TITLE 1.ADMINISTRATION

Part 3. OFFICE OF THE ATTORNEY GENERAL

Chapter 55. CHILD SUPPORT ENFORCEMENT

Subchapter H. LICENSE SUSPENSION

1 TAC §55.203

The Office of the Attorney General adopts amendments to §55.203, Figure 55.203(a), Figure 55.203(b), and Figure 55.203(c), the promulgated forms for the Notice of Filing of Petition to Suspend License, Petition to Suspend License, and Request for Hearing, with changes. The changes to the proposed text were published in the February 4, 2000 issue of the Texas Register (25 TexReg 647).

The amended forms are being adopted to clarify instructions regarding an administrative license suspension action, and to comply with recent changes in the Texas Family Code, Chapter 232. The changes to the Notice of Filing of Petition to Suspend License clarify the administrative process by instructing the obligor to retain all service papers to be used at a later hearing. The notice also clarifies information needed on the return of service. Changes to the Petition to Suspend License involve deleted language to reflect recent changes to the Texas Family Code, §232.003. Changes to the Request for Hearing clarify the administrative license suspension process by additional language that instructs the obligor to retain all service documents for use at a later hearing, and sets out in bold the location of in person hearings. These forms affect the Texas Family Code, Section 232.

No comments were received regarding the adoption of this section.

The amended forms are adopted under the Family Code, Chapter 232, Suspension of License for Failure to Pay Child Support, §232.016, which provides the Office of the Attorney General with the authority to prescribe forms and procedures for the implementation of Chapter 232.

§55.203.Forms.

(a)

Notice of Filing of Petition to Suspend License. The notice shall take the form as follows:

Figure: 1 TAC §55.203(a)

(b)

Petition to Suspend License. The petition shall take the form as follows:

Figure: 1 TAC §55.203(b)

(c)

Request for Hearing. The request shall take the form as follows:

Figure: 1 TAC §55.203(c)

(d)

Notification to Licensing Authority of Order Suspending License.

Figure: 1 TAC §55.203(d) (No change)

(e)

Notification of Licensing Authority of Order Vacating or Staying Order Suspending License.

Figure: 1 TAC §55.203(e) (No change)

(f)

Suggested model forms for use by the Courts.

Figure: 1 TAC §55.203(f) (No change)

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002458

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 4, 2000

For further information, please call: A.G. Younger at (512) 463-2110


1 TAC §55.210, §55.211

The Office of the Attorney General adopts the repeal of §55.210 and §55.211, concerning license suspension for failure to pay child support without changes to the proposal as published in the January 28, 2000, issue of the Texas Register (25 TexReg 490).

Section 55.210 requires the administrative law judge to issue a proposal for decision following a license suspension hearing. Section 55.211 gives the adversely affected party an opportunity to file exceptions to the proposal for decision for the Title IV-D Director's consideration prior to rendition of a final decision.

These sections are no longer necessary because the agency official (the administrative law judge) who conducts the hearing or reads the record will render the final decision in contested cases pursuant to amended §55.212. This eliminates the necessity of the proposal for decision required by Tex.Gov.Code §2001.062(a)(1) in cases in which the government official rendering the final decision does not hear the case or review the record. The requirement to provide the parties an opportunity to file exceptions and briefs in accordance with Tex.Gov.Code §2001.062(a)(2) is dispensed with as well. Any party desiring to challenge a final decision retains the right to file a Request for Rehearing which may be granted or denied by the administrative law judge as provided in Tex.Gov.Code §2001.145.

No comments were received regarding adoption of the repeals.

The repeals are adopted under the Family Code, Chapter 232, Suspension of License for Failure to Pay Child Support or Comply with Subpoena, §232.004(d), which provides that a proceeding in a case filed with the Title IV-D agency under this chapter is governed by the contested case provisions of Chapter 2001, Government Code.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002455

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: January 28, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Chapter 63. VICTIMS' ASSISTANCE GRANTS

The Office of the Attorney General (OAG) adopts §§63.1, 63.3, 63.11, 63.13, 63.15, 63.17, 63.19, 63.31, 63.33, 63.35, 63.37, 63.39, 63.51, 63.53, 63.55, 63.57, 63.71, 63.73, 63.81, 63.83, 63.85, 63.87, 63.89, 63.91, 63.101, 63.103, 63.105, 63.107, 63.109, 63.111, 63.113, 63.115, 63.117, 63.119, 63.121, 63.123, 63.125, 63.127, 63.129, 63.131, 63.141, 63.143, 63.145, 63.147, 63.149, 63.151, 63.153, 63.155, 63.157, 63.159, 63.161, 63.163, 63.165, 63.167, 63.169, 63.171, 63.173, 63.175, 63.177, 63.179, 63.181, 63.183, 63.185, 63.191, 63.193 and 63.195 without changes to the proposed text as published in the February 25, 2000, issue of the Texas Register (25 Tex Reg 1459) relating to rules for administration of crime victims' assistance grants (VAG) and will not be republished.

