Texas Register, Volume 42, Number 43, Pages 5913-6056, October 27, 2017 Page: 6,000
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Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: November 1, 2017
Proposal publication date: August 18, 2017
For further information, please call: (512) 424-6863
CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH
SERVICES
DIVISION 12. CERTIFIED REGISTERED
NURSE ANESTHETISTS AND ANESTHESIOL-
OGIST ASSISTANTS
1 TAC 355.8221
The Texas Health and Human Services Commission (HHSC)
adopts amendments to 355.8221, concerning Reimbursement
Methodology. The amendment is adopted with changes to the
proposed text as published in the August 4, 2017, issue of the
Texas Register (42 TexReg 3851).
BACKGROUND AND JUSTIFICATION
Certified registered nurse anesthetists (CRNAs) and anesthesi-
ologist assistants (AAs) are currently reimbursed at the lesser
of billed charges or 92 percent of the reimbursement paid to a
solo anesthesiologist for supervised services. The amendment
to 355.8221 includes language to add anesthesiologist assis-
tants to the reimbursement methodology. Further, the amend-
ment provides that CRNAs and AAs are reimbursed at the lesser
of billed charges or 50 percent of the calculated payment when
supervised by an anesthesiologist. If a CRNA is supervised by
a physician other than an anesthesiologist, HHSC reimburses
CRNAs at the lesser of billed charges or 92 percent of the cal-
culated payment.
Amendments to 355.8221 are adopted with changes based
on the 2018-19 General Appropriations Act, Senate Bill 1, 85th
Legislature, Regular Session, 2017 [Article II, HHSC, Rider 223]
that directed HHSC to review and evaluate the reimbursement
methodology and payment rates for anesthesiology supervi-
sion. Appropriations in this Act are based on a reimbursement
methodology and rate that is cost neutral with the reimburse-
ment structure in place in fiscal year 2016. Section 355.8221
was amended in response to comments received to change
the effective date to November 1, 2017, and language was
added to state that CRNAs will be reimbursed at the lesser of
billed charges or 92 percent of the calculated payment when
supervised by a physician other than an anesthesiologist.
In order to maintain cost neutrality as indicated in Rider 223,
there will be additional adjustments to reimbursement rates
which are not covered under this rule.
COMMENTS
The 30-day comment period for the amended rule ended
September 5, 2017. During the comment period, HHSC re-
ceived comments from:
Wilbarger General Hospital
Advance Practice Registered Nurse AllianceChildren's Health System of Texas
Texas Organization of Rural & Community Hospitals (TORCH)
Coalition for Nurses in Advanced Practice
Hereford Regional Medical Center
Gonzales Healthcare Systems
Ward Memorial Hospital
Golden Plains Community Hospital
Moore County Hospital District
Ochiltree Hospital District
Covenant Health
Memorial Medical Center
YPS Anesthesia Services
Brownfield Regional Medical Center
Eastland Memorial Hospital
Texas Academy of Anesthesiologist Assistants
Young Professional Services
Texas Children's Hospital - Baylor College of Medicine
Texas Society of Anesthesiologists
Texas Association of Nurse Anesthetists
Below is a summary of the comments received and HHSC's re-
sponses.
Comment: Several commenters raised concerns related to the
reduction from 92 percent to 50 percent for CRNA services pro-
vided under the supervision of a physician other than an anes-
thesiologist, where there would be only one payment made to
the CRNA at 50 percent of the calculated anesthesia rate with-
out the corresponding 50 percent payment to an anesthesiolo-
gist. This would have a significant adverse economic impact on
CRNAs, particularly in rural areas where they may be the only
available anesthesia provider. Commenters stressed that this
would adversely impact access to care for Medicaid patients in
rural communities as well.
Response: After review of comments, HHSC revised the rule
language and added a section to the rule specifying that CRNA
services provided under the supervision of a physician other than
an anesthesiologist would be reimbursed at 92 percent of the cal-
culated payment for an anesthesia service. In addition, in a sep-
arate initiative, the calculated anesthesia reimbursement rate is
proposed to increase, by increasing the conversion factors and
set fees, resulting in an overall cost neutral impact for Medicaid
anesthesia services.
Comment: Several commenters stated that they can only
support the proposed amendments if it includes a significant in-
crease in the base conversion factor for all anesthesia services
and an appropriate increase in the methodology for physician
anesthesiologists to allow for overall cost neutrality.
Response: HHSC acknowledges this concern and, in a sepa-
rate initiative, the calculated anesthesia reimbursement rate is
proposed to increase, by increasing the conversion factors and
set fees, resulting in an overall cost neutral impact for Medicaid
anesthesia services. No changes were made in response to this
comment.42 TexReg 6000 October 27, 2017 Texas Register
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Texas. Secretary of State. Texas Register, Volume 42, Number 43, Pages 5913-6056, October 27, 2017, periodical, October 27, 2017; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth897027/m1/88/?q=%22%22~1: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.