TO:
Health and Human Services Commission Council
DATE:
February 22, 2012
FROM:
Andy Vasquez, Deputy Director, Vendor Drug
Medicaid and CHIP Division
SUBJECT: Vitamins and Minerals
BACKGROUND: Federal Requirement
Legislative Requirement
Other
The Health and Human Services Commission (HHSC) proposes to amend Title 1, Part 15,
Chapter 354, Subchapter F, Division 2, §354.1831(b), Covered Drugs. This amendment removes
the language in §354.1831(b), which states that, with a few exceptions, the Medicaid Vendor
Drug Program (VDP) does not reimburse for vitamins and minerals. Currently, medically
necessary vitamins and minerals are available for Medicaid clients under age 21 only through
pharmacies that are specifically enrolled in the Medicaid Comprehensive Care Program (CCP).
The 2012-13 General Appropriations Act, H.B. 1, 82nd Legislature, Regular Session, 2011
(Article II, Health and Human Services Commission, Rider 72), requires vitamins and minerals
to be added to the VDP formulary so that all VDP-enrolled pharmacies can be reimbursed for
this CCP benefit for Medicaid clients under age 21.
HHSC identified 26 vitamins and minerals that will be available to CCP children through VDPenrolled pharmacies. This list was compiled by medical experts at Texas Southern University
and The University of Texas College of Pharmacy at San Antonio and analyzed by a scientific /
medical workgroup made up of HHSC staff and external nutritional experts. The following
vitamins and minerals will be added to the VDP formulary: Beta-carotene; Vitamin A (retinol);
Biotin; Boric acid; Copper; Iodine; Phosphorus; Zinc; Calcium; Chloride; Iron; Magnesium;
Vitamin B1 (thiamin); Vitamin B2 (riboflavin); Vitamin B3 (niacin); Vitamin B5 (pantothenic
acid); Vitamin B6 (pyridoxine, pyridoxal 5-phosphate); Vitamin B9 (folic acid); Vitamin B12
(cyanocobalamin); Vitamin C (ascorbic acid); Vitamin D (ergocalciferol); Vitamin E
(tocopherols); Vitamin K (phytonadione); Multiminerals; Multivitamins; and Trace elements.
Removing subsection (b) from §354.1831 will allow HHSC to add vitamins and minerals to the
VDP formulary and reimburse all VDP-enrolled pharmacies for this Medicaid CCP benefit.
ISSUES AND ALTERNATIVES:
There are no alternatives because this rule is required by the 2012-13 General Appropriations
Act, H.B. 1, 82nd Legislature, Regular Session, 2011 (Article II, Health and Human Services
Commission, Rider 72). There are no significant issues.
STAKEHOLDER INVOLVEMENT:
A draft of the proposed rule was sent to external stakeholders for review. HHSC received no
comments. External stakeholders included:
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Texas Osteopathic Medical Association
Texas Association of Health Plans
Texas Pharmacy Association
National Association of Chain Drug Stores
Texas Pharmacy Business Council
Texas Retailers Association (includes the Texas Federation of Drug Stores)
Texas Association of Community Health Centers
Texas Academy of Family Physicians
Children’s Hospital Association of Texas
Texas Medical Association
Texas Pediatric Society
Walgreens
Texas Organization of Rural and Community Hospitals
FISCAL IMPACT:
None
Yes
State
FY 2012
$17,738
FY 2013
$332,798
FY 2014
$474,792
FY 2015
$508,027
FY 2016
$543,589
Federal
24,717
484,887
691,773
740,197
792,010
Total
$42,455
$817,685
$1,166,565
$1,248,224
$1,335,599
SERVICES IMPACT STATEMENT:
As a result of the proposed rule, Medicaid enrollees under age 21 will have increased access to
certain vitamins and minerals.
RULE DEVELOPMENT SCHEDULE:
February 9, 2012
February 22, 2012
May 2012
August 2012
August 2012
Present to Medical Care Advisory Committee
Present to HHSC Council
Publish proposed rule in the Texas Register
Publish adopted rule in the Texas Register
Effective date
REQUESTED ACTION:
The Council recommends to the Executive Commissioner that the proposed rule be
published in the Texas Register and later adopted should there be no substantive
comment.
Vitamins and Minerals - 2
TITLE 1
PART 15
CHAPTER 354
SUBCHAPTER F
DIVISION 2
RULE §354.1831
ADMINISTRATION
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
MEDICAID HEALTH SERVICES
PHARMACY
ADMINISTRATION
Covered Drugs
PROPOSED PREAMBLE
The Texas Health and Human Services Commission (HHSC) proposes to amend §354.1831
concerning Medicaid covered drugs.
