Texas Register, Volume 30, Number 41, Pages 6499-6834, October 14, 2005 Page: 6,522
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(B) HHAs and Medicare-certified outpatient facilities
known as comprehensive outpatient rehabilitation facilities (CORFs)
and outpatient rehabilitation facilities (ORFs), 1 TAC 355.8085 of
this title;
(C) Medicare-certified freestanding rehabilitation hos-
pitals, 1 TAC 355.8063 of this title; and
(D) outpatient hospitals, 1 TAC 355.8061 of this title.
(8) Nutritional services provided by licensed dietitians for
the purpose of treating, preventing or minimizing the effects of illness,
injuries, or other impairments are reimbursed according to the lesser
of the provider's billed charges or fees determined by HHSC in ac-
cordance with 355.8085 of this title (relating to Texas Medicaid Re-
imbursement Methodology (TMRM) for Physicians and Certain Other
Practitioners).
(9) Providers are reimbursed for the administration of im-
munizations according to the lesser of the provider's billed charges or
fees determined by HHSC in accordance with 355.8085 of this title
(relating to Texas Medicaid Reimbursement Methodology (TMRM)
for Physicians and Certain Other Practitioners).
(10) Vaccines not covered elsewhere are reimbursed ac-
cording to the lesser of the provider's billed charges or the actual cost
of the vaccine.
(11) Dental services provided by independently enrolled
dentists are reimbursed in accordance with 355.8081 of this title
(relating to Payments for Laboratory and X-ray Services, Radiation
Therapy, Physical Therapists' Services, Physician Services, Podiatry
Services, Chiropractic Services, Optometric Services, Ambulance Ser-
vices, Dentists' Services, and Psychologists' Services). The fees are
calculated as access-based fees under 355.8085 of this title (relating
to Texas Medicaid Reimbursement Methodology (TMRM) for Physi-
cians and Certain Other Practitioners) and are based on a percentage
of the billed charges (i.e., the usual-and-customary amount providers
charge non-Medicaid clients for similar services) reported on Medic-
aid dental claims for each dental service, excluding billed charges that
are less than or equal to the published Medicaid fee for that service.
The fees are reviewed at least every two years. Dental services pro-
vided by federally qualified health centers (FQHCs) are reimbursed in
accordance with 355.8261 of this title (relating to Reimbursement).
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.
Filed with the Office of the Secretary of State on October 3, 2005.
TRD-200504452
Steve Arag6n
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: November 13, 2005
For further information, please call: (512) 424-6900
CHAPTER 363. COMPREHENSIVE CARE
PROGRAM
SUBCHAPTER C. PRIVATE DUTY NURSING
SERVICES
1 TAC 363.303, 363.307, 363.311, 363.313, 363.315The Texas Health and Human Services Commission (HHSC)
proposes to amend Chapter 363, Comprehensive Care
Program, Subchapter C, Private Duty Nursing, 363.303, Def-
initions; 363.307, Client Eligibility Criteria; 363.311, Private
Duty Nursing Benefits and Limitations; 363.313, Plan of Care;
and 363.315, Termination of Authorization for Private Duty
Nursing.
Background and Justification
The purpose of these amendments is to provide an additional re-
source in the delivery of private duty nursing services to Medic-
aid recipients under age 21 by adding delegation of skilled nurs-
ing services by a registered nurse (RN) to a qualified aide. The
proposed amendments define nurse delegation in accordance
with RN delegated tasks criteria as determined by the Board of
Nurse Examiners. The proposed amendments also remove ob-
solete language, include revisions necessary to better describe
current processes and procedures related to the provision of pri-
vate duty nursing (PDN) services, and add the word "services" to
"private duty nursing" where appropriate to better reflect the ar-
ray of options available to deliver PDN services: RN, licensed vo-
cational nurse/licensed practical nurse, or RN delegation. Also,
the amendments replace the term "department" with "HHSC."
Section-by-Section Summary
The Health and Human Services Commission proposes the fol-
lowing amendments to the rules:
Amend each section of the rules to add the word "Services" to
the heading title.
The amendment to 363.303, Definitions, includes adding the
definitions of a qualified aide and delegated nursing, along with
reference updates and technical changes. The amendment also
clarifies current PDN processes and procedures.
Section 363.307, Client Eligibility Criteria, subsection (a)(3)(E)
is amended to clarify care activity and remove language regard-
ing extension of private duty nursing services. The amendment
also updates references and replaces the term "department" with
"HHSC."
Section 363.311, Private Duty Nursing Benefits and Limitations,
is amended to clarify that HHSC or its designee currently pro-
vides notice of the approval, reduction, modification, or denial of
requested PDN services to the client/family and provider.
Section 363.313, Plan of Care, is amended to revise references
and replace the term "department" with "HHSC."
Section 363.315, Termination of Authorization for Private Duty
Nursing, is amended to replace the term "department" with
"HHSC."
Fiscal Note
Tom Suehs, Deputy Executive Commissioner for Financial Ser-
vices, has determined that during the first five-year period the
amended rules are in effect there will be a cost to the state
of $26,700,725 general revenue and an all funds fiscal impact
of $67,906,291 in State Fiscal Year 2006. The fiscal impact to
general revenue for State Fiscal Year 2007 is $38,581,145 and
$38,511,034 for each State Fiscal Year from 2008 through 2010.
All funds fiscal impact for each State Fiscal Year 2007 through
2010 is $100,158,737. The proposed rule will not result in any
fiscal implications for local health and human services agencies.
Local governments will not incur additional costs.
Small Business and Micro-business Impact Analysis30 TexReg 6522 October 14, 2005 Texas Register
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Texas. Secretary of State. Texas Register, Volume 30, Number 41, Pages 6499-6834, October 14, 2005, periodical, October 14, 2005; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth97314/m1/21/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.