PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 33. ADVANCED TELECOMMUNICATIONS SERVICES
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §354.1430, concerning Definitions, and §354.1434, concerning Home Telemonitoring Benefits and Limitations.
BACKGROUND AND PURPOSE
The purpose of the proposal is to implement Texas Government Code §531.001(4-a) and §531.02164, amended by House Bill (H.B.) 2727, 88th Legislature, Regular Session, 2023.
Texas Government Code §531.02164 adds federally qualified health centers (FQHCs) and rural health clinics (RHCs) as Medicaid providers of home telemonitoring services. Texas Government Code §531.001(4-a) 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.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §354.1430, Definitions, adds a new definition for the term "Federally qualified health center" in paragraph (4), "Home telemonitoring service" in paragraph (5), "hospital" in paragraph (6), and "Rural health clinic" in paragraph (10). As part of the "Home telemonitoring service" definition in paragraph (4), the proposed language clarifies that the term is synonymous with "remote patient monitoring". The proposed amendment renumbers the paragraphs because of the addition of the new terms.
The proposed amendment to §354.1434, Home Telemonitoring Benefits and Limitations, in subsection (b), adds a FQHC and RHC as providers of home telemonitoring services. The proposed amendment adds a new paragraph (4) in subsection (c) to require home telemonitoring providers to establish a plan of care with outcome measures for each recipient and, in new paragraph (5), to share the plan of care with the recipient's physician. The proposed amendment in subsection (d)(1), in the eligibility criteria for recipients, replaces "feasible" with" clinically effective". This change is needed to be consistent with the language used in Texas Government Code §531.02164(c)(1). The proposed amendment in subsection (d)(2) replaces "two or more" with "at least one." This change to reduce the home telemonitoring services eligibility criteria for recipients from two or more risk factors to at least one risk factor implements the requirement in Texas Government Code §531.02164(c)(2)(B). The proposed amendment in subsection (d)(2)(D) changes a risk factor to "a documented risk of falls" by removing "in the prior six month period; and removes the risk factor in (d)(2)(E) of "limited or absent informal support systems" and in (d)(2)(F) of "living alone or being home alone for extended periods of time". These changes are needed to implement the requirements in Texas Government Code §531.02164(c)(2)(B). The proposed amendment removes subsection (e) relating to reimbursement and replaces it with a new subsection (g). This change is made to better organize the rule within the section and to improve the readability of the rule. The proposed amendment adds a new subsection (f) to set forth that HHSC may discontinue home telemonitoring services for a condition, if after implementation, HHSC determines the provision and reimbursement of services are not cost-effective and clinically effective for that condition. The proposed amendment makes a minor editing change in subsection (c), changing "service" to "services;" changes "patient's" to "recipient's" and "clients" to "recipients" as needed; updates the numbering of the paragraphs within subsections (c) and (d); removes "only" from subsection (d); and renumbers subsection (f) as subsection (e).
FISCAL NOTE
Trey Wood, HHSC Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, there will be an estimated additional cost to state government as a result of enforcing and administering the rules as proposed.
The effect on state government for each year of the first five years the proposed rules are in effect is an estimated cost of $238,802 for all funds in fiscal year (FY) 2025, $236,270 in FY 2026, $233,766 in FY 2027, $231,288 in FY 2028, and $228,836 in FY 2029.
Enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of local government.
GOVERNMENT GROWTH IMPACT STATEMENT
HHSC has determined that during the first five years that the rules will be in effect:
(1) the proposed rules 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 rules will require an increase in future legislative appropriations;
(4) the proposed rules will not affect fees paid to HHSC;
(5) the proposed rules will not create a new regulation;
(6) the proposed rules will expand existing regulations;
(7) the proposed rules will increase the number of individuals subject to the rules; and
(8) HHSC has insufficient information to determine the proposed rules' effect on 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, microbusinesses, or rural communities because participation in providing home telemonitoring services described in the proposed rule is optional.
LOCAL EMPLOYMENT IMPACT
The proposed rules will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does not apply to these rules because the rules do not impose a cost on regulated persons and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules.
PUBLIC BENEFIT AND COSTS
Emily Zalkovsky, State Medicaid Director, has determined that for each year of the first five years the rules are in effect, the public benefit will be increased access to home telemonitoring services for eligible Medicaid recipients through federally qualified health centers and rural health clinics.
Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the provision of home telemonitoring services by providers is optional.
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 701 W. 51st 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 24R039" in the subject line.
STATUTORY AUTHORITY
The amendments are 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 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) requires the executive commissioner to adopt rules for the provision and reimbursement of home telemonitoring services under Medicaid as provided under Section 531.02164.
The amendments affect Texas Government Code §§531.0055, 531.001, and 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) [(4)] 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) [(5)] Non-behavioral health
service--Any health service that is not a behavioral health service.
(9) [(6)] Platform--This term
has the meaning assigned by Texas Government Code §531.001(4-d).
(10) Rural health clinic--This term has the meaning assigned by Texas Government Code §531.02164.
(11) [(7)] Telehealth service--This
term has the meaning assigned by Texas Occupations Code §111.001.
(12) [(8)] Telemedicine medical
service--This term has the meaning assigned by Texas Occupations Code §111.001.
§354.1434.Home Telemonitoring Benefits and Limitations.
(a) Home telemonitoring services are a benefit of the Texas Medicaid Program as provided in this section and are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.
(b) Home telemonitoring services require scheduled
remote monitoring of data related to a recipient's [patient's
] health and transmission of the data to a licensed home health
agency, federally qualified health center, rural health clinic, or
[a] hospital[, as those terms are defined by Texas
Government Code §531.02164(a)].
