Proposed Medicaid Payment Rates for Medicaid Biennial Calendar Fee Reviews, Medical Policy Reviews, and Healthcare Common Procedure Coding System (HCPCS) Reviews Agenda

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

This hearing will be conducted both in-person and online. 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/8877269310501886815

After registering, you will receive a confirmation email containing information about joining the webinar. Instructions for dialing-in by phone will be provided after you register.

If you are new to GoToWebinar, please download the GoToMeeting app at https://global.gotomeeting.com/install/626873213 before the hearing starts.

Members of the public may attend the rate hearing in person, which will be held in the Public Hearing Room 1.401, 1.402, 1.403 & 1.404 in the North Austin Complex located at 4601 W Guadalupe Street, Austin, Texas, or they may access a live stream of the meeting at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. For the live stream, select the “North Austin Complex Live” tab. 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 under the “Archived” tab. The hearing will be held in compliance with Texas Human Resources Code Section 32.0282, which requires public notice of and hearings on proposed payment rates.

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

Proposed to be effective January 01, 2025:

Medical Policy Review

End-Stage Renal Disease (ESRD) Drug – J0879

Annual HCPCS Updates

Physician Administered Drugs – Type of Service (TOS) 1 (Medical Services);

Non-Drugs – TOS 1;

Surgery Services – TOS 2 (Surgery Services), and TOS 8 (Assistant Surgery);

Radiological Services – TOS 4 (Radiology), TOS I (Professional Component), and TOS T (Technical Component);

Clinical Diagnostic Laboratory Services – TOS 5 (Laboratory);

Radiation Therapy – TOS 6 (Radiation Therapy), TOS I (Professional Component), TOS T (Technical Component); and

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies – TOS 9 (Other Medical Items or Services), TOS J (DME Purchase-New), and TOS L (DME Rental-Monthly)

Proposed to be effective March 01, 2025:

Medical Policy Review

Title V MCH FFS Program Additions: 86593 & J0561

Proposed to be effective April 01, 2025:

Calendar Fee Review

Long-Acting Reversible Contraceptives (LARCs)

Medical Policy Review

Wound Care: Q Codes

SB 1921: Wound Care Education

Methodology and Justification. The proposed payment rates were calculated in accordance with Title 1 of the Texas Administrative Code:

Section 355.8023, Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS);

Section 355.8085, Reimbursement Methodology for Physicians and Other Practitioners;

Section 355.8441, Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services (also known as Texas Health Steps);

Section 355.8561, Billing (Reimbursement Methodology for the Medical Transportation Program);

Section 355.8581, Reimbursement Methodology for Family Planning Services;

Section 355.8610, Reimbursement for Clinical Laboratory Services;

Section 355.8620, Reimbursement Methodology for Services provided in Indian Health Service and Tribal facilities; and

Section 355.8641, Reimbursement Methodology for the Women's Health Program

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 before January 31, 2025. 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, 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.  For quickest response 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.