Background and Justification
This proposed amendment removes the language in §354.1831(b), which states that, with a few
exceptions, the Medicaid Vendor Drug Program (VDP) does not reimburse for vitamins and
minerals. Currently, medically necessary vitamins and minerals are available for Medicaid
clients under age 21 only through pharmacies that are specifically enrolled in the Medicaid
Comprehensive Care Program (CCP). The 2012-13 General Appropriations Act, H.B. 1, 82nd
Legislature, Regular Session, 2011 (Article II, Health and Human Services Commission, Rider
72), requires vitamins and minerals to be added to the VDP formulary so that all VDP-enrolled
pharmacies can be reimbursed for this CCP benefit. Removing subparagraph (b) will allow
HHSC to add vitamins and minerals to the VDP formulary and reimburse all VDP-enrolled
pharmacies for this benefit for Medicaid clients under age 21.
Section-by-Section Summary
The proposed amendment deletes subsection (b) to allow for all VDP-enrolled pharmacies to
receive reimbursement for vitamins and minerals, a current CCP benefit.
Fiscal Note
Greta Rymal, Deputy Executive Commissioner for Financial Services, has determined that
during the first five-year period the proposed rule is in effect, there is an estimated cost to
general revenue of $17,738 for state fiscal year (SFY) 2012; $332,798 for SFY 2013; $474,792
for SFY 2014; $508,027 for SFY 2015; $543,589 for SFY 2016; and $581,640 for SFY 2017.
The proposed rule will not result in any fiscal implications for local health and human services
agencies. Local governments will not incur additional costs.
Small and Micro-business Impact Analysis
Ms. Rymal has also determined that there will be no effect on small businesses or microbusinesses to comply with the proposed rule, as they will not be required to alter their business
practices as a result of the amended rule. 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.
Vitamins and Minerals - 3
Public Benefit
Billy Millwee, Deputy Executive Commissioner for Health Services, has determined that for
each year of the first five years the section is in effect, the public will benefit from the adoption
of the rule. The anticipated public benefit of enforcing the proposed rule will be increased
access to vitamins and minerals for Medicaid clients under age 21.
Regulatory Analysis
HHSC has determined that this proposal is not a “major environmental rule” as defined by
§2001.0225 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 §2007.043 of the Government Code.
Public Comment
Written comments on the proposal may be submitted to Stacey Johnston, Policy Analyst,
Medicaid/CHIP Division, Texas Health and Human Services Commission, P.O. Box 85200,
Austin, TX 78708-5200, Mail Code H310; by fax to (512) 491-1953; or by e-mail to
Stacey.Johnston@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas
Register.
Public Hearing
A public hearing is scheduled for DATE, 2011, at TIME a.m./p.m. at the John H. Winters
Building, Public Hearing Room, 125-E, located at 701 W. 51st Street, Austin, Texas. Persons
requiring further information, special assistance, or accommodations should contact Leigh Van
Kirk at (512) 491-2813.
Statutory Authority
The amendment is proposed under Texas Government Code §531.033, which provides the
Executive Commissioner of HHSC with broad rulemaking authority; Texas Human Resources
Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the
authority to administer the federal medical assistance (Medicaid) program in Texas.
Vitamins and Minerals - 4
The amendment affects Texas Human Resources Code Chapter 32, and Texas Government Code
Chapters 531 and 533. No other statutes, articles, or codes are affected by this proposal.
This agency hereby certifies that the proposal has been reviewed by legal counsel and found to
be within the agency’s legal authority to adopt.
Vitamins and Minerals - 5
Legend:
[begin addition] Single Underline [end addition] = Proposed new language
[begin deletion] Strikethrough and Brackets [end deletion] = Current language proposed for
deletion
Regular Print = Current language
(No change.) = No changes are being considered for the designated subdivision
TITLE 1
PART 15
CHAPTER 354
SUBCHAPTER F
DIVISION 2
RULE §354.1831
ADMINISTRATION
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
MEDICAID HEALTH SERVICES
PHARMACY
ADMINISTRATION
Covered Drugs
(a) Only those drugs listed in the latest edition of the Texas Drug Code Index (TDCI) are
covered by the program and are payable. Venosets, catheters, and other medical accessories are
not covered and are not included when claiming for intravenous and irrigating solutions.
[begin deletion] (b) Except for vitamins K and D3, prenatal vitamins, fluoride preparations,
and products containing iron in its various salts, the Commission does not reimburse for vitamins
and legend and nonlegend multiple ingredient antianemia products. [end deletion]
[begin addition] (b) [end addition] [begin deletion] c) [end deletion] The Commission may
limit coverage of drugs listed in the TDCI. Procedures used to limit utilization may include prior
approval, cost containment caps, or adherence to specific dosage limitations recommended by
manufacturers. Limitations placed on the specific drugs are indicated in the TDCI.
Vitamins and Minerals - 6