(c) Home telemonitoring services [service]
providers must:
(1) comply with all applicable federal, state, and local laws and regulations;
(2) be enrolled and approved for participation in the Texas Medicaid Program as home telemonitoring service providers;
(3) bill for services covered under the Texas Medicaid Program in the manner and format prescribed by HHSC;
(4) establish a plan of care that includes outcome measures for each recipient who receives home telemonitoring services;
(5) share the plan of care with the recipient's physician;
(6) [(4)] share clinical information
gathered while providing home telemonitoring services with the recipient's
[patient's] physician; and
(7) [(5)] not duplicate disease
management program services provided under Human Resources Code §32.057
and further described in Division 32 of this subchapter (relating
to Texas Medicaid Wellness Program).
(d) Home telemonitoring services are available [only]
to Texas Medicaid recipients [clients] who:
(1) are diagnosed with diabetes, hypertension, or any
other conditions allowed by Texas Government Code §531.02164
and determined by HHSC to be cost effective and clinically effective
[feasible]; and
(2) exhibit at least one [two or more]
of the following risk factors:
(A) two or more hospitalizations in the prior 12-month period;
(B) frequent or recurrent emergency room admissions;
(C) a documented history of poor adherence to ordered medication regimens;
(D) a documented risk [history]
of falls [in the prior six-month period]; and
[(E) limited or absent informal support systems;]
[(F) living alone or being home alone for extended periods of time; and]
(E) [(G)] a documented history
of care access challenges.
[(e) Home telemonitoring services
are reimbursed in accordance with Chapter 355 of this title (relating
to Reimbursement Rates).]
(e) [(f)] Home telemonitoring
services are available to Texas Medicaid recipients [clients
] who are 20 years of age and younger, with one or more of the
following conditions:
(1) end-stage solid organ disease;
(2) organ transplant recipient; or
(3) requiring mechanical ventilation.
(f) Home telemonitoring services may be discontinued for a condition, if after implementation, HHSC determines the provision and reimbursement of services are not cost-effective and clinically effective for that condition.
(g) HHSC reimburses home telemonitoring services providers in accordance with Chapter 355 of this title (relating to Reimbursement Rates).
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 October 9, 2024.
TRD-202404805
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: November 24, 2024
For further information, please call: (512) 438-4651
SUBCHAPTER B. PRESCRIBED PEDIATRIC EXTENDED CARE CENTER SERVICES
1 TAC §§363.203, 363.205, 363.207, 363.209, 363.211 - 363.213, 363.215
The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §363.203, concerning Definitions; §363.205, concerning Provider Participation Requirements; §363.207, concerning Participant Eligibility Criteria; §363.209, concerning Benefits and Limitations; §363.211, concerning Service Authorization; §363.213, concerning Ordering Physician Responsibilities; §363.215, concerning Termination, Reduction, or Denial of Authorization for Prescribed Pediatric Extended Care Center Services; and new §363.212, concerning Documentation Requirements for Services Other than Transportation Services.
BACKGROUND AND PURPOSE
The purpose of the proposal is to implement Texas Health and Safety Code, §248A.1015, §248A.158, and §248A.159, and Texas Human Resources Code, §32.0287, added or amended by House Bill (H.B.) 3550, 88th Legislature, Regular Session, 2023. H.B. 3550 requires rules establishing minimum standards for transportation services for individuals served by Prescribed Pediatric Extended Care Centers (PPECCs). H.B. 3550 also requires rules for the reimbursement of services provided by PPECCs under Medicaid to clearly identify the documentation that PPECCs must obtain and maintain for reimbursement.
The proposed rules establish minimum standards for transportation services when transporting participants to a PPECC by requiring a center to coordinate the schedule of transportation services with the participant's responsible adult, as defined in the rules; determining what type of provider needs to be present during transportation; and allowing the participant's responsible adult to decline a center's transportation services entirely or on a specific date.
The proposed rules remove the requirement that the plan of care and the physician's order document a participant's need for transportation services as nursing services in a participant's plan of care.
The proposed rules update guidelines allowing participants who are eligible to receive authorized continuous skilled nursing service hours for private duty nursing (PDN) services, PPECC services, or a combination of both services with certain limitations. The proposed rules clarify that PPECC services must be a replacement of other skilled nursing services provided in a setting other than a PPECC unless additional nursing services are medically necessary.
The proposed rules establish and outline documentation requirements for admission to a PPECC and for non-transportation PPECC services for reimbursement eligibility. The proposed rules require a PPECC to include the documentation of PPECC services provided to a participant in the participant's medical record.
SECTION-BY-SECTION SUMMARY
The proposed amendment to §363.203 adds a definition for "direct care staff" and amends the definitions of "Licensed Vocational Nurse (LVN)", "Registered Nurse (RN)", and "stable". The proposed amendment also revises certain definitions to correct spelling, allow use of an acronym for a term, and make other minor corrections.
The proposed amendment to §363.205 corrects the use of acronyms and updates the reference to the current Texas Administrative Code (TAC) to the Licensing Standards for Prescribed Pediatric Extended Care Centers.
The proposed amendment to §363.207 provides for a participant's ordering physician to waive the in-person examination of the participant required in subsection (a)(6) of the rule as long as the conditions described in the proposed rule are met. The proposed amendment replaces the criteria for a participant to be "stable and eligible for outpatient medical services" with "the participant meets the criteria in 26 TAC §550.601", the admission criteria in the licensing standards. The proposed amendment revises the participant eligibility criteria to improve the readability, makes minor edits, and renumbers subsections of the rule.
