Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates.

July 20, 2022 - 1:00 pm

United States

Hearing.  The Texas Health and Human Services Commission (HHSC) will conduct a public hearing to receive public comments on proposed updates to Medicaid payment rates resulting from Calendar Fee Reviews, Medical Policy Reviews, and Healthcare Common Procedure Coding System (HCPCS) Updates.

Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. To join the hearing from your computer, tablet, or smartphone, register for the hearing in advance using the following link:

Registration URL: https://attendee.gotowebinar.com/register/5029799926841181195

Webinar ID: 195-399-795

Conference Number (for those who use phone Audio and not a computer): +1 (415) 665-0052

Please note, in order to receive an audio PIN to speak, registration is required.

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. A recording of the hearing will be archived and can be accessed on demand at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings

Proposal.  The effective date of the proposed payment rates for the topics presented during the rate hearing will be as follows:

 

Effective January 1, 2021

HCPCS Review
Annual HCPCS Update: 90377

Effective July 1, 2021

HCPCS Review
Quarterly HCPCS Update: Fensolvi – J1951

 

Effective January 1, 2022

Calendar Fee Review
Indian Health Services

 

HCPCS Review
Quarterly HCPCS Update: E1629

Effective September 1, 2022

HCPCS Review
Q1 HCPCS Drugs
Q1 HCPCS TOS 1 (90759)
Q1 HCPCS TOS 9-J-L

 

Medical Policy Review
Physician Administered Drugs: Teflaro - J0712
Physician Administered Drugs: Sinuva – J7402
Physician Administered Drugs: Famotidine – S0028

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;

§355.8085, which addresses the reimbursement methodology for physicians and other practitioners;

§355.8441, which addresses the reimbursement methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services (known in Texas as Texas Health Steps);

§355.8620, Reimbursement Methodology for Services provided in Indian Health Service and Tribal Facilities; and

§355.8660, Renal Dialysis Reimbursement.

Rate Hearing Packet.  A briefing packet describing the proposed payment rates will be made available at https://pfd.hhs.texas.gov/rate-packets on or after July 10, 2022. 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 PFDAcuteCare@hhs.texas.gov.

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
North Austin Complex
4601 W Guadalupe St.
Austin, Texas 78751

Phone number for package delivery: (512) 730-7401

Fax
Attention: Provider Finance at (512) 730-7475

E-mail
PFDAcuteCare@hhs.texas.gov

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 use 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.