Current through Reg. 49, No. 38; September 20, 2024
(a) In
the event of a statewide emergency declared by the Governor, THMP may
temporarily adjust program operations to ensure that mission critical functions
continue. These cost containment measures will be approved by the Commissioner
in writing.
(b) THMP funds must be
used as payor of last resort and coordinated with other local, state, and
federal funds, including Medicaid and Medicare.
(1) To ensure THMP's expenditures do not
exceed the budget, the department analyzes the latest actuarial projections for
the upcoming year, including the average annual cost per individual and the
projected number of individuals THMP will be able to serve using current budget
figures. The department performs this analysis of THMP expenditures every
quarter to determine if funds are sufficient to meet projected
expenditures.
(2) To make certain
that expenditures do not exceed the program's budget, the department may
implement the following temporary cost-containment measures as
necessary.
(c) If
budgetary limitations exist, this information will be shared with stakeholders
at least 60 days before implementation. The department has discretion to:
(1) Restrict or prioritize covered services
based upon:
(A) medical necessity;
(B) other third-party eligibility and
projected third party payments for the different treatment modalities;
or
(C) caseloads and demands for
services based on current or projected data.
(2) Discontinue use of the standard deduction
adjusting the applicant's gross annual income described in §
98.103(b)(4)(D)
of this title (relating to THMP Eligibility Criteria).
(3) Lower the financial eligibility criteria
established by THMP policy 220.001
https://www.dshs.texas.gov/hivstd/policy/policies/220-001.shtm
to a level that is not lower than 125% of federal poverty level.
(4) Change covered services by adding or
deleting specific services or entire categories, making changes proportionally
across a category or categories, using a combination of these methods, or
establishing a waiting list of eligible applicants. Appropriate information is
collected from each applicant who is placed on a waiting list. The information
is used to facilitate contacting the applicant when benefits become available
and to allow efficient enrollment application processing if the budgetary
limitations loosen. In the event of a waiting list, the department shall give
priority to participation in THMP to eligible women and infants and to
individuals younger than 18 years of age.
(d) As funds become available, the department
will rescind the cost-containment measures in a manner which the department
judges most appropriate given the circumstances at that
time.