The proposed amendment to §363.209 updates provisions and transportation requirements for transporting a participant to a PPECC; clarifies staffing determinations on the transport vehicle; and outlines documentation requirements regarding transportation services. The proposed amendment adds that a participant who is eligible to receive PDN services may also receive PPECC services. The proposed amendment adds that a participant may choose to receive all authorized continuous skilled nursing services through PPECC only, PDN only, or a combination of both PPECC and PDN services with certain limitations. The proposed amendment adds that PDN, home health skilled nursing, home health aide services, and personal care services may be billed on the same day as PPECC services but may not be billed simultaneously with PPECC services.
The proposed amendment to §363.211 makes editorial changes to clarify the service authorization process for PPECC services; clarifies in subsection (d) of the rule that "days" means "calendar days;" spells out "managed care organization;" makes a correction in subsection (l) of the rule by adding "termination;" clarifies a comprehensive nursing assessment is required no later than the day the participant is admitted to the center; and clarifies a revised nursing assessment is required when there are changes in the participant's medical condition that impact the amount or duration of services.
Proposed new §363.212 outlines the documentation requirements a PPECC must obtain and maintain in the participant's medical record to be eligible for reimbursement of non-transportation PPECC services. The proposed rule includes that HHSC may request documentation from the PPECC to substantiate the provision of services and may recoup payment if services are not substantiated as outlined in the rule.
The proposed amendment to §363.213 adds responsibilities and flexibilities for the ordering physician including examination of the participant when prescribing PPECC services and written requirements to ensure safe transport.
The proposed amendment to §363.215 makes editorial changes to adhere to HHS rulemaking guidelines; makes corrections in subsection (b) of the rule to add "terminate" or "termination" where needed; and clarifies in subsection (b)(3) of the rule that "days" means "calendar days."
FISCAL NOTE
Trey Wood, HHSC Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules 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 rules will be in effect:
(1) the proposed rules will not create or eliminate a government program;
(2) implementation of the proposed rules will not affect the number of HHS system employee positions;
(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;
(4) the proposed rules will not affect fees paid to the agency;
(5) the proposed rules will create new regulations;
(6) the proposed rules will expand existing regulations;
(7) the proposed rules will not change the number of individuals subject to the rules; and
(8) HHSC has insufficient information to determine the proposed rule's effect on the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS
Trey Wood has also determined that there could be an adverse economic effect on small businesses, micro-businesses, or rural communities due to cost to comply.
Currently, there are 10 PPECCs in the State of Texas. However, HHSC lacks data and is unable to determine how many PPECCS are small businesses, microbusinesses, or rural communities. HHSC is proposing this rule in response to prescriptive legislation and has no regulatory flexibility about its proposal.
LOCAL EMPLOYMENT IMPACT
The proposed rules will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code §2001.0045 does apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas and to implement legislation that does not specifically state that §2001.0045 applies to the rules.
PUBLIC BENEFIT AND COSTS
Emily Zalkovsky, State Medicaid Director, has determined that for each year of the first five years the rules are in effect, the proposal will benefit PPECC providers, Medicaid participants, and their families by reducing the provider administrative burden and increasing access to care.
Trey Wood has also determined that for the first five years the rules are in effect, persons who are required to comply with the proposed rules may incur economic costs because PPECC providers will be required to coordinate transportation schedules, maintain transportation logs, and ensure that providers are on the transportation vehicle when transporting participants to and from the PPECC. The total costs cannot be estimated because HHSC lacks the data needed to estimate the costs and savings to be experienced.
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 701 W. 51st 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 24R036 in the subject line.
STATUTORY AUTHORITY
The amendments and new section are 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 of HHSC with broad rulemaking authority; Texas Human Resources Code §32.021, which provides HHSC with the authority to administer the federal medical assistance program in Texas and to adopt rules and standards for program administration; and Texas Health & Safety Code §248A.1015, which provides that the Executive Commissioner shall by rule establish minimum standards for transportation services, including reimbursement, by Prescribed Pediatric Extended Care Centers (PPECCs).
The amendments and new section implement Texas Health & Safety Code §248A.1015, §248A.158, and §248A.159, and Texas Human Resources Code, §32.0287.
§363.203.Definitions.
The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.
(1) Activities of daily living (ADLs)--Activities that include eating, toileting, personal hygiene, dressing, bathing, transferring, positioning, and locomotion or mobility.
(2) Basic services--Basic services include:
(A) the development, implementation, and monitoring of a comprehensive protocol of care that:
(i) is provided to a medically dependent or technologically dependent participant;
(ii) is developed in conjunction with the participant's responsible adult; and
(iii) specifies the medical, nursing, psychosocial, therapeutic, and developmental services required by the participant; and
(B) the caregiver training needs of a medically dependent or technologically dependent participant's parent or responsible adult.
(3) Correct or ameliorate--To improve, maintain, or slow the deterioration of the participant's health status.
(4) Direct care staff--An employee or contractor of a PPECC who:
(A) works under the supervision of a registered nurse;
(B) provides direct care to a participant; and
(C) meets the qualifications described in 26 TAC §550.409(a) (relating to Direct Care Staff Qualifications).
(5) [(4)] Fair hearing--The process
HHSC has adopted and implemented in Chapter 357, Subchapter A, of
this title (relating to Uniform Fair Hearing Rules) in compliance
with federal and state regulations governing Medicaid Fair Hearings.
(6) [(5)] HHSC--The Texas Health
and Human Services Commission or its designee, including a contractor
or MCO. HHSC is the single state agency charged with administration
and oversight of the Texas Medicaid program. HHSC's authority is established
in Texas Government Code Chapter 531.
