Health and Human Services Commission Council. Kami Geoffray, Medicaid & CHIP Program

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Caitlin Conley
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1 TO: Health and Human Services Commission Council DATE: May 23, 2014 FROM: Kami Geoffray, Medicaid & CHIP Program SUBJECT: Agenda Item 5.b. - Payment to Anesthesiologist Assistants BACKGROUND: Federal Requirement Legislative Requirement Other On August 19, 2013, the Centers for Medicare and Medicaid Services (CMS) approved HHSC s state plan amendment to add anesthesiologist assistants to the fee schedule as a Medicaid provider with an effective date of June 1, The proposed rules reflect the conditions, requirements, and limitations described in the state plan amendment. ISSUES AND ALTERNATIVES: Anesthesiologist assistants were added to the fee schedule as a Medicaid provider with an effective date of June 1, The new rules do not alter the current reimbursement methodology, so there are no issues or alternatives. STAKEHOLDER INVOLVEMENT: The proposed rule amendments were sent to external stakeholders for review. Comments received from stakeholders were reviewed by HHSC staff and taken into consideration. External stakeholders included: Texas Academy of Anesthesiologist Assistants (TAAA) Texas Society of Anesthesiologists (TSA) Texas Association of Nurse Anesthetists (TANA) Coalition for Nurses in Advanced Practice (CNAP) Texas Hospital Association (THA) Texas Medical Association (TMA) Texas Osteopathic Medical Association (TOMA) Texas Medical Board Texas Board of Nursing Stakeholders will also have an opportunity to comment on the proposal at the MCAC and HHSC Council meetings. FISCAL IMPACT: None Yes (if yes, complete the table below) 1

plan amendment to add anesthesiologist assistants to the fee schedule as a Medicaid provider with an effective date of June 1, 2013.

2 SERVICES IMPACT STATEMENT: The anticipated public benefit of enforcing the proposed amended rules will be enrollment of new Medicaid providers, which could lead to improved access to care. RULE DEVELOPMENT SCHEDULE: May 2, 2014 May 8, 2014 May 23, 2014 August 1, 2014 September 1, 2014 Publish proposed rules in Texas Register Present to the Medical Care Advisory Committee Present to HHSC Council Publish adopted rules in Texas Register Effective date REQUESTED ACTION: Information Only. 2

RULE DEVELOPMENT SCHEDULE: May 2, 2014 May 8, 2014 May 23, 2014 August 1, 2014 September 1, 2014 Publish proposed rules in

3 TITLE 1 PART 15 CHAPTER 354 SUBCHAPTER A DIVISION 5 RULE RULE ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES Anesthesiologist Assistant Conditions Of Participation Anesthesiologist Assistant Benefits And Limitations PROPOSED PREAMBLE The Texas Health and Human Services Commission (HHSC) proposes to add new , concerning conditions of participation for anesthesiologist assistants, and new , concerning benefits and limitations for anesthesiologist assistants in Chapter 354, Medicaid Health Services. Background and Justification On August 19, 2013, the Centers for Medicare and Medicaid Services (CMS) approved HHSC s state plan amendment to add anesthesiologist assistants to the fee schedule as a Medicaid provider with an effective date of June 1, The proposed rules reflect the conditions, requirements, and limitations described in the state plan amendment. Section-by-Section Summary New includes the requirements an anesthesiologist assistant must comply with in order to be a provider in the Texas Medicaid Program, which are similar to those for physician assistants, but with educational and certification requirements applicable to anesthesiologist assistants. The proposed rule s educational requirements are similar to those in 42 C.F.R , a federal rule relating to the Medicare program. The proposed rule also requires certification by the National Commission for Certification of Anesthesiologist Assistants. New includes the conditions under which services performed by an anesthesiologist assistant can be reimbursed under the Texas Medicaid Program, which are similar to those for physician assistants, but with limitations applicable to anesthesiologist assistants practicing under the direction of an anesthesiologist. Fiscal Note Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that during the first five-year period the proposed rules are in effect, there will be no fiscal impact to state or local governments. There are no anticipated economic costs to persons who are required to comply with the proposed rule. There is no anticipated negative impact on local employment. 3

Participation Anesthesiologist Assistant Benefits And Limitations PROPOSED PREAMBLE The Texas Health and Human Services Commission (HHSC) proposes to add new 354.

