Proposed Rule for the Medicaid Reimbursement for Hospital Outpatient Services

August 26, 2021 – 9:00am

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Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on August 26, 2021, at 9:00 a.m., to receive public comments on the proposed rule for the Medicaid Reimbursement for Hospital Outpatient Services.

Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. Physical entry to the hearing will not be permitted. To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance here .

After registering, you will receive a confirmation email containing information about joining the hearing. You can also dial in using your phone at +1 (914) 614-3221.

If you are new to GoToWebinar, please download the GoToMeeting app here before the hearing starts.

HHSC will broadcast the public hearing. The broadcast will be archived for access on-demand and can be accessed here.

Proposal. HHSC proposes an amendment to rule §355.8061, concerning Medicaid Reimbursement for Hospital Outpatient Services, effective November 1, 2021.

Background and Purpose.
The purpose of the amendment is to comply with Senate Bill (S.B.) 1 , Article II, HHSC, Rider 8(f), 87th Legislature, Regular Session 2021, and to make other amendments to enhance clarity, consistency, and specificity. HHSC is required by S.B. 1 to allocate certain funds appropriated to provide an increase to outpatient reimbursement rates for rural hospitals. HHSC proposes an increase to outpatient services reimbursement by removing the cap that was established September 1, 2013, and applying a percentage increase to the cost to charge ratios for rural hospitals.

The proposed amendment will also eliminate the cost settlement of payments to maintain the level of payment directed by the rider. Rider 8 states that reimbursement for outpatient emergency department services which do not qualify as emergency visits may not exceed 65 percent of cost. Therefore, HHSC proposes a decrease in the allowable charges to 55 percent for these services to accommodate the increase in cost to charge ratios and retain the payments below 65 percent of cost.

Pursuant to S.B. 170, 86th Legislature, Regular Session, 2019 and S.B. 1621, 86th Legislature, Regular Session, 2019, HHSC’s managed care contracts require managed care organizations to reimburse rural hospitals using a minimum fee schedule for services delivered through the Medicaid managed care program. The proposed amendment adds subsection (e), requiring a Medicaid minimum fee schedule for all rural hospitals, to conform the rule to the current law as well.

In addition, HHSC proposes to explain the cost to charge ratio (CCR) rate setting process by including a section specific to rural hospitals.

For the full rule proposal, please see the August 13, 2021, issue of the Texas Register.

Written Comments. Written comments regarding the proposal may be submitted in lieu of, or in addition to, oral testimony. To be considered, comments must be submitted no later than 31 days after the August 13, 2021, issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) faxed or emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When faxing or emailing comments, please indicate “Comments on Proposed Rule 21R141” in the subject line. Questions about the content of this proposal may be directed to the HHSC Provider Finance for Hospitals department at [email protected].

Written comments may be sent by U.S. mail, overnight mail, special delivery mail, fax, or e-mail.

U.S. Mail
Health and Human Services Commission
Provider Finance Department, Mail Code H-400
P.O. Box 149030
Austin, Texas 78714-9030

Overnight mail or special delivery mail
Health and Human Services Commission
Provider Finance Department, Mail Code H-400
4601 W Guadalupe St.
Austin, Texas 78751

The phone number for package delivery: (512) 730-7401

Attention: Provider Finance at (512) 730-7475

[email protected]

Preferred Communication. During the current state of disaster due to COVID-19, physical forms of communication are checked with less frequency than during normal business operations. For the quickest response, please use email or phone, if possible, for communication with HHSC related to this public hearing.

Persons with disabilities who wish to participate in the hearing and require auxiliary aids or services should contact Provider Finance at (512) 730-7401 at least 72 hours before the hearing so appropriate arrangements can be made.

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