(7) [(6)] Licensed vocational
nurse [Vocational Nurse] (LVN)--An employee
or contractor of a PPECC who is [A person] licensed
by the Texas Board of Nursing to practice vocational nursing in [Texas
at the time and place the service is provided, in] accordance
with Texas Occupations Code Chapter 301.
(8) [(7)] Medicaid managed
care organization [Managed Care Organization] (MCO)--Any
entity with which HHSC contracts to provide Medicaid services and
that complies with Chapter 353 of this title (relating to Medicaid
Managed Care).
(9) [(8)] Medically or technologically
dependent participant--
(A) An individual 20 years of age or younger:
(i) who has an acute or chronic medically complex or fragile condition or disability; and
(ii) whose condition or disability, as stated in clause (i) of this subparagraph, requires:
(I) ongoing skilled nursing care beyond the level of skilled nursing visits normally authorized under Texas Medicaid home health skilled nursing and home health aide services, prescribed by a physician to avert death or further disability; or
(II) the routine use of a medical device to compensate for a deficit in a life-sustaining bodily function.
(B) The term does not include a participant with a controlled or occasional medical condition that does not require ongoing nursing care.
(10) [(9)] Notice (or notification)--A
letter provided by HHSC or an MCO to a participant informing the participant
of any reduction, denial, or termination of a requested service, as
described in the Code of Federal Regulations, Title 42, §§431.206
and 431.210.
(11) [(10)] Ordering physician--A
doctor of medicine or doctor of osteopathy (M.D. or D.O.), legally
authorized to practice medicine or osteopathy [at the time and
place the service is provided,] who provides ongoing medical
care for the participant and continuing medical supervision of the
participant's plan of care.
(12) [(11)] Participant--An individual
who is eligible to receive PPECC services under the Texas
Health Steps Comprehensive Care Program [(THSteps-CCP)]
from a provider enrolled in the Texas Medicaid program.
(13) [(12)] Plan of care (POC)--A written comprehensive, interdisciplinary protocol of care that
includes the physician's order for needed services, nursing care plan,
and protocols establishing delegated tasks, plans to address functional
developmental needs, plans to address psychosocial needs, personal
care services for assistance with activities of daily living, and
therapeutic service needs required by a participant and family served.
(14) [(13)] PPECC [Prescribed
Pediatric Extended Care Center (PPECC)]--Prescribed Pediatric
Extended Care Center. A center operated on a for-profit or nonprofit
basis that provides non-residential basic services to four or more
medically dependent or technologically dependent participants who
require the services of the center and who are not related by blood,
marriage, or adoption to the owner or operator of the center.
(15) [(14)] Private Duty Nursing
(PDN)--Nursing, as described by Texas Occupations Code Chapter 301,
and its implementing regulations in [at] 22
TAC Part 11 (relating to the Texas Board of Nursing), that provides
a participant with more individual and ongoing care than is available
from a visiting nurse or than is routinely provided by the nursing
staff of a hospital or skilled nursing facility. PDN services include
observation, assessment, intervention, evaluation, rehabilitation,
care and counsel, or health teachings for a participant who has a
disability or chronic health condition or who is experiencing a change
in normal health processes.
(16) [(15)] Registered nurse [Nurse] (RN)--An employee or contractor of a PPECC [A person] who is licensed by the Texas Board of Nursing to practice
professional nursing in [Texas at the time and place the service
is provided, in] accordance with Texas Occupations Code Chapter 301.
(17) [(16)] Respite--Services
provided to relieve a participant's primary care giver.
(18) [(17)] Responsible adult--An
adult, as defined by Texas Family Code §101.003, who has agreed
to accept the responsibility for providing food, shelter, clothing,
education, nurturing, and supervision for a participant. Responsible
adults include biological parents, adoptive parents, foster parents,
guardians, court-appointed managing conservators, and other family
members by birth or marriage. If the participant is 18 years of age
or older, the responsible adult must be the participant's managing
conservator or legal guardian.
(19) [(18)] Skilled nursing--Services
provided by a registered nurse or by a licensed vocational nurse,
as authorized by Texas Occupations Code Chapter 301 and 22 TAC §217.11
(relating to Standards of Nursing Practice) and §217.12 (relating
to Unprofessional Conduct).
(20) [(19)] Stable--A status [Status] determined by a [the] participant's
ordering physician that the participant's health condition does not
prohibit utilizing transportation to access outpatient medical services
and does not present significant risk to other participants or personnel
at the center[, as defined at 40 TAC §15.601 (relating to
Admission Criteria). The participant must be able to use transportation
services offered by the PPECC with the assistance of a PPECC nurse
to and from the PPECC, whether or not the participant uses the PPECC's
transportation service].
(21) [(20)] Texas Health Steps
Comprehensive Care Program (THSteps-CCP)--A federal program, required
by Medicaid and known as Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT), for children under 21 years of age who meet
certain criteria for eligibility. Services are defined in the United
States Code, Title 42, §1396d(r), and the Code of Federal Regulations,
Title 42, §440.40(b).
§363.205.Provider Participation Requirements.
(a) A PPECC service provider must be independently
enrolled in the Texas Medicaid program to be eligible to receive Medicaid
reimbursement for providing PPECC services through the Texas
Health Steps Comprehensive Care Program (THSteps-CCP) [THSteps-CCP].