This chapter adopts implementation of new rules necessary to carry out the provisions of Tex. Code Crim. Proc. Ann. art. 56.541(West 1999), which provides funds for grants or contracts that support crime victim-related services or assistance. Article 56.541 reflects the legislature's finding that it is appropriate and necessary for the state to authorize a method for the appropriation of excess money in the compensation to victims of crime fund for grants or contracts supporting victim-related services or assistance. This adopted chapter establishes a procedure by which attorneys who represent the state in criminal cases and local law enforcement authorities may apply for and administer victim assistance coordinator grants. It also establishes a procedure by which nonprofit corporations may apply for and administer VAGs for statewide training programs that benefit victims of sexual assault and grants to purchase forensic exam equipment. Article 56.541 establishes joint authority of the OAG and the comptroller to determine the proper allocation of the revenue in the compensation to victims of crime fund for purposes of the article. Article 56.541(f) authorizes the OAG to adopt rules necessary for the implementation of article 56.541. The purpose of the regulatory scheme is to establish procedures for application and administration of VAGs or contracts which support crime victim-related services or assistance and therefore carry out the purpose of the statute. The OAG may also adopt rules to carry out its own independent functions under the statute. The adopted rules accomplish the objectives as set out below:

Subchapter A (General Provisions, §§63.1, 63.3) contains the general provisions of Chapter 63, including definitions of terms, a description of the statutory authority for the grant funds, the source of the grant funds, the Constitutionally dedicated purpose of the funds, and prohibitions related to the use of grant funds. These sections also contain a description of the OAG's statutory authority to adopt rules reasonable and necessary to implement article 56.541 of the Code Crim. Proc. Ann. art. 56.541(West 1999). Adopted §63.1 establishes the definitions of terms. Adopted §63.3 states the statutory authority for the creation of the fund, recognizes the authority of the Attorney General to administer the funds, and the purpose of the funds.

Subchapter B (Grants for Victim Assistance Coordinator or Crime Victim Liaison, §§63.11, 63.13, 63.15, 63.17, and 63.19) describes permissible uses for grant funds, the class of persons or entities eligible to apply for such grant funds, the funding levels for grants awarded, the limitations of use of grant funds awarded, and the duties of individuals who are employed as a result of grant awards. Adopted §63.11 defines that grants awarded may be used to defray all or part of the salary for establishing the positions of victim assistance coordinator or crime victim liaison and the duties associated with such positions. Adopted §63.13 defines the class of persons and entities eligible to obtain crime victim assistance grants to fund positions of victim assistance coordinator and crime victim liaison. Adopted §63.15 sets forth minimum and maximum amounts of funding that may be applied for and permissible uses of VAG funds. Adopted §63.17 limits the use of grant funds to payment of salaries only and stipulates that the grant funds may not be used to pay fringe benefits, such as retirement, health insurance, etc., nor office expenses or equipment expenses. Adopted §63.19 states the requirement that individuals employed in positions funded by VAG funds provide direct services to victims of crime.

Subchapter C (Grants for Statewide Training for Programs That Benefit Victims of Sexual Assault and to Purchase Forensic Exam Equipment, §§63.31, 63.33, 63.35, 63.37, and 63.39) describes permissible uses, eligible applicants, and minimum and maximum amounts of funding for grant funds applied for and awarded for statewide training for programs that benefit victims of sexual assault and to purchase forensic exam equipment for communities with certified Sexual Assault Nurse Examiner programs. Adopted §63.31 describes the purposes for which grant funds may be used. Adopted §63.33 defines entities that may be eligible to apply for grant funding. Adopted §63.35 establishes the minimum and maximum amounts for grant funding. Adopted §63.37 specifies various conditions and requirements associated with grantee tasks and activities such as the requirement that a grantee must provide volunteer services in connection with a VAG-funded project. Adopted §63.39 sets forth the adopted rule relating to the use of grant funds for travel expenses.

Subchapter D (Grant Application, Scope of Grant, Approval, §§63.51, 63.53, 63.55, and 63.57) describes the application process, including the requirement of a timely-filed application, the OAG review criteria, and discretionary determination of funding by the OAG. Adopted §63.51 establishes applicants to complete and submit an Application Kit to the OAG Grant Coordinator and requires one original and one duplicate to be filed by the first working day in May of each year for consideration for the coming fiscal year. Adopted §63.53 requires the OAG to review and evaluate timely filed applications, establishes full discretion in the OAG for all funding decisions, and establishes other criteria for the OAG to consider in funding decisions. Adopted §63.55 establishes the grant funding period and criteria for awarding second-year funding on first year performance. Adopted §63.57 addresses the ineligibility of indirect costs as an expenditure of VAG funds.

