proposal publication date: September 8, 2023
For further information, please call: (512) 438-4395