(b) To participate in THSteps-CCP, a PPECC service provider must:
(1) be currently licensed under and comply with 26 [40] TAC Chapter 550 [15] (relating to
Licensing Standards for Prescribed Pediatric Extended Care Centers);
(2) be enrolled and approved for participation in the Texas Medicaid program;
(3) agree to provide services in compliance with all applicable federal, state, and local laws and regulations, including Texas Occupations Code Chapter 301;
(4) comply with the terms of the Texas Medicaid Provider Agreement;
(5) comply with all state and federal regulations and rules relating to the Texas Medicaid program;
(6) comply with the requirements of the Texas Medicaid
Provider Procedures Manual, including all published updates and revisions
and all handbooks, standards, and guidelines published by HHSC or a
Medicaid managed care organization (MCO) [an (MCO)]
with which the provider contracts [they contract];
(7) comply with accepted professional standards and principles of nursing practice;
(8) comply with Texas Family Code Chapter 261, and Texas Health and Safety Code Chapter 260A, concerning mandatory reporting of suspected abuse or neglect of children and adults with disabilities; and
(9) maintain written policies and procedures for obtaining consent for medical treatment for participants in the absence of the responsible adult that meet the standards of Texas Family Code §32.001.
§363.207.Participant Eligibility Criteria.
(a) A participant may be admitted to a PPECC if: [All requests for PPECC services must be based on the current medical
needs of a participant who meets the following admission criteria
for a PPECC:]
(1) the participant is eligible for the
Texas Health Steps Comprehensive Care Program (THSteps-CCP) [THSteps-CCP];
(2) the participant is [age]
20 years of age or younger;
(3) the participant requires ongoing skilled
nursing care and supervision and skilled observations, judgments,
and therapeutic interventions all or part of the day to correct or
ameliorate the participant's [his or her] health
status, such that delayed skilled intervention is expected to result in:
(A) deterioration of a chronic condition;
(B) loss of function;
(C) imminent risk to health status due to medical fragility; or
(D) risk of death;
(4) the participant is considered to be
[a] medically dependent or technologically dependent [participant];
(5) the participant meets the criteria [is
stable and eligible for outpatient medical services] in 26 [accordance with 40] TAC §550.601 [§15.601
] (relating to Admission Criteria);
(6) the participant has a physician's
order prescribing [prescription for each authorization
period for] PPECC services signed and dated by the ordering
physician who has examined the participant in person within
30 calendar days prior to admission and reviewed all appropriate
medical records, unless the physician waives this examination
because the physician:[;]
(A) has already established a diagnosis for the participant;
(B) is providing continuing care and medical supervision to the participant; and
(C) has stated in writing that an examination of the participant 30 calendar days prior to admission is not medically necessary;
(7) the participant resides with the responsible adult and does not reside in a 24-hour inpatient facility, including a:
(A) general acute hospital;
(B) skilled nursing facility;
(C) intermediate care facility; or
(D) special care facility, including sub-acute units or facilities for the treatment of acquired immune deficiency syndrome; and
(8) the PPECC has [a] consent for
[to the participant's] admission to the PPECC signed
and dated by the participant or by the participant's responsible adult.
(b) If a participant's ordering physician waives the examination of the participant in accordance with subsection (a)(6) of this section:
(1) the physician must examine the participant in person within 365 calendar days after the date of the participant's last examination; and
(2) the physician and PPECC must maintain documentation of the waived examination and the information described in subsection (a)(6) of this section in the participant's medical record.
(c) [(b)] THSteps-CCP participants
are eligible for all medically necessary PPECC services that are required
to meet the participant's documented needs.
(d) [(c)] Admission must be voluntary,
based on the participant's, or the participant's responsible adult's
choice for PPECC services.
(e) [(d)] An authorized admission
for PPECC services is not intended to supplant the right to a Medicaid Private Duty Nursing [PDN] benefit, when medically
necessary.
§363.209.Benefits and Limitations.
(a) Comprehensive plan of care (POC) and PPECC[;] permissible [PPECC] services.
(1) A [The] PPECC must develop,
implement, and monitor a comprehensive POC [plan of
care] that:
(A) is provided to a medically dependent or technologically dependent participant;
(B) is developed in collaboration with the participant's ordering physician, responsible adult, and interdisciplinary team, as well as the participant's existing service providers as needed to coordinate care;
(C) specifies the following prescribed services needed to address the medical, nursing, psychosocial, therapeutic, dietary, functional, and developmental needs of the participant and the training needs of the participant's responsible adult:
(i) skilled nursing;
(ii) personal care services to assist with activities of daily living while in the PPECC;
(iii) functional developmental services;
(iv) nutritional and dietary services, including nutritional counseling;
(v) occupational, physical and speech therapy;
(vi) respiratory care;
(vii) psychosocial services; and
(viii) training for the participant's responsible adult associated with caring for a medically or technologically dependent participant;
(D) specifies whether the participant is stable
as determined by the participant's ordering physician [if
transportation is needed];
(E) if the participant is stable, the participant's ordering physician, in collaboration with the PPECC, specifies one of the following to be on board the transport vehicle to assist the participant during transportation:
(i) a registered nurse (RN);
(ii) a licensed vocational nurse (LVN); or
(iii) direct care staff;
(F) [(E)] is reviewed and revised
for each authorization period of services per §363.211(d)
[subsection (d)] of this subchapter [section
] or more frequently as the ordering physician deems necessary;
(G) [(F)] is signed and dated
by the participant's ordering physician;
(H) [(G)] is developed [signed] and established with [dated by]
the participant or the participant's responsible adult;
(I) includes a nursing addendum signed by the participant or the participant's responsible adult;
(J) [(H)] meets additional requirements
prescribed in 26 [40] TAC §550.607 [§15.607] (relating to Initial and Updated Plan of Care);
and
(K) [(I)] meets requirements
contained in the Texas Medicaid Provider Procedures Manual.
(2) Transportation Services.
(A) A [The] PPECC must provide
transportation of a participant to and from [between
the participant's residence and] the PPECC when: [a
participant has a stated need or prescription for such transportation.]