Subchapter E (Funding of Grants, §§63.71, 63.73) provides for project approval and funding outside of the annual grant cycle. This subchapter also declares that the actual funding of approved new and existing grant projects is contingent on the availability of funds. Adopted §63.71 provides for approval of nonstandard grant funding outside of the annual grant cycle. Adopted §63.73 declares that actual funding of approved new and existing grant projects is contingent on availability of funds.

Subchapter F (Grant Budget Requirements, §§63.81, 63.83, 63.85, 63.87, 63.89, and 63.91) sets forth rules governing the use of VAG funds and documentation of such use relating to personnel. The subchapter also sets forth requirements related to expenditures for professional and contractual services, rules concerning transportation, travel, and training, and use of VAG funds for equipment. The subchapter also addresses limitations on the use of grant funds.

Adopted §63.81 governs salary for VAG-funded positions, requirements concerning verification of personnel licenses and certifications, verification of personnel time and project records, and related rules concerning grant funds for personnel. Adopted §63.83 sets out prohibitions on dual compensation and documentary requirements that a grantee must meet with regard to contracts, travel allowances, reimbursements, related party transactions, and consistency with OAG professional rate schedules.

Adopted §63.85 details rules applicable to grantees concerning transportation, travel, and training expenditures and the documentation of same. Adopted §63.87 details rules applicable to grantees concerning the acquisition of equipment. Adopted §63.89 sets forth necessary OAG approvals and rules governing the use of and prohibitions regarding the use of VAG funds for supplies and direct operating expenses. Adopted §63.91 prohibits the use of grant funds for construction costs and land acquisition costs.

Subchapter G. (Special Conditions and Required Documents, §§63.101, 63.103, 63.105, 63.107, 63.109, 63.111, 63.113, 63.115, 63.117, 63.119, 63.121, 63.123, and 63.125) addresses documents which VAG applicants are required to submit to the OAG for approval. All of these documents are necessary for the OAG to determine that grant funds are being awarded to entities which follow operating procedures consistent with state and federal law. Adopted §63.101 requires a current statistical report of anticipated productivity to be filed with the application for grant. Adopted §63.103 requires that the application for grant include a signed Equal Employment Opportunity Program Certification under certain circumstances. Adopted §63.105 requires that the application include an executed copy of a Certification Regarding Lobbying that no Victims Assistance Grant Funds have been paid or will be paid to any person for purposes of lobbying in connection with the grant. Adopted §63.107 requires that the application include a signed copy of the Nonprocurement Debarment Certification. Adopted §63.109 requires the application to include a signed copy of a Drug-Free Workplace Certification. Adopted §63.111 requires the application to include a signed copy of a Uniform Grants Management Standards Certification. Adopted §63.113 requires the application to include a signed copy of a Certified Assurances Certification. Adopted §63.115 requires the application to include a signed copy of a Cooperative Working Agreement which shall include statements that the project will be carried out in a significant part due to the cooperation of outside organizations and stipulates parties who have authority to execute such agreements. Adopted §63.117 requires pre-approval of the OAG for grantees to use grant funds to purchase equipment with a cost exceeding $25,000. In addition, adopted §63.117 establishes the process and documentation necessary for submission for review and approval of equipment purchases by the OAG. Adopted §63.119 requires that prior to execution of any contract in excess of $25,000, the grantee must submit said contract and documentation stipulated for review and approval by the OAG. In addition, adopted §63.119 establishes criteria and processes for the consideration of entering into contracts by grantees using grant funds. Adopted §63.121 requires that governmental entities and nonprofit organizations who submit applications obtain a resolution from the governing body that Designates and authorizes officials the power to accept, reject, or amend a grant. The resolution must state that in the event of misuse of grant funds, a security bond will be obtained and the funds will be returned in full. In addition, the resolution must contain non-supplanting language. Adopted §63.123 requires an applicant to submit a current organizational chart reflecting grant and non-grant funded positions. Adopted §63.125 permits the OAG to award a grant conditioned upon a post-award survey and establishes procedures for conducting the post-award survey.

Subchapter H. (Award and Grant Acceptance, §§63.127, 63.129, and 63.131) sets forth the process for the award and acceptance of grants. Adopted§63.127 requires to applicant to accept or reject in writing a grant award within 45 days of the grant award date and provides for deobligation of funds in the event a timely response is not received. This section includes the requirement that a grantee implement the VAG within 60 days of the designated start date or face relinquishment of the grant award. The section also sets forth the OAG's full discretion in approving project funding and determining grantee compliance with OAG policies. Adopted d §63.129 outlines procedures for (i) an applicant's accepting or rejecting a grant award and (ii) an applicant's response to deficiencies in a filed application. Adopted §63.131 describes the process that an applicant may pursue in the event that the OAG denies an application or part of an application and sets forth the final decision-making authority of the OAG.

