PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 18. MATERNITY CLINIC SERVICES
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §354.1271, concerning Benefits and Limitations.
The amendment to §354.1271 is adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 611). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The amendment complies with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children's Health Insurance Program (CHIP).
COMMENTS
The 31-day comment period ended March 11, 2024.
During this period, HHSC did not receive any comments regarding the proposed rule.
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 provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021(c), which provides HHSC with the authority to administer the federal medical assistance program in Texas and to establish methods of administration and adopt necessary rules for the proper and efficient operation of the medical assistance 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 May 13, 2024.
TRD-202402123
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621
The Texas Health and Human Services Commission (HHSC) adopts amendments to §366.303, concerning Definitions, §366.325, concerning Medical Eligibility Effective Dates, §366.827, concerning Medicaid Eligibility Effective Dates, §366.1011, concerning Eligible Group, §366.1025, concerning Medicaid Eligibility Effective Dates, and §366.1031, concerning Eligibility Renewal.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 613). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children's Health Insurance Program (CHIP).
COMMENTS
The 31-day comment period ended March 11, 2024.
During this period, HHSC received a comment regarding the proposed rules from one commenter, the Texas Medical Association. A summary of the comment relating to the rules and HHSC's response follows.
Comment: Regarding §366.303, the commenter has concerns about the requirement that prohibits a postpartum mother from being eligible to receive continuous eligibility for the remainder of the 12-month postpartum period when the individual voluntarily disenrolls from Medicaid or CHIP. The commenter's concern is that the prohibition is contrary to the bill's stated legislative purpose of "extending coverage" and that "the inability to re-enroll could lead to unduly harsh results." The commenter recommended that HHSC amend the rules to allow postpartum mothers who voluntarily disenroll from Medicaid or CHIP to be able to reenroll within the 12-month postpartum period.
Response: HHSC respectfully declines to make the suggested change. Federal regulations and guidance require the continuous eligibility during pregnancy and the extended postpartum period to end if the individual voluntarily withdraws. In accordance with Section 1902(e)(16) of the Social Security Act, if the individual is certified and enrolled in CHIP during their pregnancy and then voluntarily withdraws from CHIP during their postpartum period, the individual would not be eligible to receive continuous eligibility in Medicaid because the individual did not receive Medicaid while pregnant. However, the individual can re-apply for Medicaid or CHIP coverage, at which time HHSC would be required to make a new determination of eligibility in accordance with state and federal law. The continuous eligibility the individual previously received prior to voluntarily withdrawing would no longer apply.
SUBCHAPTER C. PREGNANT WOMEN'S MEDICAID
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 provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021(c), which provides HHSC with the authority to administer the federal medical assistance program in Texas and to establish methods of administration and adopt necessary rules for the proper and efficient operation of the medical assistance 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 May 13, 2024.
TRD-202402125
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621
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 provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021(c), which provides HHSC with the authority to administer the federal medical assistance program in Texas and to establish methods of administration and adopt necessary rules for the proper and efficient operation of the medical assistance 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 May 13, 2024.
TRD-202402126
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621
1 TAC §§366.1011, 366.1025, 366.1031
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 provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021(c), which provides HHSC with the authority to administer the federal medical assistance program in Texas and to establish methods of administration and adopt necessary rules for the proper and efficient operation of the medical assistance 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 May 13, 2024.
TRD-202402124
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621
The Texas Health and Human Services Commission (HHSC) adopts amendments to §370.42, concerning Age Limits, §370.49, concerning Pregnant CHIP Members, §370.60, concerning Renewal, and §370.307, concerning Continuous Enrollment Period.
The amendments are adopted without changes to the proposed text as published in the February 9, 2024, issue of the Texas Register (49 TexReg 616). These rules will not be republished.
BACKGROUND AND JUSTIFICATION
The amendments comply with House Bill (H.B.) 12, 88th Texas Legislature, Regular Session, 2023, which requires HHSC to provide 12 months of postpartum Medicaid coverage to all women receiving Medicaid at the time their pregnancy ends in accordance with Section 1902(e)(16) of the Social Security Act, which is a state option. If the option is elected under Medicaid, states are required to provide the same 12-month postpartum coverage to targeted low-income pregnant members in the Children's Health Insurance Program (CHIP).
COMMENTS
The 31-day comment period ended March 11, 2024.
During this period, HHSC received a comment regarding the proposed rules from one commenter, the Texas Medical Association. A summary of the comment relating to the rules and HHSC's response follows.
Comment: Regarding §370.49, the commenter has concerns about the requirement that prohibits a postpartum mother from being eligible to receive continuous eligibility for the remainder of the 12-month postpartum period when the individual voluntarily disenrolls from Medicaid or CHIP. The commenter's concern is that the prohibition is contrary to the bill's stated legislative purpose of "extending coverage" and that "the inability to re-enroll could lead to unduly harsh results." The commenter recommended that HHSC amend the rules to allow postpartum mothers who voluntarily disenroll from Medicaid or CHIP to be able to reenroll within the 12-month postpartum period.
Response: HHSC respectfully declines to make the suggested change. Federal regulations and guidance require the continuous eligibility during pregnancy and the extended postpartum period to end if the individual voluntarily withdraws. In accordance with Section 1902(e)(16) of the Social Security Act, if the individual is certified and enrolled in CHIP during their pregnancy and then voluntarily withdraws from CHIP during their postpartum period, the individual would not be eligible to receive continuous eligibility in Medicaid because the individual did not receive Medicaid while pregnant. However, the individual can re-apply for Medicaid or CHIP coverage, at which time HHSC would be required to make a new determination of eligibility in accordance with state and federal law. The continuous eligibility the individual previously received prior to voluntarily withdrawing would no longer apply.
SUBCHAPTER B. APPLICATION SCREENING, REFERRAL, PROCESSING, RENEWAL, AND DISENROLLMENT
DIVISION 4. ELIGIBILITY CRITERIA
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 Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Health and Safety Code Chapters 62 and 63, which provide HHSC with the authority to administer CHIP in Texas and adopt rules as necessary to implement the chapters.
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 May 13, 2024.
TRD-202402127
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621
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, and Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Health and Safety Code Chapters 62 and 63, which provide HHSC with the authority to administer CHIP in Texas and adopt rules as necessary to implement the chapters.
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 May 13, 2024.
TRD-202402128
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621
DIVISION 1. ENROLLMENT AND DISENROLLMENT
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, and Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Health and Safety Code Chapters 62 and 63, which provide HHSC with the authority to administer CHIP in Texas and adopt rules as necessary to implement the chapters.
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 May 13, 2024.
TRD-202402129
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: June 2, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 206-4621