(i) the participant's ordering physician determines the participant is stable; and
(ii) the responsible adult wants the participant to receive transportation.
(B) When a PPECC provides transportation for [to] a [PPECC] participant, an RN, [or]
LVN, or direct care staff, as determined [employed
] by the participant's ordering physician in collaboration
with the PPECC, must be on board the transport vehicle to assist the participant during transportation.
(C) A [The] PPECC must ensure
that the driver and the RN, LVN, or direct care staff on board the
transport vehicle maintain a daily transportation log that must include:
(i) the driver's name [sign, date,
and indicate the time the participant is put on the transport vehicle
to deliver the participant to the PPECC];
(ii) the name of the PPECC staff member and whether the staff member is an RN, LVN, or direct care staff;
[(ii) sign, date, and indicate the arrival time of the participant at the PPECC;]
(iii) the date;
[(iii) sign, date, and indicate the time the participant is put on the transport vehicle to return the participant to their place of residence;
and]
(iv) the name of the participant;
[(iv) sign, date, and indicate the arrival time at the participant's residence.]
(v) the time the participant is put on the transport vehicle to deliver the participant to the PPECC;
(vi) the time the participant arrives at the PPECC;
(vii) the time the participant is put on the transport vehicle to return to the responsible adult or an adult authorized by the participant's responsible adult;
(viii) the time the participant arrives at the participant's return destination and the name of the person to whom the participant was released; and
(ix) for a participant who is in transport for longer than one hour traveling to the PPECC or for longer than one hour traveling to their return destination, the reason that the transport time was longer than one hour.
(D) Payment for transportation services not substantiated by the documentation required in subparagraph (C) of this paragraph may be recouped.
(E) [ (D)] A responsible adult
is not required to accompany a participant when the participant receives
transportation services to and from the PPECC.
(F) [ (E)] A participant or participant's
responsible adult may decline a PPECC's transportation services
entirely, on a specific date, or for part of a specific date and
choose to be transported by other means.
(G) [ (F)] A non-emergency ambulance
may not be used for transport to and from a PPECC.
(3) PPECC services, including training provided to the participant's responsible adult associated with caring for a medically or technologically dependent participant, must be provided by the PPECC with the following intended outcomes:
(A) optimizing the participant's health status and outcomes; and
(B) promoting and supporting family-centered, community-based care as a component of an array of service options by:
(i) preventing prolonged or frequent hospitalizations or institutionalization;
(ii) providing cost-effective, quality care in the most appropriate environment; and
(iii) providing training and education of caregivers.
(4) A [The] PPECC must provide
written documentation about a [the] participant's
care each day to the participant's responsible adult, including documentation
of medication given, services provided, and other relevant health-related
information. A PPECC must provide [The] documentation to the participant's responsible adult [must be provided]
each day following service delivery when the responsible adult picks
up the participant or when the PPECC transports the participant to the
participant's return destination [his or her residence].
(5) For each day that PPECC services are provided, a [the] participant's medical record must identify the specific
person, for example [(e.g.], nursing, direct
care staff, or therapist[)] providing services,
the type of services performed, and the start and end times of services
performed. [The PPECC must be able to calculate the cost by practitioner
and type of service provided as requested by HHSC.]
(b) Amount and duration.
(1) HHSC evaluates the amount and duration of PPECC services requested upon review of:
(A) a physician's [physician] order;
(B) a PPECC POC [plan of care];
(C) a completed request for authorization, including all required documentation, as indicated in the Texas Medicaid Provider Procedures Manual; and
(D) the full array of Medicaid services the participant is receiving at the time the plan of care is developed.
(2) HHSC re-evaluates the amount of PPECC services when:
(A) there is a change in the frequency of skilled nursing
interventions, other PPECC medical services, or the complexity and
intensity of the participant's care, or the authorized services are
not commensurate with the participant's ['s]
medical needs and additional authorized hours are medically necessary;
(B) the participant or the participant's responsible adult chooses alternate resources for comparable care; or
(C) the responsible adult becomes available and is willing to provide appropriate care for the participant.
(c) PPECC service limitations.
(1) The Medicaid rate for PPECC services does not include a PPECC providing the following [PPECC] services:
(A) services intended to provide [mainly]
respite care or child care, or services not directly related to the
participant's medical needs or disability;
(B) services that are the legal responsibility of a local school district, including transportation;
(C) services covered separately by Texas Medicaid, such as:
(i) speech therapy, occupational therapy, physical therapy, respiratory care practitioner services, and early childhood intervention services;
(ii) durable medical equipment (DME), medical supplies, and nutritional products provided to the participant by Medicaid's DME and medical supply service providers; and
(iii) Private Duty Nursing (PDN) [private
duty nursing], skilled nursing, and aide services provided in
the home setting when medically needed in addition to the PPECC services authorized;
(D) baby food or formula;
(E) services to participants related to the PPECC owner by blood, marriage, or adoption;
(F) services rendered to a participant who does not meet the definition of a medically or technologically dependent participant; and
(G) individualized comprehensive case management beyond the service coordination required by the Texas Occupations Code Chapter 301.
(2) PPECC services are limited to 12 hours per day. Services begin when the PPECC assumes responsibility for the care of the participant (the point the participant is boarded onto PPECC transportation or when the participant is brought to the PPECC) and ends when the care is relinquished to the participant's responsible adult or an adult authorized by the participant's responsible adult.
(3) A participant who is eligible to receive PDN services may also receive PPECC services. A participant may choose to receive all authorized continuous skilled nursing service hours through PPECC services only, PDN services only, or a combination of both PPECC and PDN services. If a participant chooses to receive both PPECC and PDN services, the participant must not receive service hours in addition to what was initially authorized for PPECC and PDN, unless additional hours are medically necessary.