Subchapter I (Administering Grants, §§63.141, 63.143, 63.145, 63.147, 63.149, 63.151, 63.153, 63.155, 63.157, 63.159, 63.161, 63.163, 63.165, 63.167, 63.169, 63.171, 63.173, 63.175, 63.177, 63.179, 63.181, 63.183, and 63.185) proposes rules for the administration of VAGs. The rules establish duties and responsibilities for grant officials, requirements regarding records, requests for funds procedures, grant adjustments, copyrights, procurement procedures, and rules relating to property management, bonding, and insurance. The subchapter addresses OAG authority to withhold funds or terminate a grant under certain conditions and a grantee's ability to request a reconsideration of a decision to withhold funds or terminate a grant project. Adopted Subchapter G also contains procedures for grantee self- evaluation of a project, submission of regular progress reports to the OAG, evaluation of third party contracts, if any, and winding up a VAG administration.

Adopted §63.141 requires that each grantee designate three grant officials whose duties are described in the section. Adopted §63.143 requires OAG approval if grant funds are obligated prior to the start date or later than the ending date of the grant period. Adopted §63.145 sets forth grant records retention requirements for a period of five years and availability of the records in an electronic format for purposes of audit. Adopted §63.147 requires the grantee to file financial expenditure reports each calendar quarter on forms promulgated by the OAG and the consequences for filing to file a timely report. Adopted §63.149 requires the grantee to maintain an inventory report on file in the principal office of the grantee. Adopted §63.151 establishes time limits for the filing of the grantee's final request for funds and the consequences of a grantee's failure to submit accurate reports in a timely manner. Adopted §63.153 describes the procedure for a grantee to follow in submitting a request for a grant adjustment. Adopted §63.155 establishes the OAG's claim to a license to use copyrighted material where the purchase of such copyright was funded in any part by OAG funds. Adopted §63.157 governs procurement procedures, including OAG review and approval, to be used by a grantee who purchases equipment or professional or consultant services in excess of $25,000. §63.159 establishes the Uniform Grant Management Standards published by the Governor's Office of Budget and Planning as the governing property management standards for a grantee. Adopted §63.161 provides guidance regarding equipment disposition methods where a grantee that has purchased equipment in whole or in part with OAG funds is no longer funded by the OAG. Adopted §63.163 provides guidance regarding the transfer of title to equipment and nonexpendable personal property acquired with grant funds. Adopted §63.165 sets forth a grantee's bonding and insurance requirements.

Adopted §63.167 addresses the OAG's authority and discretion to withhold funds from a specific project or from all projects operated by a grantee if any of the enumerated conditions or situations occur and a grantee's ability to request a reconsideration of a decision by the OAG to withhold funds. Adopted §63.169 outlines the procedures regarding cancellation or termination of a grant, the consequences of such action, and a grantee's ability to request a reconsideration of a decision by the OAG to terminate a grant project.

Adopted §63.171 sets for the requirements for de-obligation of grant funds at the end of the funding period and provides for final expenditure reports to be submitted within a certain time limit. Adopted §63.173 requires the grantee to obligate and expend all outstanding liabilities within certain specified time frames. Adopted §63.175 requires the grantee and its personnel to report immediately upon discovery to the OAG and the prosecuting attorney's office any violation of the law appertaining to the use and expenditure of grant funds. Adopted §63.177 contains a prohibition against behavior constituting a conflict of interest on the part of any person affiliated with the VAG project. Adopted §63.179 imposes contract monitoring and self-evaluation requirements on a grantee. In this section, the OAG seeks to ensure that a grantee takes a sustained, active role in assessing actual delivery of service to victims of crime through the VAG project. Adopted §63.181 imposes the requirement for the filing of timely and complete progress reports. Adopted §63.183 requires a grantee who uses grant funds to contract with a third party to maintain proper records to ensure that the requirements of the contract are met. Adopted §63.185 establishes the requirement for accuracy of grant records and the recourse for providing false information.

Subchapter J (Program Monitoring and Audits, §§63.191, 63.193, and 63.195) contains provisions concerning OAG monitoring activities, compliance reviews, and auditing authority and standards as well as procedures for grantee appeals of OAG decisions relating to audit findings.

Adopted §63.191 explains that OAG monitoring will attempt to ensure that a grantee is achieving VAG performance goals and that grant awards are used in accord with applicable laws, rules, and grant agreements. Adopted §63.193 requires a grantee to be required to file independent annual audits in accordance with UGMS and GAAS. Adopted §63.195 contains guidance as to the substance of OAG reviews and the substance of required annual audits.

No comments were received regarding adoption of these new sections.

