The following are several rule changes that were published in last Friday’s Texas Register. A link to the actual proposed rule change follows each summary.
Summary of Proposed Rule Changes to 1 TAC §355.8060
- The purpose of this rulemaking action is to separate the Medicaid reimbursement methodology for freestanding psychiatric facilities into a stand-alone rule to clarify definitions, processes, and timing related to freestanding psychiatric facility reimbursement.
- These changes include a clarification of the terms “facility” and “hospital.”
- “Facility” is used when describing the Medicare prospective payment methodology.
- “Hospital” is used only when describing a freestanding psychiatric facility that is requesting designation as a children’s hospital and, therefore, exemption from the prospective payment methodology.
- The new rule will become effective for claims approved for payment for admissions in state fiscal year 2010.
http://www.sos.state.tx.us/texreg/sos/PROPOSED/1.ADMINISTRATION.html#12
Summary of Proposed Rule Changes 1 TAC §355.8061
- The proposed amendment is part of a larger revision to repeal language in §355.8063 and replace it with program-specific, stand-alone Medicaid hospital reimbursement rules.
- The amendment removes references to §355.8063, Reimbursement Methodology for Inpatient Hospital Services, and references to outpatient supplemental payments.
- The amendments will make it easier for providers to find the reimbursement methodology that governs specific programs.
- The proposed amendment will not result in any fiscal implications for local health and human services agencies. Local governments will not incur additional costs.
http://www.sos.state.tx.us/texreg/sos/PROPOSED/1.ADMINISTRATION.html#14
Summary of Proposed Rule Changes to 1 TAC 355.8069:
- HHSC is rewriting the language of this rule to add language that will require each governmental entity or group of entities that owns a rural public hospital that is participating in this program to provide:
- the intergovernmental transfer (IGT) for its specific UPL payment;
- change the calculation period from a state fiscal year to a federal fiscal year and use adjudicated claims to compute supplemental payments;
- provide for a fourth-quarter payment reconciliation;
- and detail the process by which HHSC will recover an overpayment.
- The new language in the rule allows stakeholders to find all the information about this UPL program in one administrative rule and is written in a format that is easier to understand.
http://www.sos.state.tx.us/texreg/sos/PROPOSED/1.ADMINISTRATION.html#18
Summary of Proposed Rule changes to 1 TAC §355.8070:
- HHSC is combining the Medicaid inpatient and outpatient hospital supplemental payment methodologies from existing rules into one new comprehensive rule that will fully describe Medicaid supplemental payments made to eligible private hospitals.
- HHSC is updating the language in the new rule to better explain the complex processes used in private hospital supplemental payments (also known as Upper Payment Limit or UPL payments).
- The new rule reflects the existing UPL payment methodology for private hospitals that is included in Texas’ approved Medicaid state plan.
- During the first five-year period the proposed rule is in effect there will be no fiscal impact to state or local government as a result of proposing this new rule.
http://www.sos.state.tx.us/texreg/sos/PROPOSED/1.ADMINISTRATION.html#20
Summary of Proposed Rule Changes to 1 TAC §355.8071
- HHSC is repealing current §355.8071 and proposing to replace it with new §355.8071 to standardize the payment methodology and terminology to be consistent with rules governing other Medicaid supplemental payment programs.
- The propped rule expands the definitions and clarifies the processes used to calculate the supplemental payments to children’s hospitals.
- HHSC is redefining the calculation period from the state fiscal year to the federal fiscal year to be consistent with the Disproportionate Share Hospital (DSH) program and other UPL programs for 2010.
- No changes are being made to the calculations used to process payments.
- The changes described to the children’s hospital UPL program rule will have a neutral fiscal impact and local governments will not incur additional costs.
http://www.sos.state.tx.us/texreg/sos/PROPOSED/1.ADMINISTRATION.html#22
Summary of Proposed Rule Changes to 25 TAC §§421.1, 421.8, 421.9
- HHSC proposed amendments (32 TexReg 6030, September 7, 2007 Texas Register) to collect and report “diagnosis present on admission” (POA) indicators from all hospitals required to report under Health and Safety Code, Chapter 108, and to report the data collected, but the proposed amendment was later removed.
- Stakeholders suggested that the department propose the POA rules as previously written in 2007. It was indicated that many of the health plans are requiring POA indicators for claims adjudication.
- This proposed amendment requires the department to include a POA Indicator data element in the public use data file.
- Hospital types that are exempt from the reporting of the POA indicator new data element are: (1) Critical Access Hospitals; (2) Inpatient Rehabilitation Hospitals; (3) Inpatient Psychiatric Hospitals; (4) Cancer Hospitals; (5) Children’s or Pediatric Hospitals; and (6) Long Term Care Hospitals.
http://www.sos.state.tx.us/texreg/sos/PROPOSED/25.HEALTH%20SERVICES.html#96
