Section 98.108 - Limitations and Cost Containment(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:(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).(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.25 Tex. Admin. Code § 98.108
The provisions of this §98.108 adopted to be effective August 28, 2003, 28 TexReg 6855; amended to be effective December 16, 2007, 32 TexReg 9128; Adopted by Texas Register, Volume 47, Number 45, November 11, 2022, TexReg 7558, eff. 11/17/2022