PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354. MEDICAID HEALTH SERVICES
SUBCHAPTER A. PURCHASED HEALTH SERVICES
DIVISION 11. GENERAL ADMINISTRATION
The Texas Health and Human Services Commission (HHSC) adopts an amendment to §354.1149, concerning Exclusions and Limitations.
Section 354.1149 is adopted without changes to the proposed text as published in the June 14, 2024, issue of the Texas Register (49 TexReg 4117). This rule will not be republished.
BACKGROUND AND JUSTIFICATION
The purpose of the adoption is to align Texas Medicaid coverage of vaccines for adults with federal requirements in section 11405 of the Inflation Reduction Act (IRA) of 2022 (Public Law 117-169). On June 27, 2023, the Centers for Medicare & Medicaid Services issued guidance on its interpretation of the amendments to the Social Security Act made by the IRA to require Medicaid programs to cover vaccines and their administration, provided that the vaccine is approved by the U.S. Food and Drug Administration (FDA) for use by adult populations and is administered in accordance with recommendations of the Advisory Committee on Immunization Practices (ACIP), effective October 1, 2023. States were directed to add coverage for all ACIP-recommended vaccines for adults, including vaccines solely for travel to or from foreign countries. As a result, the adopted rule removes the exclusion of all FDA-approved and ACIP-recommended vaccines used solely for travel to or from foreign countries as a Medicaid benefit for the adult population.
COMMENTS
The 31-day comment period ended July 15, 2024.
During this period, HHSC received comments regarding the proposed rule from two individuals with The University of Texas Southwestern Medical Center. A summary of comments relating to the rule and HHSC's responses follows.
Comment: One individual commented that the proposed rule is an opportunity to provide equitable access to necessary vaccines for adults and that expanding coverage to include all ACIP-recommended vaccines not only aligns with state and federal requirements but also addresses gaps in immunization. The commenter expressed concern about the implementation of the proposed rule and suggested that efforts should be made to increase awareness.
Response: HHSC agrees with the commenter that the proposed rule will increase access to adult vaccines. Regarding implementation of the proposed rule, HHSC publishes provider notifications to the Texas Medicaid & Healthcare Partnership website when new benefits are added. The process is and will continue to be applied to new ACIP-recommended vaccine benefits.
Comment: The second individual commented and provided support of the proposal to amend §354.1149 to align Texas Medicaid coverage of vaccines for adults with federal requirements to remove travel-based exclusions. The commenter expressed that the change is critical to ensure that all adults have access to FDA-approved and ACIP-recommended vaccines regardless of their occupation or travel plans and that vaccines prevent the spread of disease through travel to new areas and provides all Texans with the opportunity to get vaccinated and stay healthy. The commenter urges HHSC to adopt the proposed rule as the proposed rule is a common-sense change that will improve the health of Texans, save lives, and meet IRA of 2022 requirements.
Response: HHSC agrees with the commenter and thanks the commenter for their support.
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, which provides HHSC with the authority to administer the federal medical assistance program in Texas and to adopt rules and standards for program administration.
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 September 17, 2024.
TRD-202404465
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: October 7, 2024
Proposal publication date: June 14, 2024
For further information, please call: (512) 438-4651