The Texas Health and Human Services Commission (HHSC) proposes new Division 3, Comprehensive Rehabilitation Services for Individuals with a Traumatic Brain Injury or Traumatic Spinal Cord Injury, and new §355.9040, concerning Reimbursement Methodology for Comprehensive Rehabilitation Services Program, under Subchapter M.

BACKGROUND AND JUSTIFICATION

This rule establishes the reimbursement methodology for the Comprehensive Rehabilitation Services (CRS) program administered by the Texas Department of Assistive and Rehabilitative Services (DARS). HHSC, under its authority and responsibility to administer and implement rates, is proposing this rule to codify the reimbursement methodology for this program, which provides services to individuals with a traumatic brain injury (TBI) or traumatic spinal cord injury (SCI).

The proposed reimbursement methodology describes the method by which HHSC will determine the rates for TBI and SCI Inpatient Comprehensive Medical Rehabilitation Services, TBI and SCI Outpatient Services, Post-Acute Brain Injury (PABI) Residential Services, and PABI and Post-Acute SCI Non-Residential Services.

SECTION-BY-SECTION SUMMARY

Proposed §355.9040(a) describes the payment rate determination methodology for all four categories of service arrays in the CRS program.

Proposed §355.9040(b) makes information in the cost determination process rules applicable to this rule.

Proposed §355.9040(c) authorizes HHSC to require providers to submit cost reports, describes the rules a provider must follow in submitting such reports, and explains the means by which a contracted provider may be excused from submitting a cost report.

FISCAL NOTE

Rebecca Trevino, Chief Financial Officer for DARS, has determined that, during the first five-year period the rule is in effect, there will not be a fiscal impact to state government.

There are no fiscal implications for local governments as a result of enforcing or administering the rule. The rule will not affect a local economy or local employment for the first five years the proposed rule will be in effect.

SMALL BUSINESS AND MICRO-BUSINESS IMPACT ANALYSIS

HHSC has determined that there is no adverse economic effect on small businesses or micro-businesses as a result of the rule. The implementation of the proposed rule does not require any changes in practice or additional cost to a contracted provider, and HHSC anticipates that the new methodology will lead to increased rates for those CRS providers that qualify as small or micro-businesses.

PUBLIC BENEFIT AND COST

Pam McDonald, Director of Rate Analysis for HHSC, has determined that for each of the first five years the rule is in effect, the expected public benefit is that the reimbursement methodology for the CRS program will be documented, consistent, and transparent.

Ms. McDonald does not anticipate that there will be any economic cost to persons who are required to comply with the proposed rule during the first five years the rule will be in effect.

REGULATORY ANALYSIS

HHSC has determined that this proposal is not a "major environmental rule" as defined by §2001.0225 of the Texas Government Code. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment or the public health and safety of a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that this proposal does not restrict or limit an owner's right to his or her private real property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Questions about the content of this proposal may be directed to Andrew Wolfe in the HHSC Rate Analysis Department by telephone at (512) 707-6072. Written comments on the proposed rule may be submitted to Mr. Wolfe by facsimile at (512) 730-7475, by e-mail to andrew.wolfe@hhsc.state.tx.us, or by mail to HHSC Rate Analysis, Mail Code H-400, P.O. Box 149030, Austin, Texas, 78714-9030, within 30 days of publication of this proposal in the Texas Register.

STATUTORY AUTHORITY

The new rule is proposed under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority, and under §531.0055, which provides the Executive Commissioner with the authority to promulgate rules for the provision of health and human services by the health and human services agencies.

The new rule affects the Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by this proposal.