Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009 Page: 5,453
5445-5614 p. ; 28 cm.View a full description of this periodical.
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PRoPOSED_
IJn S^. Proposed rules include new rules, amendments to existing rules, and repeals of existing rules.
1w JjjrjS A state agency shall give at least 30 days' notice of its intention to adopt a rule before it
adopts the rule. A state agency shall give all interested persons a reasonable opportunity to
submit data, views, or arguments, orally or in writing (Government Code, Chapter 2001).
Symbols in proposed rule text. Proposed new language is indicated by underlined text. [Square brackets and st.ikethfzugh]
indicate existing rule text that is proposed for deletion. "(No change)" indicates that existing rule text at this level will not be
amended.TITLE 1. ADMINISTRATION
PART 15. TEXAS HEALTH AND
HUMAN SERVICES COMMISSION
CHAPTER 354. MEDICAID HEALTH
SERVICES
SUBCHAPTER A. PURCHASED HEALTH
SERVICES
DIVISION 11. GENERAL ADMINISTRATION
1 TAC 354.1149
The Texas Health and Human Services Commission (HHSC)
proposes amendments to 354.1149, relating to Medicaid ben-
efit exclusions and limitations.
Background and Justification
Currently, adults in Medicaid managed care plans receive annual
preventive well exams as a Medicaid benefit; however, this is not
a benefit for adults receiving Medicaid through fee-for-service or
Primary Care Case Management. HHSC proposes to add adult
preventive services as a benefit for all eligible adults. This re-
quires amending 354.1149 to remove adult preventive services
from the list of Medicaid excluded services. The benefit will in-
clude preventive services recommended by the U.S. Preventive
Services Task Force. The rule conforms with legislative empha-
sis on preventive health services.
The amendments also update the rule to reflect current HHSC
policies and procedures regarding a number of other Medicaid
benefit exclusions and limitations.
Additional changes are proposed to update terms, remove ob-
solete language, clarify language, and re-format the rule.
Section-by-Section Summary
Section 354.1149(a) describes a number of services that are not
Medicaid benefits. Subsections (b), (c) and (d) describe other
Medicaid benefit exclusions and limitations.
HHSC proposes to make the following changes to 354.1149(a)
to reflect the new adult preventive services benefit:
Remove the exclusion of most immunizations from subsection
(a)(2) and move revised immunization benefit information to re-
numbered subsection (a)(9).
Revise re-numbered subsection (a)(9) to remove the reference
to services and supplies provided in connection with routine
physical exams because these services and supplies will be
covered as part of the adult preventive services benefit. Insert
new language in subsection (a)(9) to exclude from benefits im-munizations for foreign travel or immunizations that are not part
of a routine preventive immunization schedule. Immunizations
that are part of a routine preventive immunization schedule will
be covered under the new adult preventive services benefit,
unless specifically excluded by HHSC.
HHSC proposes to make the following additional changes to
354.1149 to reflect current HHSC policies and procedures re-
garding Medicaid benefit exclusions and limitations:
Revise subsection (a) to clarify that Medicaid reimbursement is
only available for service and supplies that are medically nec-
essary; that the listed benefit exclusions and limitations are only
applicable for services or supplies provided under Subchapter A
related to Medicaid purchased health services; that the listed ex-
clusions and limitations are not applicable when the services or
supplies are benefits in the Texas Health Steps Comprehensive
Care Program; and that additional exclusions and limitations are
listed in the Texas Medicaid Provider Procedures Manual.
Revise subsection (a)(1) to clarify that benefits do not include
services provided to a recipient between the ages of 22 and 64
in an institution for mental disease.
Remove from subsection (a)(2) the reference to occupational
therapy because occupational therapy is a benefit.
Remove from subsection (a)(5) extraneous language related to
providers of dental services and a description of these services.
Remove an obsolete reference to another rule. Remove a refer-
ence to services authorized under the Early and Periodic Screen-
ing, Diagnosis, and Treatment Program (EPSDT) because this
reference was added to the top of subsection (a) (referenced in
subsection (a) as the Texas Health Steps Comprehensive Care
Program).
Remove subsection (a)(6) relating to eyeglasses and exams be-
cause these are benefits. Subsequent paragraphs are re-num-
bered.
Clarify in re-numbered subsection (a)(7) that orthodontic ser-
vices that are authorized and initiated while a recipient is Medic-
aid eligible may be continued for a limited time after a recipient
is no longer Medicaid eligible.
Revise re-numbered subsection (a)(8) to match the correspond-
ing paragraph in the Social Security Act, Section 1862(a)(10)
related to cosmetic surgery.
Revise re-numbered subsection (a)(10) to clarify that certain im-
mediate family members may provide personal care services as
described in Title 42 Code of Federal Regulations 488.303.
Delete subsection (a)(12) related to services or supplies that are
not reasonable and necessary because a reference was added
to the top of subsection (a) regarding services and supplies that
are not medically necessary. Also, delete the reference in sub-PROPOSED RULES August 14, 2009
34 TexReg 5453
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Texas. Secretary of State. Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009, periodical, August 14, 2009; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth90865/m1/8/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.