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(a)In the event of a statewide emergency declared
by the Governor, THMP may temporarily adjust program operations to
ensure that mission critical functions continue. These cost containment
measures will be approved by the Commissioner in writing.
(b)THMP funds must be used as payor of last resort
and coordinated with other local, state, and federal funds, including
Medicaid and Medicare.
(1)To ensure THMP's expenditures do not exceed the
budget, the department analyzes the latest actuarial projections for
the upcoming year, including the average annual cost per individual
and the projected number of individuals THMP will be able to serve
using current budget figures. The department performs this analysis
of THMP expenditures every quarter to determine if funds are sufficient
to meet projected expenditures.
(2)To make certain that expenditures do not exceed
the program's budget, the department may implement the following temporary
cost-containment measures as necessary.
(c)If budgetary limitations exist, this information
will be shared with stakeholders at least 60 days before implementation.
The department has discretion to:
(1)Restrict or prioritize covered services based upon:
(A)medical necessity;
(B)other third-party eligibility and projected third
party payments for the different treatment modalities; or
(C)caseloads and demands for services based on current
or projected data.
(2)Discontinue use of the standard deduction adjusting
the applicant's gross annual income described in §98.103(b)(4)(D)
of this title (relating to THMP Eligibility Criteria).
(3)Lower the financial eligibility criteria established
by THMP policy 220.001 https://www.dshs.texas.gov/hivstd/policy/policies/220-001.shtm
to a level that is not lower than 125% of federal poverty level.
(4)Change covered services by adding or deleting specific
services or entire categories, making changes proportionally across
a category or categories, using a combination of these methods, or
establishing a waiting list of eligible applicants. Appropriate information
is collected from each applicant who is placed on a waiting list.
The information is used to facilitate contacting the applicant when
benefits become available and to allow efficient enrollment application
processing if the budgetary limitations loosen. In the event of a
waiting list, the department shall give priority to participation
in THMP to eligible women and infants and to individuals younger than
18 years of age.
(d)As funds become available, the department will
rescind the cost-containment measures in a manner which the department
judges most appropriate given the circumstances at that time.
The agency certifies that legal counsel has reviewed
the
adoption and found it to be a valid exercise of the agency's legal
authority.
Filed
with the Office of the Secretary of State on October 28, 2022
TRD-202204235 Cynthia Hernandez
General Counsel
Department of State Health Services
Effective date: November 17, 2022
Proposal publication date: June 10, 2022
For further information, please call: (737) 255-4300
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