Subchapter A. GENERAL PROVISIONS

1 TAC §63.1, §63.3

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002494

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter B. GRANTS FOR VICTIM ASSISTANCE COORDINATOR OR CRIME VICTIM LIAISON

1 TAC §§63.11, 63.13, 63.15, 63.17, 63.19

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002495

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter C. GRANTS FOR STATEWIDE TRAINING FOR PROGRAMS THAT BENEFIT VICTIMS OF SEXUAL ASSAULT AND TO PURCHASE FORENSIC EXAM EQUIPMENT

1 TAC §§63.31, 63.33, 63.35, 63.37, 63.39

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002496

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter D. GRANT APPLICATION, SCOPE OF GRANT, APPROVAL

1 TAC §§63.51, 63.53, 63.55, 63.57

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002497

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter E. FUNDING OF GRANTS

1 TAC §63.71, §63.73

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002498

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter F. GRANT BUDGET REQUIREMENTS

1 TAC §§63.81, 63.83, 63.85, 63.87, 63.89, 63.91

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002499

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter G. SPECIAL CONDITIONS AND REQUIRED DOCUMENTS

1 TAC §§63.101, 63.103, 63.105, 63.107, 63.109, 63.111, 63.113, 63.115, 63.117, 63.119, 63.121, 63.123, 63.125

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002500

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter H. AWARD AND GRANT ACCEPTANCE

1 TAC §§63.127, 63.129, 63.131

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002501

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter I. ADMINISTERING GRANTS

1 TAC §§63.141, 63.143, 63.145, 63.147, 63.149, 63.151, 63.153, 63.155, 63.157, 63.159, 63.161, 63.163, 63.165, 63.167, 63.169, 63.171, 63.173, 63.175, 63.177, 63.179, 63.181, 63.183, 63.185

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002502

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Subchapter J. PROGRAM MONITORING AND AUDITS

1 TAC §§63.191, 63.193, 63.195

The new rules are adopted under the Texas Code of Criminal Procedure, Article 56.541, which the OAG interprets as authorizing the Office of the Attorney General to adopt rules reasonable and necessary to implement Chapter 56, and in order to provide funds for grants or contracts that support crime victim-related services or assistance.

The new rules affect Texas Code of Criminal Procedure, Chapter 56.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002503

Elizabeth Robinson

Assistant Attorney General

Office of the Attorney General

Effective date: April 27, 2000

Proposal publication date: February 25, 2000

For further information, please call: A.G. Younger at (512) 463-2110


Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 355. MEDICAID REIMBURSEMENT RATES

Subchapter C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES

The Texas Health and Human Services Commission (HSSC) adopts the repeal of §355.307; adopts an amendment to §355.306; and adopts new §355.307, without changes to the proposed text published in the February 25, 2000, issue of the Texas Register (25 TexReg 1474). New §355.308 is adopted with changes to the proposed text.

Justification of the amendment and new sections is to implement the Texas Department of Human Services appropriations rider 38 regarding nursing facilities passed by the 76th legislature. These rules were developed in consultation with representatives of the legislature, representatives of provider organizations, and individual providers.

The amendment and new sections implement the Texas Department of Human Services (DHS) appropriations rider 38 regarding nursing facilities passed by the 76th legislature. The amendment and new sections will function by establishing procedures for providers to obtain additional funds for increased staffing for registered nurses (RNs), licensed vocational nurses (LVNs), Medication Aides, and nurse aides in nursing facilities. Providers receiving the additional funds must demonstrate compliance with enhanced staffing requirements. Providers who choose not to receive additional funds will have their direct care staff rate increase each year limited to routine inflation. All providers must spend 85% of the revenues received for direct care staff compensation for RNs, LVNs, Medication Aides, and nurse aides or funds intended for those purposes are recouped by DHS. The proposal modifies the cost areas to separate the new direct care staff cost center from the other resident care cost center and separates the dietary cost center from the general and administrative cost center.

A public hearing was held on March 9, 2000, in the Texas Department of Human Services Board Room, 701 West 51st Street, Austin, Texas.

Comments were received from representatives of the following associations: Texas Association of Homes and Services for the Aging and Texas Health Care Association. Comments were also received from representatives of Texas Advocates for Nursing Home Residents, the Senior Advocacy Coalition, and Advocates for Nursing Home Reform.

General Comments: One commenter stated that the department should institute staffing ratios for nurse aides.

Response: The purpose of these rules is to implement the Texas Department of Human Services appropriations rider 38 regarding nursing facilities passed by the 76th legislature. This rider directs the department to incentivize increased direct care staffing and direct care wages and benefits in nursing homes. Instituting staffing ratios would mandate increased direct care staffing rather than incentivize it.

Comment concerning §355.308(j): All but one commenter stated that this subsection should be broadened to include nurse aides. One commenter stated that nurse aides should be included at a later date.

Response: Language has been added to include Medication Aides and nurse aides (Certified Nurse Aides and nurse aides in training as per 40 TAC §94.4) in the direct care staff enhancement.

Comment concerning §355.308(j): One commenter recommended that RN and LVN minutes be combined based on weighted average minutes into a single nursing staff time measure to allow providers greater flexibility in meeting their direct care staff enhancement requirements.

