Texas Register, Volume 3, Number 5, Pages 183-226, January 17, 1978 Page: 191
183-226 p. ; 28 cm.View a full description of this periodical.
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An agency may adopt a proposed rule no earlier than 30
days after publication in the Register, except where a federal
statute or regulation requires implementation of a rule on
shorter notice.
An agency, on request, shall provide a statement of the
reasons for and against adoption of a rule. Any interested
person may request this statement before adoption or within
30 days afterward. The statement shall include the principal
reasons for overruling considerations urged against the
agency's decision.
Numbering System-Each rule is designated by a
unique 10-digit number which is divided into four units by
decimal points. The first unit (three digits) indicates the
agency which promulgates the rule. The second unit (two
digits) indicates the chapter of rules to which the rule
belongs. The third unit (two digits) indicates the subchapter
of rules, if any, within the chapter. The fourth unit (three
digits) indicates the individual rule.
Symbology-Changes to existing material are indicated in
bold italics [Brackets] indicate deletion of existing
material.
Texas Department of Human
Resources
Pharmacy Services
Administration 326.40.01
The Texas Department of Human Resources proposes to
amend Rule 326.40.01.002 about the Kidney Health Care
Program. This amendment will eliminate reference to a
specific number of monthly prescriptions allowed under the
Vendor Drug Program. This change in no way affects the
benefits under the program.
The department has determined that there will be no fiscal
implications for any level of government as a result of this
proposed amendment. The change merely provides flexibility
in this rule to allow for possible cost containment measures in
the future.
Written comments are invited and may be sent to Susan L.
Johnson, Administrator, System and Procedures Bureau-
030, Texas Department of Human Resources, John H.
Reagan Building, Austin, Texas 78701, within 30 days of
publication of this Register.
This amendment is proposed under the authority of Texas
Civil Statutes, Articles 695c and 695j-1.
.002. Kidney Health Care Program.
(a) Only those pharmacies in the Vendor Drug Pro-
gram may participate in the Texas Kidney Health Care Pro-
gram.
(b) Recipients need not be receiving welfare, but they
must have Kidney Health Care ID cards. Prescriptions nec-
essary for the care and treatment of a chronic kidney disease
are to be billed to the Texas Department of Health
(Resources] which directs the Kidney Health Care Program.(c) If recipients are eligible under the Vendor Drug
Program, these prescriptions do not count as one of their
Ithreel basic monthly prescriptions.
Doc. No. 780231
Reimbursement 326.40.08
The Texas Department of Human Resources provides phar-
maceutical services to eligible recipients of the Texas Medi-
cal Assistance Program under Title XIX. However, due to an
unexpectedly high number of recipients, a deficit is expected
in the program before the end of the state fiscal year 1978
and will continue for the rest of the biennium. Consequently,
the department is proposing cost containment measures to
maintain fiscal integrity for the Vendor Drug Program.
Specific cost containment measures to be presented to the
Texas Board of Human Resources are published in the follow-
ing proposed amendments to Rules 326.40.08.001 and
326.40.09.001. After additional statistical projections are
reviewed and public comment is received, one or more of
these measures may be adopted or combined with prudent
suggestions from the public to formulate new proposals.
Since all of these proposals are cost containment measures,
there is no fiscal impact in the sense that additional monies
would be used. All of the proposals would offer substantial
cost savings for the program. Approximations of these sav-
ings are included in the descriptions of each proposal.
The proposed amendments to Rule 326.40.08.001 provide
flexibility in Sections (a) and (f) for the establishment of a
federally approved co-payment system as allowed in Federal
Regulations 42 CFR Part 449.40. Such a system would allow
the department to require Medicaid recipients to share the
cost of covered pharmacy services by paying a nominal pro-
rated amount for each prescription directly to the provider of
service. Federal regulations limit co-payments for vendor
drugs to not more than 50 cents per prescription of $10 or
less. A co-payment of this amount would result in a savings
to the program of approximately $3,124,500 during the first
fiscal year it was in effect. For prescriptions of more than
$10 through those costing $51 and more, the co-payment can
be increased in steps to a maximum of three dollars per
prescription.
Section (a) of this amendment also provides the department
with an option to discount the gross reimbursement to large
volume providers based upon the annual volume of prescrip-
tions. Such discounts are justified by the fact that large
volume providers can still obtain a reasonable and equitable
reimbursement on their costs even when the reimbursement
is discounted because of the cost savings implicit in large
volume operations. Estimates on the savings available to the
program as a result of a discount system are unavailable at
this time. However, substantial cost savings have been dem-
onstrated in other states utilizing variations of this sytem.
Another proposed amendment to this rule deals with reduc-
ing drug acquisition costs to the lowest possible level. The
current system as defined in Section (b) of Rule
326.40.08.001 allows reimbursement for costs incurred in ac-
quiring stock through wholesale distributors. Although cer-
tain drug products are available only through such distribu-
tors, many pharmaceutical supplies can be obtained with sig-Volume 3. Number 5. .anuarv 17. 1978
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Texas. Secretary of State. Texas Register, Volume 3, Number 5, Pages 183-226, January 17, 1978, periodical, January 17, 1978; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth252892/m1/9/: accessed April 27, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.