Texas Register, Volume 29, Number 5, Pages 727-1096, January 30, 2004 Page: 743
727-1096 p. ; 28 cm.View a full description of this periodical.
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Steve Arag6n
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: February 29, 2004
For further information, please call: (512) 424-6576
1 TAC 371.212 - 371.214
The Health and Human Services Commission (HHSC) proposes
to amend Chapter 371, Medicaid Fraud and Abuse Program In-
tegrity, Subchapter C, Utilization Review, 371.212, Case Mix
Classification System, 371.213, Utilization Review and Control
Activities Performed by Texas Department of Human Services,
concerning the authority for on-site utilization review activities,
and 371.214, Texas Index for Level of Effort (TILE) Assess-
ments.
The 75th Legislature, Regular Session, 1997, through Senate
Bill 30, directed the transfer of Utilization Assessment and Re-
view and all its powers, duties, functions, and programs from
the Texas Department of Human Services (TDHS) to HHSC, ef-
fective September 1, 1997. Rules were officially transferred in
March 2000, without language change, from Title 40 of this code
to Title 1. One of the functions transferred was the case mix re-
view of nursing facilities. "Case mix" refers to a method of classi-
fying recipients based on their resource and service needs and
determining a payment rate based on that classification.
HHSC's Utilization Review (UR) staff has been evaluating the
current process since the transfer of the case mix review func-
tion to HHSC in 1997. UR staff has determined that these pro-
posed rule amendments are needed to increase the UR staff's
effectiveness in the identification, prevention, and elimination of
fraud, abuse, waste, and neglect, as well as the enforcement of
applicable laws and rules. In addition, the proposed rule amend-
ments add or delete language in order to clarify requirements,
correct grammar and spelling, eliminate outdated terms, and re-
flect current terminology.
These proposed amendments to the case mix rules were devel-
oped in conjunction with a work group consisting of representa-
tives from the Texas Health Care Association, the Texas Associa-
tion of Homes and Services for the Aging, the Texas-New Mexico
Hospice Association, New Bell General Services, National Her-
itage Insurance Company, and state health and human services
agencies.
Proposed 371.212 generally describes the case mix classifica-
tion system and facility documentation requirements, gives di-
rection on completing the Client Assessment Review and Eval-
uation (CARE) form, and gives definitions of the various clinical
categories necessary to establish a Texas Index for Level of Ef-
fort (TILE) assessment. Under the proposed rules, there are
changes in the Rehabilitation/Restorative requirements, oxygen
administration requirements, respiratory therapy requirements,
wound dressing requirements, training in reference to feeding,
signature requirements, and the word "permanent" was replaced
with "significant", including the definition of that term.
Proposed 371.213 deletes specific language in regard to the
quality of care review of children. HHSC staff determined that
there is no longer a need to conduct quality of care reviews on
children in nursing facilities, because there are multiple agencies
currently conducting these reviews, i.e., DHS, PASSAR, MHMR,
etc.Proposed 371.214 generally describes and provides direction
for the completion of the TILE assessment. Under the proposed
rules, there are changes in the process for conducting routine
TILE reviews, the reconsideration process, the TILE training
requirements for providers, and the corrective action process.
Also, language in reference to the Default TILE 212 is deleted.
Tom Suehs, Deputy Commissioner for Financial Services, has
determined that for each year of the first five years the proposed
rules are in effect, the public will benefit from adoption of the
rules by the resulting clarification of the criteria that govern the
routine case mix review process.
Tom Suehs, Deputy Commissioner for Financial Services, has
also determined that for each year of the first five years the pro-
posed rules are in effect the proposed rules will have a positive
fiscal impact to on state government. The estimated cost sav-
ings to the state agency will be approximately $56,000.00 due
to the shifting of the financial responsibility for TILE training from
the state to the Nursing Facility Providers. Enforcing or adminis-
tering the amended rules does not have foreseeable implications
relating to costs or revenues of state or local governments, other
than the cost savings to the state noted above Small and Mi-
cro-business Impact Analysis
The proposed rules may result in additional costs to persons re-
quired to comply with the rules. The rules may have an adverse
effect on small or micro-businesses. That adverse effect would
be a result of shifting the financial responsibility for TILE training
from the state to the Nursing Facility Providers, including those
Providers that are small and micro businesses. Pursuant to Sec-
tion 2006.002 of the Government Code, HHSC considered the
measures that could be taken to reduce the adverse impact on
micro or small businesses. It is not feasible for HHSC to exempt
micro or small businesses from all or part of the rules or to estab-
lish separate compliance or reporting requirements for small or
micro businesses. However, to reduce the anticipated adverse
effect, HHSC eliminated the requirement that nursing facility staff
take the TILE training during the corrective action process and,
in practical effect, reduced the number of nursing facility staff re-
quired to take the TILE training. The proposed rules could result
in only slightly increased cost or even a cost neutral situation
for the providers who are small or micro businesses in that fewer
staff have to take TILE training and have to take it less frequently
than under the previous rules. The cost of compliance for small
or micro businesses per each employee would be roughly the
same as the cost of compliance for the largest Nursing Facility
Providers affected by the proposed rules. It is not anticipated
that the proposed rules will have a negative effect on local em-
ployment.
The Commission has determined that none of the proposed rules
is a "major environmental rule," as defined by 2001.0225, Gov-
ernment Code. "Major environmental rule" is defined to mean
a rule the specific intent of which is to protect the environment
or reduce risks 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 envi-
ronment, or the public health and safety of the state or a sector
of the state. None of the proposed rules is specifically intended
to protect the environment or reduce risks to human health from
environmental exposure.
HHSC 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 government action and, therefore, do
not constitute a taking as defined in Texas Government CodePROPOSED RULES January 30, 2004 29 TexReg 743
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Texas. Secretary of State. Texas Register, Volume 29, Number 5, Pages 727-1096, January 30, 2004, periodical, January 30, 2004; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth101101/m1/15/: accessed May 21, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.