Texas Register, Volume 46, Number 17, Pages 2627-2862, April 23, 2021 Page: 2,724
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Response: No changes were made in response to this comment.
The suggested edits would change the UC program, which is
outside of the scope of this rule amendment.
Comment: Commenters suggested multiple edits in the eligibility
divisions.
- Commenters requested that the lead-in to 355.8600(c)(2)(A),
"Eligibility for supplemental payments," be replaced with "Eligi-
bility for UC Supplemental Payments."
- Another commenter suggested splitting up subparagraph
355.8600(c)(2)(A), Eligibility for supplemental payments, into
a new clause (i) "Initial Application." Additionally, there was
a request to move subparagraph 355.8600(c)(2)(C), Cost
reports, after 355.8600(c)(2)(A)(vii) as clause (ii) and retitling
it to "Annual cost Reports." A commenter also requested that
language in 355.8600(c)(2)(C) "delivered to Medicaid and,
effective March 1,2012, uninsured clients" be replaced with
"delivered to eligibly charity care recipients."
- Commenters requested that 355.8600(c)(2)(B), Eligibility for
enhanced supplemental payments, be split into two: subpara-
graph (B) and clause (i). Commenters suggested that the new
(i) be titled "Initial ACR Application," and wanted to change the
word "cost" to "utilization." Commenters also suggested that the
lead-in for subparagraph (B) be replaced with "Eligibility for En-
hanced ACR supplemental payments."
- Commenters requested that language in 355.8600(c)(2)(C)(i-
i), Purpose, "Medicaid and uncompensated care costs," be re-
placed with "uncompensated charity care costs."
- Commenters requested that language in 355.8600(c)(2)(C)(i-
ii), Allocating allowable costs, "Medicaid and uninsured patients
based on the ratio of charges for Medicaid and uninsured pa-
tients to the charges for all patients," be replaced with "to charity
care based on the ratio of charges for charity care to charges for
all financial classes (payors)."
- Commenters suggested adding a date to the first sentence of
366.8600(c)(2)(C)(i).
Response: Except for the last suggestion, HHSC disagrees with
the comments, as they would change the UC program, which
is outside of the scope of the rule amendment. The changes
recommended to the enhanced supplemental payment program
add unnecessary redundancy, length, and complexity to the rule.
HHSC has added the date, "September 30," to the first sentence
of 355.8600(c)(2)(C)(i).
Comment: Commenters suggested that the lead-in to
355.8600(c)(2)(D) "Calculation of supplemental payments" be
changed to "Calculation of Enhanced Supplemental Payments."
Commenters also suggested adding the top five commercial
payers in subparagraph (E)(i), as well as the acronym "ACR"
before "supplemental payments" to (E)(i)(l). Commenters
suggested adding "by procedure code" so that (E)(i)(II) and
(E)(i)(III) would read "H HSC will apply average commercial rate
by procedure code."
Response: HHSC agrees that the title of subparagraph (D)
should reference enhanced supplemental payments and has
changed the title to "Calculation of supplemental payments and
enhanced supplemental payments" as subparagraph (D) relates
to both supplemental payments and enhanced supplemental
payments. HHSC did not abbreviate "average commercial
rate" throughout the rule. HHSC disagrees with the additional
language relating to using the top five commercial payers asit does not comply with the payment calculations as intended.
Allowing the use of only the top five commercial payers creates
a risk of rate inflation.
Comment: Commenters requested changing 355.8600(c)(2)(
D)(iii) to (C)(iii) as well as changing subparagraph (D) to (E).
Response: No changes were made in response to this comment.
HHSC disagrees with this suggestion as the relabeling is inac-
curate.
Comment: Commenters recommended that 355.8600(c)(2)(E)
(i)(VI) should be edited to read "HHSC will re-determine the av-
erage commercial rate annually."
Response: HHSC agrees with the recommendation and has
modified the language in the rule text.
Comment: One commenter opposed the eligibility criteria
provided in 355.8600(c)(2)(A), Eligibility for supplemental
payments, requesting to add providers that are not public
providers. The commenter mentions that there are "783 EMS
provider organizations licensed by the Department of State
Health Services" and 503 of those provider organizations are
ineligible to participate in the enhanced supplemental payment
program. The commenter believes that with the negative
economic impact of the Covid-19 pandemic has brought, the
enhanced supplemental payment program "should include and
be made voluntarily available to all of the Texas licensed EMS
organizations regardless of provider type."
Response: HHSC values the role of all providers in serving Tex-
ans, but intends for this program to focus on publicly owned
ground emergency ambulance service providers.
STATUTORY AUTHORITY
The amendment is adopted under Texas Government Code
531.033, which authorizes the Executive Commissioner of
HHSC to adopt rules necessary to carry out HHSC's duties;
Texas Human Resources Code 32.021 and Texas Government
Code 531.021(a), which provide HHSC with the authority to
administer the federal medical assistance (Medicaid) program
in Texas; and Texas Government Code 531.021(b-1), which
establishes HHSC as the agency responsible for adopting
reasonable rules governing the determination of fees, charges,
and rates for medical assistance payments under the Texas
Human Resources Code Chapter 32.
355.8600. Reimbursement Methodology for Ambulance Services.
(a) Authority. Payments are made to private and governmen-
tal providers of ground and air ambulance services as specified in the
ambulance program rules in Chapter 354, Subchapter A, Division 9 of
this title (relating to Ambulance Services). The reimbursement deter-
mination authority is specified in 355.101 of this chapter (relating to
Introduction).
(b) Definitions. The following words and terms, when used
in this section, have the following meanings unless the context clearly
indicates otherwise.
(1) Allowable costs--Expenses that are reasonable and nec-
essary for the normal conduct of operations relating to the provision of
ground and air ambulance services.
(2) Average Commercial Rate--The average amount
payable by commercial payers for the same service.
(3) Centers for Medicare and Medicaid Services (CMS)--
The federal agency within the United States Department of Health and46 TexReg 2724 April 23, 2021 Texas Register
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Texas. Secretary of State. Texas Register, Volume 46, Number 17, Pages 2627-2862, April 23, 2021, periodical, April 23, 2021; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1330690/m1/98/: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.