February 5, 2021 - 9:00am

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Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only.

Please Register for the HHSC Public Rate Hearing for Annual Healthcare Common Procedure Coding System (HCPCS) Updates to be held on February 5, 2021, at 9:00 AM CST here.

After registering, you will receive a confirmation email containing information about joining the webinar.

Due to a delay in publication of necessary information by the Centers for Medicare and Medicaid Services (CMS), HHSC has delayed the Annual HCPCS Rate Hearing until February 2021.

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 2021 Annual Healthcare Common Procedure Coding System (HCPCS) Updates. 

The meeting will be archived and can be accessed on demand here. The public hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.

Proposal. The payment rates for the 2021 Annual HCPCS Updates are proposed to be effective January 1, 2021, for the following services:

Physician Administered Drugs – TOS 1 (Medical Services);

Medical Services – TOS 1 (Medical Services);

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

Hospital Diagnostic Imaging - TOS 4 (Radiology);

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

Clinical Diagnostic Laboratory Services - TOS 5 (Laboratory);

Nonclinical Laboratory Services – TOS 5 (Laboratory), TOS I (Professional Component), and TOS T (Technical Component);

Ambulatory Surgical Center and Hospital Ambulatory Surgical Center - TOS F (Ambulatory Surgical Center); and

Dental Services – TOS W (Texas Health Steps Dental/Orthodontia).

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

§355.8021, which addresses the reimbursement methodology for home health services;

§355.8061, which addresses outpatient hospital reimbursement;

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

§355.8097, which addresses the reimbursement methodology for physical, occupational, and speech therapy services;

§355.8121, which addresses the reimbursement for ambulatory surgical centers;

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

§355.8610, which addresses the reimbursement for clinical laboratory services.

Briefing Packets.  Briefing packets describing the proposed payment rates for each topic will be available here on or January 26, 2021. Packets will be posted separately by topic as soon as they are complete. Interested parties may obtain copies of the briefing packets prior to the hearing by contacting Rate Analysis 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 in lieu 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: Rate Analysis, Mail Code H-400
P.O. Box 149030
Austin, Texas 78714-9030

Overnight mail, special delivery mail, or hand delivery
Texas Health and Human Services Commission
Attention: Rate Analysis, Mail Code H-400
Brown-Heatly Building
4900 North Lamar Blvd.
Austin, Texas 78751

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

Fax
Attention: Rate Analysis 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 attend the hearing and require auxiliary aids or services should call Rate Analysis at (512) 730-7401 at least 72 hours in advance, so appropriate arrangements can be made.