4 Small and Micro-business Impact Analysis Ms. Rymal has also determined that there will be no adverse effect on small businesses or micro businesses, as the rule makes no change to current reimbursement methodology. Public Benefit Chris Traylor, Chief Deputy Commissioner, has determined that for each year of the first five years the sections are in effect, the public will benefit from the adoption of the rules. The anticipated public benefit of enforcing the proposed amended rules will be enrollment of new Medicaid providers, which could lead to improved access to care. Regulatory Analysis HHSC has determined that this proposal is not a major environmental rule as defined by of the Texas Government Code. A major environmental rule is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment, or the public health and safety of a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure. Takings Impact Assessment HHSC has determined that this proposal does not restrict or limit an owner s right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under of the Government Code. Public Comment Written comments on the proposal may be submitted to Kami Geoffray, Policy Advisor, Office of Medicaid/CHIP Policy, Medicaid/CHIP Division, Health and Human Services Commission, MC-H310, Brown Heatly Building, P.O. Box 85200, Austin, TX ; by fax to (512) ; or by to Kami.Geoffray@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas Register. Statutory Authority These new rules are proposed under Texas Government Code , which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code and Texas Government Code , which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas. The proposed rules affect Texas Human Resources Code Chapter 32, and Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by this proposal. This agency hereby certifies that this proposal has been reviewed and approved by legal counsel and found to be within the agency s legal authority to adopt. 4

Public Benefit Chris Traylor, Chief Deputy Commissioner, has determined that for each year of the first five years the sections are in effect, the public will benefit from the adoption of the rules.

5 Legend: Single Underline = Proposed new language [Strikethrough and brackets] = Current language proposed for deletion Regular print = Current language (No change) = No changes are being considered by the designated subdivision TITLE 1 PART 15 CHAPTER 354 SUBCHAPTER A DIVISION 5 RULE ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES Anesthesiologist Assistant Conditions Of Participation To be a provider of Medicaid covered services, an anesthesiologist assistant must: (1) be a graduate of a medical school-based anesthesiologist assistant educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs and includes approximately two years of specialized basic science and clinical education in anesthesia at a level that builds on a premedical undergraduate science background; (2) be certified by the National Commission for Certification of Anesthesiologist Assistants; (3) comply with all applicable federal and state law and policy governing the service provided; (4) be enrolled and approved for participation in the Texas Medicaid Program; (5) sign a written provider agreement with the Health and Human Services Commission or its designee (HHSC); (6) comply with the terms of the provider agreement and all requirements of the Texas Medicaid Program, including federal and state rules, manuals, standards, and guidelines published by HHSC; and (7) bill for services covered by the Texas Medicaid Program in the manner and format prescribed by HHSC. 5

1064 ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES Anesthesiologist Assistant Conditions Of

6 TITLE 1 PART 15 CHAPTER 354 SUBCHAPTER A DIVISION 5 RULE ADMINISTRATION TEXAS HEALTH AND HUMAN SERVICES COMMISSION MEDICAID HEALTH SERVICES PURCHASED HEALTH SERVICES PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES Anesthesiologist Assistant Benefits And Limitations (a) Subject to the specifications, conditions, requirements, and limitations established by the Health and Human Services Commission or its designee (HHSC), services performed by an anesthesiologist assistant are considered for reimbursement if the services: (1) are within the scope of practice for an anesthesiologist assistant practicing under the personal or direct supervision of a licensed physician anesthesiologist in accordance with state law; (2) are consistent with rules promulgated by the Texas Medical Board; and (3) would be covered by the Texas Medicaid Program if provided by a licensed physician anesthesiologist. (b) Services must be reasonable and medically necessary as determined by HHSC to be considered for reimbursement. (c) Covered services provided by an anesthesiologist assistant may be billed under the anesthesiologist assistant's Texas Medicaid Program provider number. Anesthesiologist assistants who are employed or remunerated by a physician, hospital, facility, or other provider may bill the Texas Medicaid Program directly for their services, using the anesthesiologist assistant provider number. If the services are benefits reimbursed through Medicaid and the anesthesiologist assistant bills under an anesthesiologist assistant provider number, payment will be made to the anesthesiologist assistant. 6

Limitations (a) Subject to the specifications, conditions, requirements, and limitations established by the Health and Human Services Commission or its designee (HHSC), services performed by an

Medical Care Advisory Committee. Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission

TO: Medical Care Advisory Committee DATE: November 8, 2013 FROM: Andy Vasquez, Deputy Director, Medicaid/CHIP Vendor Drug Program Health and Human Services Commission Agenda Item No.: 7 SUBJECT: Fee-for-Service