Texas Register, Volume 38, Number 26, Pages 4053-4242, June 28, 2013 Page: 4,147
4053-4242 p. ; 28 cm.View a full description of this periodical.
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the reference to "Part D" to clarify that any coverage under a
Medicare drug plan is covered under the rule. This amendment
is needed because Medicare prescription drug coverage is now
offered in a variety of different plans due to the introduction and
availability of Medicare managed care plans. The proposed
deletion of "Part D" would therefore allow the program to include
anyone covered under any Medicare prescription drug plan.
The proposed amendments to 98.5(c) and 98.8(a) and (b) are
needed to reflect recent changes in the name of the Branch un-
der which the program resides and reflect changes to the pro-
gram's mailing address.
Proposed amendments to 98.10(a)(1)(A) would replace "Medi-
care" with "Social Security Administration" to more accurately
reflect the source of Low Income Subsidies.
Proposed amendments to 98.11 would clarify that the depart-
ment may contract with a claims processor to interface with
"plans that provide Medicare prescription drug benefits" and
would delete the reference to Medicare "Part D." This amend-
ment is needed because Medicare prescription drug coverage
is now offered in a variety of different plans and providers due
to the introduction and availability of Medicare managed care
plans.
Proposed amendments to 98.12(a) would reflect recent
changes in the name of the Branch under which the program
resides and also reflect changes to the program's mailing
address. Proposed amendments to subsection (b) would reflect
recent changes made to the name of the agency Unit and the
Branch and corresponding titles for managers who participate
in the appeal review panel described in this subsection.
Proposed amendments to 98.13(c) would reflect changes to the
department's HIPAA Privacy Officer contact information, includ-
ing new mailing address, phone numbers and email address.
Proposed amendments to 98.101 would better reflect the statu-
tory role for hospital districts, local health departments, public or
nonprofit hospitals and clinics and nonprofit community organi-
zations as described in Health and Safety Code, 85.064(c). Un-
der that provision, these entities may contribute money into the
program for the purpose of purchasing medications for patients.
This provision has been incorrectly interpreted at times by these
other entities to mean that the program could buy medications at
special pricing available only to state programs for those entities
in this provision and have those entities reimburse the depart-
ment. The federal Office of Pharmacy Affairs has clarified that
state programs cannot purchase medications for other entities
and that doing so would be illegal. However, the entities refer-
enced in the statutory provision do benefit indirectly from the pro-
gram when patients with HIV disease in their respective jurisdic-
tions receive direct assistance from the program, thereby elim-
inating the need for those entities to provide services to these
patients.
Proposed amendments to 98.102 add new definitions for "HIV
Disease" and for "Payer of Last Resort." The new definitions are
needed to help ensure consistency in the use of these terms
across the program. The addition of the term "Payer of Last Re-
sort" is also needed to reflect state law, department policy and
federal grant conditions that require the program to be the payer
of last resort. Amendments to the definition of a "Texas resident"
are needed in order to clarify that the department may request
what information it believes is relevant to help in its residency de-
terminations. The remaining parts of the section are proposed tobe renumbered as appropriate, given the proposed substantive
changes.
Proposed amendments to 98.103, 98.110, and 98.118 would
update recent changes in the name of the Branch under which
the program resides and reflect changes to the program's mailing
address.
Proposed amendments to 98.107 would delete language that
allows the Director of the Health Promotions Unit to make excep-
tions to the Medical Eligibility Criteria. This is proposed in order
to better meet the statutory requirements of Health and Safety
Code, 85.062, regarding eligibility. In addition, federal grant
conditions specify that only HIV-positive individuals are eligible
for the program and that no exceptions to this criterion can be
made.
Proposed amendments to 98.109 would clarify that the program
is the payer of last resort and reflect state law, department policy
and federal grant conditions that require the program to be the
payer of last resort.
Proposed amendments to 98.115(c)(1) would delete language
that calls for a specific order of implementing and reversing cost-
containment measures. Potential program budget shortfalls as
revealed by quarterly actuarial projections may require the need
for cost-containment measures. The proposed change in this
subsection gives the program and the department greater flexi-
bility to address those shortfalls while attempting to minimize im-
pact to affected patients. Proposed amendments to subsection
(c)(2) delete language that calls for reversing cost-containment
measures in the order which they were implemented to paral-
lel proposed deleted language in subsection (c)(1). Proposed
new language in subsection (c)(2) gives the department greater
flexibility to rescind cost-containment measures appropriate to
specific circumstances at the time when the measures are im-
plemented.
FISCAL NOTE
Janna Zumbrun, Director, Disease Intervention and Prevention
Section, has determined that for each year of the first five years
that the sections will be in effect, there will be no fiscal implica-
tions to state or local governments as a result of enforcing and
administering the sections as proposed. The proposed amend-
ments should improve the efficiency of the program's operations
and also improve the user-friendliness of the rules for agency
stakeholders, and this could have positive fiscal impacts.
MICRO-BUSINESSES AND SMALL BUSINESSES IMPACT
ANALYSIS
Ms. Zumbrun has also determined that there will be no ad-
verse impact on small businesses or micro-businesses required
to comply with the sections as proposed. This was determined
by interpretation of the rules that small businesses and micro-
businesses will not be required to alter their business practices
in order to comply with the sections.
ECONOMIC COSTS TO PERSONS AND IMPACT ON LOCAL
EMPLOYMENT
There are no anticipated economic costs to persons who are
required to comply with the sections as proposed. There is no
anticipated negative impact on local employment.
REGULATORY ANALYSIS
The department has determined that this proposal is not a
"major environmental rule" as defined by Government Code,PROPOSED RULES June 28, 2013 38 TexReg 4147
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Texas. Secretary of State. Texas Register, Volume 38, Number 26, Pages 4053-4242, June 28, 2013, periodical, June 28, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth313178/m1/95/: accessed April 19, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.