The Texas Health and Human Services Commission (HHSC) proposes an amendment to §353.1305, concerning Uniform Hospital Rate Increase Program.

BACKGROUND AND PURPOSE

In March of 2017, HHSC adopted rules governing a provider payment initiative through Medicaid managed care organizations (MCOs) called the Uniform Hospital Rate Increase Program (UHRIP) (42 TexReg 1748). Under the UHRIP initiative, a service delivery area (SDA) may apply to receive an increase in certain hospital rates which would vary by class of hospital. Although UHRIP was to begin in September 2017 and be available to any SDA, operational issues necessitated a delay. Such issues included lack of readiness by MCOs, lack of program understanding among providers, and incomplete approvals from the Centers for Medicare & Medicaid Services (CMS). HHSC proposes to amend the UHRIP rule in three ways.

First, HHSC proposes to amend §353.1305(b)(7) and (8), the definitions of "rural private hospital" and "rural public hospital," to be consistent with a revised definition of "rural hospital" that was adopted in §355.8052 (relating to Inpatient Hospital Reimbursement) to be effective September 1, 2017. The definitions in this rule would now refer to the definition of "rural hospital" in §355.8052.

Second, HHSC proposes to add §353.1305(k), which would allow for a limited December 1, 2017, entry into UHRIP for a subset of SDAs. Specifically, if HHSC received an approval from CMS for any particular SDA by April 15, 2017, that SDA would be able to participate in UHRIP for dates of service beginning December 1, 2017.

Third, HHSC standardizes references to SDA throughout the section.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §353.1305(a) adds an acronym for "service delivery area."

The proposed amendment to §353.1305(b) changes the definitions of "rural private hospital" and "rural public hospital" to refer to the definition of "rural hospital" in §355.8052. The proposed amendment also changes "service delivery area" to the acronym "SDA."

The proposed amendment to §353.1305(c), (d), (e), (f), and (g) changes "service delivery area" to the acronym "SDA."

Proposed new §353.1305(k) allows SDAs that received participation approval from CMS by April 15, 2017, to implement UHRIP for dates of service beginning December 1, 2017.

FISCAL NOTE

Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that for each year of the first five years that the amendment will be in effect, there will be no fiscal implications to state government as a result of enforcing or administering the amendment as proposed. There may be fiscal implications to local governments, but there is insufficient information to provide an estimate because HHSC does not know which non-state governmental entities will voluntarily sponsor rate increases under this section or at what level of funding.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Ms. Rymal has also determined that there will be no adverse impact on small businesses, micro-businesses, or rural communities required to comply with the amendment as proposed. To the extent any entity is economically impacted by this rule, the impact would be positive.

ECONOMIC COSTS TO PERSONS AND IMPACT ON LOCAL EMPLOYMENT

There are no anticipated economic costs to persons who are required to comply with the amendment as proposed.

There is no anticipated negative impact on local employment.

PUBLIC BENEFIT

Pam McDonald, Director of Rate Analysis, has determined that for each year of the first five years the amended rule is in effect, the public will benefit from adoption of the amendment. The public benefit anticipated as a result of enforcing or administering the amendment is that areas of the state that received early UHRIP-related approvals from CMS will have access to enhanced Medicaid payments for hospital services. An additional public benefit is that the definitions of "rural" hospitals will be consistent across multiple reimbursement programs and in the administrative rules associated with those programs.

REGULATORY ANALYSIS

The department has determined that this proposal is not a "major environmental rule" as defined by Government Code, §2001.0225. "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 the 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 Government Code, §2007.043.

PUBLIC HEARING

A public hearing is scheduled for September 27, 2017, at 9:30 a.m. (central time) in the Brown Heatly Building Public Hearing Room 1410, at 4900 North Lamar Blvd., Austin, Texas. Persons requiring further information, special assistance, or accommodations should contact Selvadas Govind at (512) 707-6080.

PUBLIC COMMENT

Written comments on the proposal may be submitted to Kevin Niemeyer, HHS Rate Analysis, P.O. Box 149030, Mail Code H-400, Brown-Heatly Building, 4900 N. Lamar Blvd., Austin, Texas 78714-9030; by fax to (512) 730-7475; or by e-mail to kevin.niemeyer@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas Register.

To ensure that the comments will be considered, comments must be submitted no later than 30 days after the date of this issue of the Texas Register. The last day to submit comments falls on a Sunday; therefore, comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) faxed or e-mailed by midnight on the last day of the comment period. When faxing or e-mailing comments, please indicate "Comments on Proposed Rule UHRIP" in the subject line.

STATUTORY AUTHORITY

The amendment is 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; Texas Government Code §531.021(b), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under the Texas Human Resources Code, Chapter 32; and with Texas Government Code §533.002, which authorizes HHSC to implement the Medicaid managed care program.

The proposed amendment implements Texas Human Resources Code, Chapter 32; Texas Government Code, Chapter 531; and Texas Government Code, Chapter 533. No other statutes, articles, or codes are affected by this proposal.