[(3) A participant who is eligible
may receive both PDN and PPECC services on the same day. However,
PPECC services are intended to be a one-to-one replacement of PDN
hours unless additional hours are medically necessary. The following
medically necessary services may be billed on the same day as PPECC
services, but they may not be billed simultaneously with PPECC services.
These services may be billed before or after PPECC services:]
[(A) private duty nursing;]
[(B) home health skilled nursing; and]
[(C) home health aide services.]
(4) The following medically necessary services may be billed on the same day as PPECC services, but may not be billed simultaneously with PPECC services. These services may be billed before or after PPECC services:
(A) PDN;
(B) home health skilled nursing;
(C) home health aide services; and
(D) personal care services.
(d) Parental accompaniment is not required for PPECC services, including therapy services rendered in a PPECC setting.
§363.211.Service Authorization.
(a) Authorization is required for payment of services. A PPECC [The provider] must submit a complete request
for prior authorization [in order] to be considered by
HHSC for reimbursement. Prior authorization is a condition for reimbursement,
but not a guarantee of payment.
(b) HHSC only authorizes [Only]
those services that HHSC determines to be medically necessary and
appropriate [are authorized].
(c) HHSC prior authorizes PPECC services
[are prior authorized] with reasonable promptness. HHSC
completes prior [Prior] authorization requests
for PPECC services [determinations are completed by HHSC]
within three business days of receipt of a complete request.
(d) Initial authorization may not exceed 90 calendar days from the start of care. Following the initial authorization, no authorization for payment of PPECC services may be issued for a single service period exceeding 180 calendar days. In addition, specific authorizations may be limited to a time period less than the established maximum based on factors such as the stability and predictability of the participant's medical condition.
(e) HHSC may deny or reduce the PPECC services when:
(1) the participant does not meet the medical necessity criteria for admission;
(2) the participant does not have an ordering physician;
(3) the participant is not 20 years of age or younger;
(4) the services requested are not covered under this subchapter;
(5) the participant's needs are not beyond the scope
of services available through Texas Medicaid home
health skilled nursing [Title XIX Home Health Skilled Nursing]
or home health aide services [Home Health Aide Services],
because the needs can be met on a part-time or intermittent basis
through a visiting nurse as described by Chapter 354, Subchapter A,
Division 3 of this title (relating to Medicaid Home Health Services);
(6) there is a duplication of services;
(7) the services are intended to provide [primarily] respite care or child care;
(8) the services are provided for the sole purpose
of training the participant's responsible adult [training];
(9) the prior authorization request is incomplete;
(10) the information in the prior authorization request is inconsistent; or
(11) the requested services are not nursing services as defined by the Texas Occupations Code Chapter 301 and its implementing regulations.
(f) All authorization requests, including initial authorization and authorization of extensions or revisions to an existing authorization, must be submitted in writing.
(g) Initial authorization requests for PPECC services must include the following documentation, which adheres to requirements in the Texas Medicaid Provider Procedures Manual:
(1) physician order for services (a physician signature on the PPECC plan of care serves as a physician order for authorization purposes);
(2) a plan of care developed by the PPECC in compliance with §363.209(a)(1) of this subchapter (relating to Benefits and Limitations);
(3) all required prior authorization forms listed in
the Texas Medicaid Provider Procedures Manual, or Medicaid managed
care organization [(MCO)] forms if they contain comparable
content; and
(4) signed consent of the participant or participant's responsible adult, that includes:
(A) documentation that the participant
or participant's responsible adult chose [documenting the
choice of] PPECC services; [. The signed consent
must include an]
(B) acknowledgement by the participant or
the participant's responsible adult that the PPECC informed the
participant or participant's responsible adult [he or
she has been informed] that other services such as private duty
nursing might be reduced as a result of accepting PPECC services;
and [. Consent]
(C) the participant's or participant's
responsible adult's consent for the PPECC to share the participant's
personal health information with the participant's other providers,
as needed to ensure coordination of care[, must also be obtained].
(h) Required documentation for recertification of PPECC service authorization after the initial authorization or after an authorization period ends includes the same documents required for an initial authorization, as set forth in subsection (g) of this section.
(i) Revisions during an existing authorization period may be requested at any time, if medically necessary. Revision requests must include the same documentation required for an initial request, as set forth in subsection (g) of this section.
(j) If inadequate or incomplete information is provided,
HHSC requests additional documentation from the PPECC [provider
] to enable HHSC to make a decision on the request.
(k) During the authorization process, PPECCs [providers] are required to deliver the requested services from
the start of care date.
(l) PPECCs [Providers] are responsible
for a safe transition of services when the authorization decision
is a termination, denial, or reduction in the
PPECC services being delivered.
(m) A comprehensive nursing assessment must
be completed, signed and dated by a PPECC registered nurse [RN] no earlier than three business days before the initial start
of care and no later than the day the participant is admitted
to the center. A nursing assessment is also required for
a revision when there are changes in the participant's medical
condition that impact the amount or duration of services during
an existing authorization period, and for recertification of
PPECC service authorization. The nursing assessment is used
to establish the participant's plan of care, and must contain the
elements identified in the Texas Medicaid Provider Procedures Manual.
§363.212.Documentation Requirements for Services Other Than Transportation Services.
