Texas Register, Volume 34, Number 33, Pages 5445-5614, August 14, 2009 Page: 5,454
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section (a)(12) to cosmetic surgery because it duplicates lan-
guage in re-numbered subsection (a)(8).
Delete subsection (a)(14) related to utilization review findings
and services that are not medically necessary because it is re-
dundant with the revised language at the top of subsection (a).
Delete subsection (a)(15) related to whole blood or packed red
cells because these products are a benefit when medically nec-
essary.
Delete subsection (a)(19) related to the prior authorization re-
quirement for parenteral hyperalimentation because the many
Medicaid benefits that require prior authorization are not listed
in this rule.
Revise re-numbered subsection (a)(15) relating to the annual
inpatient limit of $200,000 per recipient to clarify current policy,
remove an exemption for recipients less than age one because
this rule does not apply to Medicaid services provided through
the Texas Health Steps Comprehensive Care Program, remove
extraneous language, update references, and re-format.
Revise re-numbered subsection (a)(16) relating to services or
supplies that are experimental or investigational, to remove ex-
traneous language.
Revise subsection (c) to clarify rule language.
Additional changes are proposed throughout the rule to update
terms, remove obsolete language, clarify language, and re-for-
mat the rule.
Fiscal Note
Thomas M. Suehs, Deputy Executive Commissioner for Finan-
cial Services, has determined that during the first five-year pe-
riod the amended rule is in effect there will be a fiscal impact of
$8,772,506 (SFY 2010); $9,431,080 (SFY 2011); $10,171,179
(SFY 2012); $10,974,702 (SFY 2013); $11,852,679 (SFY 2014)
to state government. The proposed rule will not result in any fis-
cal implications for local health and human services agencies.
Local governments will not incur additional costs.
Small and Micro-Business Impact Analysis
Mr. Suehs has also determined that there will be no effect on
small businesses or micro-businesses to comply with the new or
amended requirements, as they will not be required to alter their
business practices as a result of the rule. The new and amended
requirements update the rule to conform to current policies and
practices, and add a new adult well exam benefit that is not ex-
pected to alter business practices.
There are no anticipated economic costs to persons who are re-
quired to comply with the proposed rule. There is no anticipated
negative impact on local employment.
Public Benefit
Chris Traylor, Associate Commissioner for Medicaid and CHIP,
has determined that for each year of the first five years the pro-
posed amendments are in effect, the public will benefit from the
adoption of the amended rule. The anticipated public benefit of
enforcing the proposed amendments will be improved access to
and quality of health care services.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environ-
mental rule" as defined by 2001.0225 of the Texas GovernmentCode. "Major environmental rule" is defined to mean a rule the
specific intent of which is to protect the environment or reduce
risk to human health from environmental exposure and that may
adversely affect, in a material way, the economy, a sector of the
economy, productivity, competition, jobs, the environment or the
public health and safety of a state or a sector of the state. This
proposal is not specifically intended to protect the environment
or reduce risks to human health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or
limit an owner's right to his or her property that would other-
wise exist in the absence of government action and, therefore,
does not constitute a taking under 2007.043 of the Texas Gov-
ernment Code. Under 2007.003(b) of the Texas Government
Code, HHSC has determined that Chapter 2007 of the Texas
Government Code does not apply to this rule. The changes this
rule makes do not implicate a recognized interest in private real
property. Accordingly, HHSC is not required to complete a tak-
ings impact assessment regarding this rule.
Public Comment
Written comments on the proposed amendments may be submit-
ted to Garry Walsh, Senior Policy Analyst, Medicaid/CHIP Divi-
sion, Texas Health and Human Services Commission, P.O. Box
13247, H390, Austin, Texas 78711; by fax to (512) 249-3731; or
by e-mail to garry.walsh@hhsc.state.tx.us within 30 days of pub-
lication of this proposal in the Texas Register.
Public Hearing
A public hearing is scheduled for August 20, 2009, from 2:00 to
3:00 p.m. at the John H. Winters Building, Public Hearing Room,
125-E, located at 701 W. 51 st Street, Austin, Texas. Persons re-
quiring further information, special assistance, or accommoda-
tions should contact Mary Haifley at (512) 491-5605.
Statutory Authority
The amendments are proposed under Texas Government Code
531.033, which provides the Executive Commissioner of HHSC
with broad rulemaking authority; and Human Resources Code
32.021 and Texas Government Code 531.021 (a), which pro-
vide HHSC with the authority to administer the federal medical
assistance (Medicaid) program in Texas.
The proposed amendments affect the Human Resources Code,
Chapter 32, and the Texas Government Code, Chapter 531. No
other statutes, articles, or codes are affected by this proposal.
354.1149. Exclusions and Limitations.
(a) Notwithstanding any other provision of this subchapter,
Medicaid services or supplies that are not medically necessary will not
be considered for Medicaid reimbursement. The following benefit ex-
clusions and limitations are applicable under the Medicaid program for
services provided under this subchapter. They do not apply to Medic-
aid services provided through the Texas Health Steps Comprehensive
Care Program. Additional exclusions and limitations are listed in the
Texas Medicaid Provider Procedures Manual. The following benefits
are not included in the Texas Medicaid Program [Benefits do not ex-
tendl to]
(1) services provided to any individual who is an inmate in
a public institution (except as a patient in a medical institution approved
for participation in the Medicaid program [Texas Medical Assistance
Program]), or is a patient in:34 TexReg 5454 August 14, 2009
Texas Register
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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/m1/9/?rotate=270: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.