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

BACKGROUND AND PURPOSE

The purpose of the rule amendment is to include non-state-owned institutions for mental diseases (IMDs) as a class of hospital eligible for rate increases under the uniform hospital rate increase program (UHRIP).

UHRIP is a Medicaid managed care directed payment program authorized by 42 CFR §438.6(c). HHSC launched UHRIP as a pilot project in December 2017 in the El Paso and Bexar managed care service delivery areas (SDAs). In September 2018, UHRIP expanded to the entire state. Through UHRIP, managed care organizations (MCOs) are contractually required to increase the reimbursement rate paid to hospitals for inpatient and outpatient services. The rate increase is a uniform percentage that varies by hospital class. UHRIP is a voluntary program and requires participation from all MCOs and network hospitals in an SDA.

Federal regulation has largely prohibited states from receiving federal Medicaid funds for services provided to beneficiaries in IMDs. This restriction is commonly referred to as the "Medicaid IMD Exclusion." However, two exemptions exist under §1905(a) of the Social Security Act: (1) inpatient hospital services and nursing facility services for individuals 65 years of age or older, and (2) inpatient psychiatric hospital services for individuals under age 21.

HHSC proposes to include non-state-owned IMDs among the classes of hospitals eligible for rate increases under UHRIP. Rate increases will apply only to payments made for inpatient psychiatric hospital services provided by non-state-owned IMDs to individuals under the age of 21 or inpatient hospital services provided by non-state-owned IMDs to individuals 65 years of age or older. Expanding UHRIP to these providers will increase the availability of services for eligible Medicaid beneficiaries with behavioral health needs.

HHSC also proposes to clarify that UHRIP rate increases apply only to the in-network managed care claims billed under the primary National Provider Identifier (NPI) number associated with the hospital. This proposed change clarifies that a non-hospital sub-provider owned or operated by a hospital is not eligible to receive the increase.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §353.1305(c) adds "non-state-owned IMDs" as a class of hospital eligible to receive rate increases under UHRIP for inpatient services.

The proposed amendment to §353.1305(e) adds that rate increases for a non-state owned IMD are limited to inpatient services provided to individuals under the age of 21 and to inpatient services provided to individuals 65 years or older. The proposed amendment also clarifies that UHRIP rate increases apply only to in-network managed care claims billed under a hospital's primary NPI number associated with the hospital.

FISCAL NOTE

Trey Wood, Acting Deputy Executive Commissioner for Financial Services, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rule will be in effect:

(1) the proposed rule will not create or eliminate a government program;

(2) implementation of the proposed rule will not affect the number of HHSC employee positions;

(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;

(4) the proposed rule will not affect fees paid to HHSC;

(5) the proposed rule will not create a new rule;

(6) the proposed rule will not expand, limit, or repeal existing rule;

(7) the proposed rule will increase the number of individuals subject to the rule; and

(8) the proposed rule will not affect the state's economy.

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

Trey Wood has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The proposed rule will allow non-state-owned IMDs to receive a directed payment under UHRIP. However, participation in the program described by the proposed rules is optional.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule does not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Charles Greenberg, Director of Hospital Finance and Waiver Programs, has determined that for each year of the first five years the rule is in effect, the public benefit will be that eligible Medicaid beneficiaries have access to inpatient hospital services that meet their behavioral health needs.

Trey Wood has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule. Participation in the program is optional.

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 Texas Government Code §2007.043.

PUBLIC HEARING

Details for the public hearing will be published as a notice in the Texas Register at a later date.

PUBLIC COMMENT

Written comments on the proposal may be submitted to HHSC, Mail Code 1000, P.O. Box 13247, Austin, Texas 78711-3247, or by email to RAD_1115_Waiver_Finance@hhsc.state.tx.us.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; or (2) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 20R046" in the subject line.

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services agencies; Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules necessary to carry out HHSC's duties; 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-1), 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 Texas Government Code §533.002, which authorizes HHSC to implement the Medicaid managed care program.

The amendment affects Human Resources Code Chapter 32 and Government Code Chapters 531 and 533.