2013 Texas Attorney General Reports and Opinions 1 (2013)

handle is hein.sag/sagtx0215 and id is 1 raw text is: ATTORNEY GENERAL OF TEXAS
GREG ABBOTT
January 29, 2013
The Honorable John J. Carona                   Opinion No. GA-0983
Chair, Committee on Business and Commerce
Texas State Senate                             Re:   Whether the Medicaid reimbursement
Post Office Box 12068                          methodology imposed by rule 354.1143 of the
Austin, Texas 78711-2068                       Health and Human      Services Commission
impermissibly conflicts with section 32.050(c)
of the Human Resources Code (RQ-1075-GA)
Dear Senator Carona:
You ask whether the Medicaid reimbursement methodology established by administrative
rule 354.1143 of the Health and Human Services Commission (HHSC) impermissibly conflicts
with section 32.050(c) of the Human Resources Code.'
Section 32.050 of the Human Resources Code governs benefits provided to individuals who
receive medical assistance under Medicaid who are also eligible to receive similar assistance under
the Medicare program. Thx. HUM. RES. CODE ANN.  32.050(a) (West Supp. 2012) (entitled Dual
Medicaid and Medicare Coverage).2 HHSC's administrative rules refer to such individuals as dual
eligibles. 1 TEX. ADMIN. CODE  353.2(26) (2012). Subsection 32.050(b) of the Human Resources
Code directs HHSC to examine claims submitted for payment under Medicaid for services rendered
to dual eligibles to ensure that payment is sought first under the Medicare program to the extent
allowed by law. TEx. HuM. REs. CODE ANN.  32.050(b) (West Supp. 2012). Subsection
32.050(c), the subject of your question, states that [for an ambulance service provided to a [dual
eligible, Medicaid] shall pay the Medicare deductibles and coinsurance. Id.  32.050(c).
See Letter from Honorable John J. Carona, Chair, Senate Bus. & Commerce Comm., to Honorable Greg
Abbott, Tex. Att'y Gen. at 1 (Aug. 1, 2012), http://www.texasattorneyger.eral.gov/opin (Request Letter).
2 As one court has explained, Medicaid is a federal-state assistance program, run by state governments within
federal guidelines, that pays for health care services provided to eligible recipients-low-income people of any
age-from federal, state, and local tax funds. Hawkins v. Dallas Cnty. Hosp. Dist., 150 S.W.3d 535, 537 (Tex.
App.-Austin 2004, no pet.). Medicare is a distinct medical insurance program run by the federal government that pays
for health care services provided to covered beneficiaries-primarily people over the age of 65, regardless of income,
and younger disabled and dialysis patients. Id. at 537 n.2.

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