Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,852
2821-2988 p. ; 28 cm.View a full description of this periodical.
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THSteps medical case management services mandated by the
federal EPSDT program.
Ravi Rupsingh, M.P.A., Actuary, Actuary Analysis, HHSC, has
determined for the first five years the sections are in effect, there
will be cost savings to the state through the combination of the
two programs as described in this preamble. Total cost savings
per year are $1,724,820, $6,153,493, $6,348,526, $6,549,411
and $6,745,893 in state fiscal years 2003, 2004, 2005, 2006 and
2007, respectively, for a total of $27,522,143 over these five state
fiscal years. There will be no impact on local government.
Duane Thomas, Ph.D., Texas Department of Health, Director of
Regional Case Management has also determined that for each
of the first five years the sections are in effect, anticipated pub-
lic benefits include better access to primary care providers, pre-
ventative health services, other health services and community
resources for children and pregnant women accessing the ser-
vices. There will be costs to small businesses and micro-busi-
nesses. This was determined after concluding that the elimina-
tion of the Intake as a billable contact for Targeted Case Manage-
ment for Pregnant Women and Infants providers will decrease
the amount of reimbursement that these providers currently re-
ceive. The cost to small and micro-businesses for the first year
of implementation is estimated to be $7,327 while the cost to
large businesses for the first year of implementation is estimated
to be $7,281. The estimated costs are based on the assumption
that 70% of Targeted Case Management for Pregnant Women
and Infants providers are large businesses and 30% of providers
are small or micro-businesses. There will be no anticipated eco-
nomic costs to persons who receive the services. The depart-
ment has determined that the proposed rules do not restrict or
limit an owner's right to their property that would otherwise exist
in the absence of governmental action and therefore does not
constitute a taking under Government Code, 2007.043.
Comments on the proposal may be submitted to Cossy Hough,
LMSW-ACP, Texas Department of Health, 1100 West 49th
Street, Austin, Texas 78756, (512) 458-7111, extension 6664.
Comments will be accepted for 30 days following publication of
the proposal in the Texas Register.
A public hearing regarding these proposed rules will be held on
April 8, 2003, from 1:00 p.m. to 4:00 p.m. at the Texas Depart-
ment of Health, Moreton Building, Room M-739, 1100 West 49th
Street, Austin, Texas 78756.
The new sections are proposed under the Health and Safety
Code, 12.001, which provides the Board of Health (board) with
the authority to adopt rules to implement every duty imposed
by law on the board, the department and the commissioner of
health; and under the Health and Safety Code, Chapter 32,
which provides the board with the authority to establish ma-
ternal and infant health improvement services programs in the
department to serve eligible recipients; the Human Resources
Code, 22.0031, which mandates case management for high
risk pregnant women and high risk infants under 1915(g) of
the federal Social Security Act (42 U.S.C. 1396n); the Human
Resources Code, Chapter 32, which enables the state to provide
medical assistance; the Government Code, 531.021, which
provides HHSC with the authority to propose rules to administer
the state's medical assistance program and are submitted by
the Texas Department of Health under its agreement with HHSC
to operate the EPSDT program, and as authorized under 1.07
of the Acts of the 72nd Legislature, First Called Session (1991),
Chapter 15, as amended by the Acts of the 73rd Legislature,
Chapter 747, 2.The proposed new sections affect the Health and Safety Code,
Chapter 32, the Human Resources Code, 22.0031 and Chapter
32.
27.1. Definition of Terms.
The following words and terms when used in this chapter shall have
the following meanings unless the context clearly indicates otherwise.
(1) Access--The ability of an eligible recipient to obtain
health and health-related services, as determined by factors such as:
the availability of THSteps services; service acceptability to the eligi-
ble child, family, and/or pregnant woman; the location of health care
facilities and other resources; transportation; hours of facility opera-
tion and length of time available to see the healthcare provider.
(2) Applicant--An agency, organization, or individual who
submits an application to the department to provide Case Management
for Children and Pregnant Women under this subchapter and who meets
the applicant qualifications and requirements as stated in 27.9 and
27.11 of this title (relating to Applicant Qualifications and Case Man-
agement Provider Requirements).
(3) Application process--Submission of an application to
provide Case Management for Children and Pregnant Women and the
department's ensuing review and disposition of the application.
(4) Billable contact--A documented Comprehensive Visit
or Follow-up contact with an eligible recipient, by an approved case
manager who provides an eligible case management service, as de-
fined in 27.5 of this title (relating to Case Management and Pregnant
Women).
(5) Board--The Texas Board of Health.
(6) Case manager--An individual who provides Case Man-
agement for Children and Pregnant Women services either indepen-
dently or as an employee of a Case Management Provider.
(7) Case management provider--An agency or individual
approved by the department to provide Case Management for Children
and Pregnant Women Services and enrolled as a Medicaid provider.
(8) Case Management for Children and Pregnant Women--
The federal enhancement service which assists eligible recipients in
gaining access to medically necessary medical, social, educational, and
other services.
(9) Children with a health condition/health risk--Children
who have or are at risk for a medical condition, illness, injury, or dis-
ability that results in limitation of function, activities or social roles
in comparison with healthy age peers in the general areas of physical,
cognitive, emotional, or social growth and development.
(10) Continuity of care--The degree to which: the care of a
child is provided by the same medical home or primary care provider;
the system of care remains stable and services are consistent, undupli-
cated and uninterrupted.
(11) Department--The Texas Department of Health.
(12) EPSDT--Early and Periodic Screening, Diagnosis and
Treatment program. All states participating in the Medicaid program
must offer EPSDT to children under age 21 who qualify for Medicaid.
EPSDT provides medical and dental services to Medicaid and Texas
Health Steps clients under age 21 years. In Texas, EPSDT is known as
Texas Health Steps (THSteps).
(13) Family--A basic unit in society having at its nucleus:
one or more adults living together and cooperating in the care and rear-
ing of their own or adopted children; a person or persons acting as the28 TexReg 2852 April 4, 2003 Texas Register
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Texas. Secretary of State. Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003, periodical, April 4, 2003; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth101027/m1/31/: accessed May 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.