Texas Register, Volume 42, Number 43, Pages 5913-6056, October 27, 2017 Page: 6,001
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Comment: Several commenters stated that reducing reimburse-
ment for anesthesia services will significantly impact children's
hospitals that provide care for the state's most medically vulner-
able children and potentially harm the patients these hospitals
serve.
Response: HHSC does not anticipate that this update will sig-
nificantly impact children's hospitals because the proposed pay-
ment methodology is expected to be cost neutral overall. As
a result, HHSC does not anticipate a disruption in medical ser-
vices to Texas patients. No changes were made in response to
this comment.
Comment: One commenter suggested that the proposed rate
change will adversely affect access to and quality of care for
the Medicaid population in Texas through the anesthesia care
team model, with specific reference to services provided by AAs.
According to the commenter, the Medicaid population is often at
a higher risk for complications and includes a significant pediatric
population. A reduction in payment could force suboptimal care
upon these fragile patients.
Response: HHSC acknowledges the commenter's concerns re-
lated to access to care for Medicaid clients but disagrees that it
will be affected by the rate change because the proposed pay-
ment methodology is anticipated to be cost neutral overall as
explained in previous responses. AAs are expected to continue
to provide healthcare to the Medicaid population. No changes
were made in response to this comment.
Comment: One commenter supports adoption of the proposed
amendment because the proposed amendment appropriately
recognizes the roles of physician anesthesiologists and other
directing physicians in the delivery of anesthesia care to Texas
Medicaid patients/clients.
Response: HHSC understands this statement to be a comment
in relation to the Anesthesia Care Team model to provide anes-
thesia services. No changes were made in response to this com-
ment.
STATUTORY AUTHORITY
The rule amendment is adopted under Texas Government Code
531.033, which authorizes the Executive Commissioner of
HHSC to adopt rules necessary to carry out HHSC's duties;
Texas Human Resources Code 32.021 and Texas Government
Code 531.021(a), which provide HHSC with the authority to
administer the federal medical assistance (Medicaid) program
in Texas; and Texas Government Code 531.021(b), which
establishes HHSC as the agency responsible for adopting
reasonable rules governing the determination of fees, charges,
and rates for medical assistance payments under the Texas
Human Resources Code, Chapter 32.
355.8221. Reimbursement Methodology.
(a) Effective for services delivered on and after November 1,
2017, covered anesthesia services provided by a certified registered
nurse anesthetist (CRNA) or an anesthesiologist assistant (AA) under
the supervision of an anesthesiologist are reimbursed the lesser of the
CRNA's or AA's billed charges or 50 percent of the calculated payment
for a supervised anesthesia service. For example, if the calculated pay-
ment for a supervised anesthesia service is $100, the payment to the
CRNA or AA would be $50.
(b) Effective for services delivered on and after November 1,
2017, covered anesthesia services provided by a CRNA under the su-
pervision of a physician, other than an anesthesiologist, are reimbursed
at 92 percent of the calculated payment for an anesthesia service.The agency certifies that legal counsel has reviewed the adop-
tion and found it to be a valid exercise of the agency's legal au-
thority.
Filed with the Office of the Secretary of State on October 10,
2017.
TRD-201704076
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: October 30, 2017
Proposal publication date: August 4, 2017
For further information, please call: (512) 707-6071
TITLE 4. AGRICULTURE
PART 1. TEXAS DEPARTMENT OF
AGRICULTURE
CHAPTER 17. MARKETING AND
PROMOTION
SUBCHAPTER A. TEXAS COMMODITY
REFERENDUM LAW
The Texas Department of Agriculture (Department) adopts the
repeal of Title 4, Part 1, Chapter 17, Subchapter A, Texas Com-
modity Referendum Law, Division 1, General Rules, 17.1 -
17.10 and 17.12; Division 2, Texas Beef Checkoff Program,
17.20 - 17.25; Division 3, Texas Grain Producer Indemnity
Fund Program, 17.26 - 17.29. The adoptions are made with-
out changes to the proposal published in the September 8, 2017,
issue of the Texas Register (42 TexReg 4557).
The repeals are adopted in order to move all subchapters to new
Title 4, Part 1, Chapter 23, related to Texas Commodity Law
(Chapter 23). New Chapter 23 relocates all current commod-
ity referendum law rules into one location for convenience and
accessibility of the public and industry stakeholders.
New Chapter 23 has been proposed for adoption and shall be
effective November 5, 2017.
No comments were received on the proposal.
DIVISION 1. GENERAL RULES
4 TAC 17.1 - 17.10, 17.12
The adoption is made pursuant to Chapter 41 of the Agriculture
Code, which provides the Department with the authority to adopt
rules to administer its duties related to commodity boards.
The code affected by the adoption is Texas Agriculture Code,
Chapter 41.
The agency certifies that legal counsel has reviewed the adop-
tion and found it to be a valid exercise of the agency's legal au-
thority.
Filed with the Office of the Secretary of State on October 16,
2017.
TRD-201704119ADOPTED RULES October 27, 2017 42 TexReg 6001
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Texas. Secretary of State. Texas Register, Volume 42, Number 43, Pages 5913-6056, October 27, 2017, periodical, October 27, 2017; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth897027/m1/89/?q=%22%22~1&rotate=270: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.