Response: Language has been added to combine staff types into a single staff time measure based on weighted average minutes. The language at §355.308(l)(1)-(3) and §355.308(n) was also revised to combine staff types into a single staff time measure.

Comment concerning §355.308(j)(1)(F): One commenter recommended that facilities' minimum required staffing levels be lowered from 95% of the statewide average adjusted for their case mix to 90% of the statewide average adjusted for their case mix.

Response: Language at 355.308(j)(1) has been revised to reflect a more logical calculation sequence. Data used to determine minimum required minutes are adjusted to account for Medicare acuity and other factors at 355.308(j)(1)(A), before minimum required minutes by category are calculated. These adjustments at the beginning of the calculation process reduce statewide average minutes by approximately six percent. Thus the five percent adjustment specified at 355.308(j)(1)(F) was eliminated.

Comment concerning §355.308(n)(2): One commenter recommended that the department modify this paragraph to require annual recoupment rather than quarterly recoupment for facilities failing to meet their agreed upon staffing requirements.

Response: The language has been revised to require semi-annual recoupment rather than quarterly recoupment for facilities failing to meet their agreed upon staffing requirements. Recoupment only on an annual basis is not responsive enough to make adjustments for facilities failing to meet their agreed upon staffing requirements. As a result of this revision, rule provisions at §355.308(f)(1) and (2), §355.308(j)(3), and §355.308(n)(2)-(6) adjusting staffing levels upward during the rate period were eliminated.

Comment concerning §355.308(n): One commenter recommended that the department modify this subsection to make allowances for providers that try in good faith to meet their requirements and still fail.

Response: Participation in the direct care staff enhancement is voluntary. Recoupment based upon failure to meet staffing requirements will be limited to enhancement dollars paid to the facility specifically to hire or retain staff. If the facility is unable to hire or retain the required staff, they will not have incurred the additional costs the enhancement is intended to pay for and the enhancement should be recouped by the department. HHSC is adopting this subsection without change. HHSC is revising §355.308(j)(3) to allow enhancements of providers failing to meet their staffing requirements to continue to qualify as pre-existing enhancements for purposes of granting staffing enhancements if the provider can demonstrate to the satisfaction of the Department of Human Services (DHS) that the facility has been unable, despite diligent efforts, to recruit appropriate personnel.

In addition to the changes detailed above, the department has made the following changes.

The department has modified §355.308(a) to clarify that staff which are to be included in the direct care staff cost center include Directors of Nursing (DONs) and Assistant Directors of Nursing (ADONs).

The department has added §355.308(a)(5) to clarify that for facilities receiving supplemental reimbursement for children with tracheostomies requiring daily care, staff required by 40 TAC §19.901(14)(C)(iii) (relating to Quality of Care) performing nursing-related duties for Medicaid contracted beds are included in the direct care staff cost center.

The department has added §355.308(a)(6) to clarify that nursing facility administrators are not included in the direct care staff cost center.

The department has modified §355.308(a)(3) to clarify that nurse aides include Certified Nurse Aides and nurse aides in training as per 40 TAC §94.4(c) (relating to Facility Requirements).

The department has modified §355.308(c) to change the standard open enrollment period from June to July to move the enrollment period closer to the rate year.

The department has modified §355.308(d) to allow for more flexibility in applying vendor hold. The subsection now states, "Facilities failing to submit an acceptable enrollment contract amendment by the end of the open enrollment period may be placed on vendor hold until such time as an acceptable enrollment contract amendment is received and processed by DHS."

The department has modified §355.308(d) and (g) to eliminate from the rule the specificity of the information required in the enrollment contract amendment, Six-Month Staffing Report and Annual Staffing and Compensation Report. The data collected on these documents could change as data needs change.

The department has modified §355.308(f)(1) to change the due date for the Annual Staffing and Compensation Report from within 30 days of the end of the rate year to within 60 days of the end of the rate year to allow more time to complete the forms.

The department has modified §355.308(f)(1)(A) to clarify the reporting requirements for new owners when a facility changes ownership.

The department has modified 355.308(g) and (h) to have the titles of reports match the titles of the reports as specified in 355.308(f)(1) and (2).

The department has modified §355.308(i) to clarify that a facility's participation in the enhanced direct care staff rate will end when the facility is removed from participation by DHS as described in §355.308(n)(3).

The department has modified §355.308(j) and (l) to incorporate staff time requirements for Medicaid residents receiving supplemental payments for ventilator or pediatric tracheostomy care into the calculation of minimum staffing requirements because there are additional staff times associated with these residents.

1 TAC §§355.306-355.308

The amendment and new sections are adopted under the Government Code, §531.033, which authorizes the commissioner of the Health and Human Services Commission to adopt rules necessary to carry out the commission's duties, and §531.021(b), which establishes the commission as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under Chapter 32, Human Resources Code.

The amendment and new sections implement the Government Code, §§531.033 and 531.021(b).

