Below is a spotlight on the proposed, adopted, and withdrawn rules from the November 17 edition of the Texas Register.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
- MEDICAID MANAGED CARE – HHSC proposes an amendment concerning Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019. The proposed amendment would modify the eligibility criteria for NSGO NFs. Beginning in state fiscal year 2025, the eligibility criteria related to the NF being located in the same Regional Healthcare Partnership as, or within 150 miles of, the non-state governmental entity taking ownership of the facility would be amended to require the NSGO NF to be located in the state of Texas in the same county as, or county contiguous to, the non-state governmental entity taking ownership of the facility. The proposed amendment would also require an NSGO NF that is eligible to participate in QIPP due to an active partnership, to produce certain documentation in connection with the enrollment application that demonstrates active partnership between the NF and the governmental entity exists. The amendments to the active partnership criteria will enable HHSC to confirm NSGO eligibility at the time of program enrollment. Beginning in state fiscal year 2026, QIPP-enrolled NFs that undergo a change of ownership that changes the class of the facility during the program period will be removed from the program for the remainder of the program period after the CHOW effective date. The proposed amendment would also modify the funding allocations and frequency of QIPP payment distributions beginning in state fiscal year 2025. Earliest possible date of adoption: December 17, 2023
- MEDICAID HEALTH SERVICES – HHSC proposes an amendment concerning Medicaid Third Party Recovery. SB 1342 88(R) amended Texas Human Resources Code 32.0424 and repealed Texas Human Resources Code §32.042. Section 32.0424 requires a third party health insurer to: (1) provide certain insurance coverage information, upon timely request, to HHSC or HHSC’s designee; (2) with some exceptions, accept authorization from HHSC or HHSC’s designee that an item or service is covered by Medicaid as if that authorization is a prior authorization made by the third party health insurer; and (3) respond within 60 days to an inquiry from HHSC or HHSC’s designee regarding a claim for payment for health care submitted to the third party health insurer. Texas Human Resources Code §32.0424 defines “third party health insurer” to mean a health insurer or other person or arrangement that is legally responsible by state or federal law or private agreement to pay some or all claims for health care items or services provided to an individual. The proposed rules aim to implement the recent changes to the Texas Human Resources Code as it applies to Medicaid Third Party Recovery. Additionally, the proposed rules implement other changes made of the Social Security Act prior to H.R. 2471, such as obligating the state to require health insurers to accept the State’s right of recovery and assignment to the State of any right to payment for an item or service for which payment has been made under Medicaid and to agree not to deny a claim submitted by the State solely on the basis of the date of submission of the claim or the type or format of the claim form. The proposed revisions also add and update definitions; clarify the sections of the proposed rules that would apply to managed care organizations; add HHSC’s right, based on the United States Supreme Court decision in Gallardo v. Marstiller, 142 S. Ct. 1751 (2022), to seek reimbursement from settlement amounts representing past or future payments for medical care. Earliest possible date of adoption: December 17, 2023
PUBLIC UTILITY COMMISSION OF TEXAS
- SUBSTANTIVE RULES APPLICABLE TO ELECTRIC SERVICE PROVIDERS – The PUC adopts a new chapter relating to Texas Backup Power Package Advisory Committee. The commission adopts this rule with changes to the proposed text as published in the September 29, 2023, issue of the Texas Register. The new section implements the Public Utility Regulatory Act enacted by SB 2627 88(R). The new rule will establish an advisory committee to advise the commission on the administration of the Texas backup power package program. Specifically, the new rule will establish the purpose, duties, composition, membership, procedures, and term of the committee. The commission received comments on the proposed rule from East Texas Distribution Cooperatives (ETDC); Microgrid Resources Coalition (MRC), RPower LLC (RPower); Texas Electric Cooperatives (TEC); Texas Public Power Association (TPPA). A detailed description of the public comments can be found here.