Texas Register, Volume 38, Number 31, Pages 4821-4956, August 2, 2013 Page: 4,831
4821-4956 p. ; 28 cm.View a full description of this periodical.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
Greta Rymal, Deputy Executive Commissioner for Financial Ser-
vices, has determined that, for each year of the first five years
that the amended rules will be in effect, there will be no fiscal
impact to local governments or the state government. Enforcing
or administering the sections does not have foreseeable impli-
cations relating to costs or revenues of local governments or the
state government.
Small and Micro-business Impact Analysis
HHSC has determined that there will be no adverse economic
effect on small or micro-businesses as a result of enforcing or
administering these amended rules, as the changes proposed
do not change policy or practice.
Public Benefit and Costs
Chris Traylor, Chief Deputy Commissioner, has determined that
for each year of the first five years the amended rules will be
in effect, the public benefit expected as a result of adopting the
proposed rules is correct rule citations.
Greta Rymal, Deputy Executive Commissioner for Financial Ser-
vices, anticipates that, for each year of the first five years that the
amended rules will be in effect, there will not be an economic cost
to persons who are required to comply with the amendments.
HHSC has determined that the amended rules will not affect a
local economy or local employment.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environ-
mental rule" as defined by 2001.0225 of the Texas Government
Code. A "major environmental rule" is defined to mean a rule the
specific intent of which is to protect the environment or reduce
risk 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 environment or the
public health and safety of a state or a sector of the state. This
proposal is not specifically intended to protect the environment
or reduce risks to human health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this 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 2007.043 of the Texas Government
Code.
Public Comment
Written comments on the proposal may be submitted to Alexan-
der Melis, Medicaid/CHIP Policy Development, Texas Health
and Human Services Commission, P.O. Box, 85200, MC-H310,
Austin, Texas 78708-5200; by fax to (512) 462-6270 or by e-mail
to alex.melis@hhsc.state.tx.us within 30 days of publication in
the Texas Register.
DIVISION 1. MEDICAID PROCEDURES FOR
PROVIDERS
1 TAC 354.1005
Statutory Authority
The amendment is proposed under Texas Government Code
531.033, which authorizes the Executive Commissioner of
HHSC to adopt rules necessary to carry out HHSC's duties
under Texas Government Code, Chapter 531; and Texas Hu-
man Resources Code 32.021 and Texas Government Code531.021, which provide HHSC with the authority to administer
the federal medical assistance (Medicaid) program in Texas.
The amendment implements Texas Human Resources Code,
Chapter 32, and Texas Government Code, Chapter 531. No
other statutes, articles, or codes are affected by this proposal.
354.1005. Unauthorized Charges.
(a) An eligible provider [Eligible providers] must certify that
no charges beyond reimbursement paid under the Texas Medicaid
[Medical Assistance] Program for a covered service has [services
have] been, or will be, billed to an [the] eligible recipient.
(b) Within the provisions cited in 354.1131 [29.140 ] of this
chapter (relating to Payments [Payment] to Eligible Providers), an eli-
gible provider [providers] may not bill [eligible recipients] or take other
recourse against an eligible recipient recipientss] for claims denied as
a result of an error errors(s] attributed to the provider.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.
Filed with the Office of the Secretary of State on July 22, 2013.
TRD-201302962
Steve Aragon
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: September 1, 2013
For further information, please call: (512) 424-6900
DIVISION 11. GENERAL ADMINISTRATION
1 TAC 354.1131
Statutory Authority
The amendment is proposed under Texas Government Code
531.033, which authorizes the Executive Commissioner of
HHSC to adopt rules necessary to carry out HHSC's duties
under Texas Government Code, Chapter 531; and Texas Hu-
man Resources Code 32.021 and Texas Government Code
531.021, which provide HHSC with the authority to administer
the federal medical assistance (Medicaid) program in Texas.
The amendment implements Texas Human Resources Code,
Chapter 32, and Texas Government Code, Chapter 531. No
other statutes, articles, or codes are affected by this proposal.
354.1131. Payments to Eligible Providers.
(a) The Health and Human Services Commission or its de-
signee (HHSC) pays an [health insutig agent makes payment to] eli-
gible provider [preiders] on behalf of an eligible recipient recipientss]
for a service that is a benefit of the Texas Medicaid Program [authorized
benefits as defined in this chapter] when the [items of] service is [are]
medically necessary for diagnosis or treatment, or both, of illness or
injury, or when the [such items ef] service is [are] appropriately autho-
rized for prevention of the occurrence of a medical condition, and is
[are] prescribed by a physician or doctor, as appropriate to the partic-
ular benefit [benefits], in accordance with the utilization review provi-
sions of this chapter.
(b) Subject to the qualifications, limitations, and exclusions
set forth in this chapter, Medicaid payment [payments] for a covered
service is [services eevered are] made only to an eligible provider
[providers] of that service [such services]. The provider must [havePROPOSED RULES August 2, 2013 38 TexReg 4831
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
Texas. Secretary of State. Texas Register, Volume 38, Number 31, Pages 4821-4956, August 2, 2013, periodical, August 2, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth326805/m1/11/: accessed May 1, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.