The Texas Health and Human Services Commission (HHSC) has proposed amendments in the following areas – concerning Reimbursement Methodology for Common Services in Home and Community-Based Services Waivers and living assistance and support services, funding for DSRIP monitoring program, and certain FFS to pharmacy provider types who are enrolled in a federal drug pricing discount program:
REIMBURSEMENT RATES
HHSC proposes to amend 1 TAC §355.502, concerning Reimbursement Methodology for Common Services in Home and Community-Based Services Waivers, and §355.505, concerning Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program, and §355.723, concerning Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs.
These amendments are being proposed to add cognitive rehabilitative therapy as a service to the Community Living Assistance and Support Services (CLASS) and Home and Community-based Services (HCS) programs. The Legislature provided funding of these services in the 83rd Legislative session.
TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT
HHSC proposes new 1 TAC §355.8204, concerning Funding for Delivery System Reform Incentive Payment (DSRIP) Monitoring Program.
The proposed new rule describes the method by which HHSC will determine the amount of intergovernmental transfer allocated for DSRIP monitoring and provides for a method by which unused funds will be returned to transferring governmental entities.
PHARMACY SERVICES: REIMBURSEMENT
HHSC proposes to amend 1 TAC §355.8548, concerning certain Medicaid fee-for-service (FFS) pharmacy provider types who are enrolled in a federal drug pricing discount program.
Proposed amended §355.8548 clarifies that the 340B program requires drug manufacturers to provide outpatient drugs to eligible patients at reduced prices; indicates that entities enrolled in the federal 340B Program will be reimbursed on HHSC's best estimate of the 340B Program price plus a dispensing fee; and defines terms used in the section.