The Texas Health and Human Services Commission (HHSC) proposes amendments to Chapter 353, Subchapter A, General Provisions, §353.2, concerning Definitions; Subchapter G, STAR+PLUS, §353.601, concerning General Provisions; and §353.603, concerning Member Participation; and Subchapter H, STAR Health, §353.701, concerning General Provisions; and §353.702, concerning Member Participation.

HHSC proposes new Subchapter M, concerning Home and Community Based Services in Managed Care, including new §353.1151, concerning General Provisions; §353.1153, concerning STAR+PLUS Home and Community Based Services (HCBS) Program; and §353.1155, concerning Medically Dependent Children Program. HHSC also proposes new Subchapter N, concerning STAR Kids, including new §353.1201, concerning General Provisions; §353.1203, concerning Member Participation; §353.1205, concerning Service Coordination; §353.1207, concerning Participating Providers; and §353.1209, concerning STAR Kids Handbook.

BACKGROUND AND JUSTIFICATION

HHSC proposes amendments to Subchapter A to update the definitions rule for Chapter 353. HHSC proposes amended rules in Subchapters G and H, concerning STAR+PLUS and STAR Health, to make changes resulting from the STAR Kids implementation. These primarily include changes to the list of client populations who are mandatory, voluntary, or excluded for these programs.

HHSC proposes amendments to STAR+PLUS member participation and program rules under Subchapter G to implement Senate Bill 169 (84th Legislature, Regular Session, 2015), which enacted new Texas Government Code §531.0931 regarding military members and their dependents who are on interest or waiting lists for services.

HHSC proposes to create new Subchapter M, concerning Home and Community Based Services in Managed Care. This subchapter describes the member participation and assessment requirements for the STAR+PLUS Home and Community Based Services (HCBS) program offered to qualified members in the STAR+PLUS managed care program and the Medically Dependent Children Program (MDCP).

HHSC proposes to create new Subchapter N, concerning STAR Kids. Senate Bill 7 (83rd Legislature, Regular Session, 2013) enacted new Texas Government Code §533.00253, which directs HHSC to establish a mandatory, capitated STAR Kids managed care program tailored to provide Medicaid benefits to individuals with disabilities under the age of 21. HHSC intends for the STAR Kids program to improve coordination of care, access to care, health outcomes, and quality of care, with an operational start date of November 1, 2016. Proposed Subchapter N contains the rules required to implement this program.

SECTION-BY-SECTION SUMMARY

Proposed §353.2 adds definitions for "CFR," "Consumer Directed Services (CDS) option, " "Habilitation, " "Legally authorized representative," "MDCP, " and "STAR Kids. " Proposed amendments also revise the definitions of "Action," "CMS," "Covered Services, " "Cultural Competency, " "Long term service and support (LTSS), " "Medical Assistance Only (MAO), " "Medically necessary, " and "STAR+PLUS Home and Community-Based Services Waiver. "

Proposed §353.601 lists subchapters that apply to the STAR+PLUS program.

Proposed §353.603 removes the option of voluntary enrollment in STAR+PLUS for those children who will be served by the STAR Kids program, as described in proposed Subchapter N, and makes other non-substantive updates and corrections.

Proposed §353.701 lists subchapters that apply to the STAR Health program and corrects a cross reference.

Proposed §353.702 revises the categories of individuals who cannot participate in STAR Health, to remove the exclusion of children and young adults who are dual eligible, to ensure these children and young adults receive services through STAR Health rather than STAR Kids. Proposed amendments also remove references to the Former Foster Care in Higher Education (FFCHE) program and make other nonsubstantive corrections.

Proposed §353.1151 outlines general provisions for home and community-based services offered through a Medicaid managed care organization (MCO).

Proposed §353.1153 describes eligibility and assessment processes for the STAR+PLUS Home and Community-Based Services (HCBS) program.

Proposed §353.1155 describes eligibility and assessment processes for the Medically Dependent Children Program (MDCP).

Proposed §353.1201 outlines general provisions for the STAR Kids program, including a list of certain subchapters of Chapter 353 that apply to the STAR Kids program.

Proposed §353.1203 describes the populations that will be mandatorily enrolled in STAR Kids and the populations that are excluded from STAR Kids.

Proposed §353.1205 describes the service coordination available to STAR Kids members.

Proposed §353.1207 outlines requirements for STAR Kids participating providers.

Proposed §353.1209 describes the purpose of the STAR Kids Handbook.

FISCAL NOTE

Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that during the first five years the proposed new and amended rules are in effect, there could be a reduction in cost due to the transition of the service delivery model from fee-for-service to managed care for STAR Kids and for MDCP services delivered through STAR Kids and STAR Health. However, there may be capitation rate increases for STAR Health due to this implementation. Capitation rate negotiations later this year will determine the outcome of any capitation changes. With capitation rate development pending, uncertainties as to the fiscal impact exist due to potential for a resulting cost or savings.

There is no anticipated impact to costs and revenues of local governments.

SMALL BUSINESS AND MICRO-BUSINESS IMPACT ANALYSIS

HHSC has determined that there will be no adverse economic effect on small businesses or micro-businesses as a result of enforcing or administering the proposed new and amended rules, because no Texas Medicaid MCO qualifies as a small business or micro-business.

PUBLIC BENEFIT AND COST

Gary Jessee, State Medicaid Director, has determined that for each year of the first five years the rules are in effect, the proposed new and amended rules are expected to positively impact individuals receiving Medicaid services. The proposed new rules provide guidance regarding the new STAR Kids program. Proposed amendments to existing STAR+PLUS and STAR Health, and proposed new rules related to HCBS in managed care, provide increased clarity and guidance, which will make it easier for Medicaid providers and members to understand managed care and how to access services. This will lead to increased access to care and will help ensure continuity of care across programs and MCOs.

Ms. Rymal has also determined there is no anticipated economic cost to persons required to comply with the proposed new and amended rules.

HHSC has determined that the proposed new and amended rules will not affect a local economy. There is no anticipated negative impact on local employment.

REGULATORY ANALYSIS

HHSC has determined that this proposal is not a "major environmental rule" as defined by §2001.0225 of the Texas Government Code. A "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 property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under §2007.043 of the Government Code.

PUBLIC COMMENT

Written comments on the proposal may be submitted to Kellie Dees, STAR Kids Specialist, at 4900 N. Lamar Blvd, MC H-312, Austin, Texas 78751; by fax to (512) 730-7452; or by e-mail to kellie.dees@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas Register.

STATUTORY AUTHORITY

The new rules are proposed under Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §533.00253, which requires HHSC to implement the STAR Kids managed care program.

The proposed new rules affect Texas Human Resources Code Chapter 32 and Texas Government Code Chapters 531 and 533. No other statutes, articles, or codes are affected by these proposed new rules.