(a) A PPECC must obtain and maintain the following documentation in a participant's medical record to be eligible for reimbursement for non-transportation PPECC services provided to the participant:
(1) a physician's specific, written, signed, and dated orders prescribing PPECC services;
(2) an approved prior authorization from HHSC that includes:
(A) a Comprehensive Care Program (CCP) Prior Authorization Request Form;
(B) a PPECC Plan of Care (POC);
(C) a PPECC nursing assessment;
(D) a Nursing Addendum to POC for Private Duty Nursing (PDN) and/or PPECC;
(E) consent for PPECC services as described in the Texas Medicaid Provider Procedures Manual; and
(F) documentation of medical necessity;
(3) the daily attendance log required by subsection (b) of this section; and
(4) the documentation required by subsection (c) of this section.
(b) A PPECC must maintain a daily attendance log that includes:
(1) the date of attendance;
(2) the name of the participant;
(3) the signature of the responsible adult and the time when the PPECC assumes responsibility for the care of the participant which is:
(A) the time the participant boards the PPECC transport vehicle; or
(B) the time the participant is brought to the PPECC by a responsible adult;
(4) the signature of the responsible adult and time when the responsible adult assumes responsibility for the care of the participant which is:
(A) the time the participant is taken off the transport vehicle at the participant's return destination; or
(B) the time the participant is picked up from the PPECC by a responsible adult; and
(5) the name of the PPECC staff member riding in the transport vehicle when PPECC transportation services are utilized and whether the staff member is a registered nurse, licensed vocational nurse, or direct care staff.
(c) A PPECC must maintain the following documentation:
(1) notes from interdisciplinary team meetings;
(2) discrepancies between the weekly service hours scheduled and the service hours provided;
(3) the names of the staff member providing services;
(4) the date of service;
(5) the type of service performed; and
(6) the start and end times of the service performed.
(d) HHSC may request that a PPECC provide documentation to substantiate the provision of services in addition to that required by subsections (a) - (c) of this section.
(e) HHSC may recoup payment for services not substantiated by the documentation required in this section.
§363.213.Ordering Physician Responsibilities.
(a) An ordering physician in an employment or contractual relationship with a PPECC cannot provide the required physician's order unless the physician has a therapeutic relationship with and ongoing clinical knowledge of the participant.
(b) The ordering physician's responsibilities include:
(1) providing an in person examination or
treatment to the participant within 30 calendar days before
the start of PPECC services unless the physician waives this
examination because:[;]
(A) a diagnosis has already been established by the physician;
(B) the participant is under the continuing care and medical supervision of the physician; and
(C) the physician has stated in writing that an examination of the participant 30 calendar days prior to admission is not medically necessary;
(2) if a physician waives an examination in accordance with subsection (b)(1) of this section:
(A) the physician must examine the participant in person within 365 calendar days after the date of the participant's last examination; and
(B) the physician and PPECC must maintain documentation of the waived examination and the information described in subsection (b)(1) of this section in the participant's medical record;
(3) [(2)] providing a written, signed, and dated order prescribing [prescription or written,
dated physician's order for] PPECC services within 30 calendar
days before the participant's start of services[, which is valid
through the initial authorization period and complies with requirements
contained in the Texas Medicaid Provider Procedures Manual];
(4) providing specific, written, signed, and dated physician orders for PPECC services which is valid through the initial authorization period and complies with requirements contained in the Texas Medicaid Provider Procedures Manual;
(5) [(3)] providing specific,
written, signed, and [a signed prescription or written,]
dated physician orders [physician's order] for
each PPECC authorization period, once the initial [prescription
or] order is no longer valid;
(6) [(4)] performing an
in person [a face-to-face] evaluation of the participant
each year;
(7) [(5)] reviewing, approving,
signing, and dating a plan of care (POC), and any other
documentation required for service prior authorization, including
any updates or changes;
(8) [(6)] affirming in writing
that PPECC services are medically necessary for the participant;
(9) [(7)] affirming in writing
that the participant's medical condition is sufficiently stable to
permit safe delivery of PPECC services as described in the POC [plan of care; and];
(10) affirming in writing that the participant's medical condition is stable and the type of provider, a registered nurse, licensed vocational nurse, or direct care staff, that must be present on the PPECC transportation vehicle as indicated in the POC; and
(11) [(8)] providing continuing
care to and medical supervision of the participant.
§363.215.Termination, Reduction, or Denial of Authorization for Prescribed Pediatric Extended Care Center Services.
(a) HHSC terminates authorization for PPECC services when:
(1) the participant is no longer eligible for the
Texas Health Steps Comprehensive Care Program [(THSteps-CCP)];
(2) the participant no longer meets the medical necessity criteria for PPECC services;
(3) the PPECC cannot ensure the health and safety of the participant;
(4) the participant or the participant's responsible adult refuses to comply with the plan of care, and compliance is necessary to assure the health and safety of the participant;
(5) the participant changes PPECC providers, and the change of notification is submitted to HHSC in writing with a prior authorization request from the new PPECC provider; or
(6) [after receiving PPECC services,] the
participant declines to continue receiving PPECC services
and chooses to receive [receives] services at
home. [The home health agency or independent provider offering
these services must submit and update all required authorization documentation.]
(b) Notice to approve, reduce, [or] deny,
or terminate requested PPECC services.
(1) HHSC notifies the participant and the responsible
adult in writing of the approval, reduction, [or] denial,
or termination of PPECC services.
(2) HHSC notifies the provider in writing of the approval,
reduction, [or] denial, or termination of PPECC services.
(3) The effective date of the service reduction or denial is 30 calendar days after the date on the individual's notification letter.
(4) HHSC notifies the individual in writing of the process to appeal the reduction or denial of services.
(c) All participants of Medicaid-funded services have the right to appeal actions or determinations made by HHSC as described in Chapter 357, Subchapter A of this title (relating to Uniform Fair Hearing Rules).
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 October 10, 2024.
TRD-202404822
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: November 24, 2024
For further information, please call: (512) 438-2910