November 13, 2020 - 9:00am
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Agenda
Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only.
After registering, you will receive a confirmation email containing information about joining the webinar.
Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing to receive public comment on proposed Medicaid payment rates for the Medicaid Biennial Calendar Fee Review. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements. HHSC will broadcast the public hearing; the broadcast can be accessed here. The broadcast will be archived and can be accessed on demand at the same website.
Proposal. The payment rates for the Medicaid Biennial Calendar Fee Review are proposed to be effective March 1, 2021, for the following services:
Anesthesia
Ambulatory Surgical Center(ASC)/Hospital Based ASC
Birthing Centers
Clinical Labs
Clinical Labs Gapfill
G Codes Hospitals
General and Integumentary System Surgery
Nervous System Surgery
Orthotic Procedures and Devices
Physician Administered Drugs (PAD) Non-Oncology
PAD Oncology
PAD Vaccines
PAD NDCX List
Methodology and Justification. The proposed payment rates were calculated in accordance with Title 1 of the Texas Administrative Code
§355.8023, which addresses the reimbursement methodology for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS);
§355.8061, which addresses outpatient hospital reimbursement;
§355.8085, which addresses the reimbursement methodology for physicians and other practitioners;
§355.8121, which addresses the reimbursement for ambulatory surgical centers;
§355.8181, which addresses the reimbursement methodology for birthing center services;
§355.8221, which addresses the reimbursement methodology for certified registered nurse anesthetists and anesthesiologist assistants; and
§355.8441, which addresses the reimbursement methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (known in Texas as Texas Health Steps).
Rate Hearing Packet. A briefing packet describing the proposed payment rates will be made available here on or after October 30, 2020. Interested parties may obtain a copy of the briefing packet on or after that date by contacting Provider Finance by telephone at (512) 730-7401; by fax at (512) 730-7475; or by e-mail at RADAcuteCare@hhsc.state.tx.us.
Written Comments. Written comments regarding the proposed payment rates may be submitted instead of, or in addition to, oral testimony until 5 p.m. the day of the hearing. Written comments may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or e-mail:
U.S. Mail
Texas Health and Human Services Commission
Attention: Provider Finance, Mail Code H-400
P.O. Box 149030
Austin, Texas 78714-9030
Overnight mail or special delivery mail
Texas Health and Human Services Commission
Attention: Provider Finance, Mail Code H-400
Brown-Heatly Building
4900 North Lamar Blvd
Austin, Texas 78751
Phone number for package delivery: (512) 730-7401
Fax
Attention: Provider Finance at (512) 730-7475
E-mail
RADAcuteCare@hhsc.state.tx.us
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 quickest response, and to help curb the possible transmission of infection, please turn to e-mail or phone if possible for communication with HHSC related to this rate hearing.
Persons with disabilities who wish to participate in the hearing and require auxiliary aids or services should call Provider Finance at (512) 730-7401 at least 72 hours before the hearing so appropriate arrangements can be made.