§355.308.Enhanced Direct Care Staff Rate.

(a)

Direct care staff cost center. This cost center will include compensation for employee and contract labor Registered Nurses (RNs) including Directors of Nursing (DONs) and Assistant Directors of Nursing (ADONs), Licensed Vocational Nurses (LVNs) including DONs and ADONs, Medication Aides, and nurse aides performing nursing-related duties for Medicaid contracted beds.

(1)

Compensation to be included for these employee staff types is the allowable compensation defined in §355.103(b)(1) of this title (relating to Specifications for Allowable and Unallowable Costs) that is reported as either salaries and/or wages (including payroll taxes and workers' compensation) or employee benefits. Benefits required by §355.103(b)(1)(A)(iii) of this title (relating to Specifications for Allowable and Unallowable Costs) to be reported as costs applicable to specific cost report line items are not to be included in this cost center.

(2)

Direct care staff who also have administrative duties not related to nursing must properly direct charge their compensation to each type of function performed based upon daily time sheets maintained throughout the entire reporting period.

(3)

Nurse aides must meet the qualifications enumerated under 40 TAC §94.3 (relating to Facility Requirements) to be included in this cost center. Nurse aides include Certified nurse aides and nurse aides in training as per 40 TAC §94.4(c) (relating to Facility Requirements).

(4)

Contract labor refers to personnel for whom the contracted provider is not responsible for the payment of payroll taxes (such as FICA, Medicare, and federal and state unemployment insurance) and who perform tasks routinely performed by employees. Allowable contract labor costs are defined in §355.103(b)(2)(C) of this title (relating to Specifications for Allowable and Unallowable Costs).

(5)

For facilities receiving supplemental reimbursement for children with tracheostomies requiring daily care as described in §355.307(b)(3)(G) of this title (relating to Reimbursement Setting Methodology), staff required by 40 TAC §19.901(14)(C)(iii) (relating to Quality of Care) performing nursing-related duties for Medicaid contracted beds are included in the direct care staff cost center.

(6)

Nursing facility administrators are not included in the direct care staff cost center.

(b)

Rate year. The standard rate year begins on the first day of September and ends on the last day of August of the following year. An implementation rate period will begin on May 1, 2000, and end on August 31, 2000. Except where otherwise noted, all the rules in this section apply to the implementation rate period as well as the standard rate year.

(c)

Open enrollment. Implementation open enrollment begins on April 1, 2000, and ends on April 14, 2000. Standard open enrollment begins on the first day of July and ends on the last day of that same July preceding the standard rate year for which payments are being determined.

(d)

Enrollment contract amendment. All contracted facilities must submit an enrollment contract amendment during the open enrollment period. On the enrollment contract amendment the provider must specify for each facility its desire to participate or its desire not to participate. The provider also must submit with the contract amendment all required documentation to the Texas Department of Human Services (DHS), in a manner specified by DHS. Facilities failing to submit an acceptable enrollment contract amendment by the end of the open enrollment period may be placed on vendor hold until such time as an acceptable enrollment contract amendment is received and processed by DHS.

(e)

New facilities. For purposes of this section, for each rate year a new facility is defined as a facility delivering its first day of service to a DHS recipient after the first day of the open enrollment period, as defined in subsection (c) of this section, for that rate year. Facilities that underwent an ownership change are not considered new facilities. New facilities must complete the enrollment contract amendment specified in subsection (d) of this section within 30 days of notification by DHS. Facilities failing to submit an acceptable enrollment contract amendment within 30 days of notification by DHS will be placed on vendor hold until such time as an acceptable enrollment contract amendment is received and processed by DHS. Based on the enrollment contract amendment information received, the facility's direct care staff rate will be adjusted effective on the sixty-first day of the contract with DHS. New facilities will receive the direct care staff rate associated with minimum staffing requirements as determined in subsection (j)(1) of this section for the first 60 days of their contract with DHS.

(f)

Staffing and Compensation Report submittal requirements. Staffing and Compensation Reports must be submitted as follows:

(1)

All contracted facilities. All contracted facilities will provide DHS, in a method specified by DHS, an Annual Staffing and Compensation Report reflecting the activities of the facility while delivering contracted services from the first day of the rate year through the last day of the rate year. This report will be used as the basis for determining compliance with the staffing requirements and recoupment amounts as described in subsection (n) of this section for the last six months of the rate year for participants, and as the basis for determining the spending requirements and recoupment amounts as described in subsection (o) of this section for all facilities. Facilities failing to submit an acceptable Annual Staffing and Compensation Report within 60 days of the end of the rate year will be placed on vendor hold until such time as an acceptable report is received and processed by DHS. For the implementation rate period, a Staffing and Compensation Report is required reflecting the activities of the facility while delivering contracted services from June 1, 2000, through August 31, 2000.

