Source: https://www.garloward.com/2013/08/05/tx-register-updates-fee-schedules-supplemental-payments/
Timestamp: 2020-06-02 05:24:16
Document Index: 144140849

Matched Legal Cases: ['§354', '§354', '§354', '§354', '§354', '§354', '§355', '§1905', '§185', '§9', '§9', '§9', '§9', '§9', '§354', '§354', '§355', '§355', '§355', '§355', '§355']

TX Register Updates: Fee Schedules, Supplemental Payments - Garlo Ward, P.C.
The following information was obtained from the August 2 issue of the Texas Register.
HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance to update the fee schedules for the following existing services: Ambulance; Chemical Dependency Treatment Facilities; Physicians and Other Practitioners; Early and Periodic Screening, Diagnostic, and Treatment; and Physical, Occupational, and Speech Therapy provided by Comprehensive Outpatient Rehabilitation Facilities/Outpatient Rehabilitation Facilities, Home Health Agencies, and Independent Therapists.
HHSC intends to submit an amendment to the Texas State Plan for Medical Assistance to update the fee schedules for Family Planning Services.
Finally, HHSC intends to submit to CMS a request to amend the Youth Empowerment Services waiver program to add supported employment and employment assistance as available services in the waiver, update the service definition for paraprofessional services, and change the name of professional services to specialized therapies.
HHSC proposed to amend §354.1005, Unauthorized Charges, and §354.1131, Payments to Eligible Providers, which would update obsolete code citations, update agency and program names, clarify the use of inconsistent terminology, and align the rules with HHSC’s preferred drafting style.
HHSC proposed to amend §354.1149, Exclusions and Limitations, and §354.1175, Organ Transplants, to be consistent with the claims system processes implemented as part of the new methodologies.
HHSC proposed to amend §354.1322, Provider Participation Requirements, which would change the rules to prohibit spending state funds to reimburse the costs of a federally qualified health center (FQHC) for Medicaid services performed or provided by a provider or group of providers under an affiliation agreement with the FQHC, unless HHSC determines that the agreement complies with federal law or administrative rules adopted by HHSC.
HHSC proposed to repeal Division 27, Women’s Health Program, §§354.1361 – 354.1364, Medicaid Women’s Health Program, which would delete obsolete material in the code and mitigate possible consumer and provider confusion over the applicability of the obsolete rules to the Texas WHP.
Finally, HHSC proposed to amend §355.8600, Reimbursement for Ambulance Services, which would allow approved governmental ambulance providers to receive supplemental payments for unreimbursed costs of providing ambulance services to Medicaid and uninsured patients if the services meet the definition of “medical assistance” as defined in §1905(a) of the Social Security Act.
For details, see the Texas Register.
The Texas Medical Board proposed new §185.29, Report of Impairment on Registration Form, which would provide that if a licensee has an impairment that affects the ability to actively practice as a physician assistant, the licensee will be given the opportunity to place his or her license on retired status, convert the license to an inactive status if the impairment is solely physical, voluntarily surrender his or her license, or be referred to the Texas Physician Health Program. For more information, see the Texas Register.
HHSC proposed to amend §9.553, Definitions; §9.555, Definitions of TxHmL program service components; §9.567, Process for Enrollment; §9.578, Program Provider Certification Principles: service delivery; and §9.583, TxHmL program principles for local authorities, in Subchapter N, Texas Home Living (TxHmL) Program, in Chapter 9, Intellectual Disability Services–Medicaid State Operating Agency Responsibilities. The changes would ensure compliance with Board of Nursing standards specific to a RN in the TxHmL program. See the Texas Register for more information.
HHSC adopted amendments to §§354.1061, 354.1071, and 354.1101, Additional Claim Information Requirements, which clarify claim information requirements related to diagnosis codes for physician and physician assistant services, hospital services, and podiatry services.
HHSC adopted an amendment to §354.1281, Psychologists’ Services, Benefits, and Limitations, which will add provisionally licensed psychologists (PLP) as another type of provider who can perform psychological counseling and services under the direct supervision of a licensed psychologist.
HHSC adopted an amendment to §355.8081, Reimbursement Methodology for Laboratory and X-ray Services, Radiation Therapy, Physical Therapists’ Services, Physician Services, Podiatry Services, Chiropractic Services, Optometric Services, Ambulance Services, Dentists’ Services, Psychologists’ Services, Licensed Psychological Associates’ Services, Provisionally Licensed Psychologists’ Services, Maternity Clinic Services, and Tuberculosis Clinic Services. The change provides that the licensed psychologist who supervises a PLP will be reimbursed for the PLP’s services at 70 percent of the Medicaid rate paid for a licensed psychologist’s services.
HHSC adopted new §355.8203, Waiver Payments to Other Performers, to describe the reimbursement rules for all other providers not addressed by §355.8201 or §355.8202.
Finally, HHSC adopted amendments to §355.8401, Reimbursement Methodology for Case Management for Children and Pregnant Women, to update and clarify the methodology used to determine the Medicaid reimbursement rates for providers of Case Management for Children and Pregnant Women services.
For details about each entry, see the Texas Register.