The Texas Health and Human Services Commission (HHSC) adopts §354.1149, concerning Exclusions and Limitations, and §354.1175, concerning Organ Transplants, without changes to the proposed text as published in the August 2, 2013, issue of the Texas Register (38 TexReg 4832) and will not be republished.

Background and Justification

Section 6507 of the Patient Protection and Affordable Care Act (PPACA) requires a state Medicaid program, for claims filed on or after October 1, 2010, to use mechanized claims processing and information retrieval systems that are compatible with National Correct Coding Initiative (NCCI) methodologies that have been identified by the Secretary of the United States Health and Human Services. HHSC accordingly implemented the specified NCCI medical coding edits for claims processing.

HHSC adopts §354.1149 and §354.1175 to be consistent with claims processing system processes that have been implemented as part of the new methodologies. Specifically, the claims processing system now processes inpatient hospitalization and related expenditures on all claims that exceed the annual individual inpatient cap of $200,000 sequentially, based on the date of service, rather than based on the date billings are received.

In addition to the amendments adopted to effectuate §6507 of the PPACA, HHSC adopts §354.1175 to correct rule and agency references.

Comments

The 30-day comment period ended September 1, 2013. HHSC received no comments regarding the proposed amendments.

Legal Authority

The amendments are adopted under Texas Government Code §531.0055, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which authorize HHSC to administer the federal medical assistance (Medicaid) program in Texas.