(A)

When a facility changes ownership, the prior owner must submit a Staffing and Compensation Report covering the period from the beginning of the rate year to the date recognized by DHS as the ownership-change effective date. This report will be used as the basis for determining any recoupment amounts as described in subsections (n) and (o) of this section. The new owner will be required to submit a Staffing and Compensation Report covering the period from the day after the date recognized by DHS as the ownership-change effective date to the end of the rate year.

(B)

Facilities whose contracts are terminated either voluntarily or involuntarily must submit a Staffing and Compensation Report covering the period from the beginning of the rate year to the date recognized by DHS as the contract termination date. This report will be used as the basis for determining any recoupment amounts as described in subsections (n) and (o) of this section.

(C)

Participating facilities who voluntarily withdraw from participation as per subsection (r) of this section must submit a Staffing and Compensation Report covering the period from the beginning of the rate year to the date of withdrawal as determined by DHS. This report will be used as the basis for determining any recoupment amounts as described in subsections (n) and (o) of this section.

(2)

Participating facilities. Within 30 days of the end of the first six months of the rate year, all participating facilities will provide DHS, in a method specified by DHS, with a Six-Month Staffing Report reflecting the activities of the facility while delivering contracted services from the first day of the rate year through the last day of the sixth month of the rate year. These reports will be used as the basis for determining compliance with the staffing requirements and recoupment amounts as described in subsection (n) of this section for the first six months of the rate year. Facilities failing to submit an acceptable Six-Month Staffing Report within 30 days of the end of the sixth month of the rate year will be placed on vendor hold until such time as an acceptable report is received and processed by DHS.

(3)

Other reports. DHS may require other Staffing and Compensation Reports from all facilities as needed.

(g)

Report contents. Annual Staffing and Compensation Reports and Six- Month Staffing Reports will include any information required by DHS to implement this enhanced direct care staff rate.

(h)

Completion of Reports. All Staffing and Compensation Reports and Staffing Reports must be completed in accordance with the provisions of §§355.102-355.105 of this title (relating to General Principles of Allowable and Unallowable Costs, Specifications for Allowable and Unallowable Costs, Revenues, and General Reporting and Documentation Requirements, Methods, and Procedures) and may be reviewed or audited in accordance with §355.106 of this title (relating to Basic Objectives and Criteria for Audit and Desk Review of Cost Reports).

(i)

Enrollment. Facilities choosing to participate in the enhanced direct care staff rate must submit to DHS a signed contract amendment as described in subsection (d) of this section, before the end of the open enrollment period. Participation will remain in effect, subject to availability of funds, until the facility notifies DHS in accordance with subsection (r) of this section that it no longer wishes to participate or the facility is removed from participation as described in subsection (n)(3) of this section. Facilities voluntarily withdrawing from participation will have their participation end effective on the date of the withdrawal as determined by DHS.

(j)

Determination of staffing requirements for participants. Facilities choosing to participate in the enhanced direct care staff rate agree to maintain certain direct care staffing levels. In order to permit facilities the flexibility to substitute RN, LVN and aide (Medication Aide and nurse aide) staff resources and, at the same time, comply with an overall nursing staff requirement, total nursing staff requirements are expressed in terms of LVN equivalent minutes. Conversion factors to convert RN and aide minutes into LVN equivalent minutes are based upon most recently available, reliable relative compensation levels for the different staff types.

(1)

Minimum staffing levels. DHS determines, for each participating facility, minimum LVN equivalent staffing levels as follows.

(A)

Determine minimum required LVN equivalent minutes per resident day of service for various types of residents using time study data, cost report information, and other appropriate data sources.

(i)

Determine LVN equivalent minutes associated with Medicare residents based on the data sources from subparagraph (A) of this paragraph adjusted for estimated acuity differences between Medicare and Medicaid residents.

(ii)

Determine minimum required LVN equivalent minutes per resident day of service associated with each Texas Index for Level of Effort (TILE) case mix group and additional minimum required minutes for residents reimbursed under the TILE system who also qualify for supplemental reimbursement for ventilator care or pediatric tracheostomy care as described in §355.307 of this title (relating to Reimbursement Setting Methodology) based on the data sources from subparagraph (A) of this paragraph adjusted for acuity differences between Medicare and Medicaid residents and other factors.

(B)

Based on most recently available, reliable utilization data, determine for each facility the total days of service by TILE group, days of service provided to TILE residents qualifying for Medicaid supplemental reimbursement for ventilator or tracheostomy care, total days of service for Medicare Part A residents, and total days of service for all other residents.

(C)

Multiply the minimum required LVN equivalent minutes for each TILE group and supplemental TILE reimbursement group from subparagraph (A) of this paragraph by the facility's Medicaid days of service in each TILE group and supplemental TILE reimbursement group from subparagraph (B) of this paragraph and sum the products.

(D)

Multiply the minimum required LVN equivalent minutes for Medicare residents by the facility's Medicare Part A days of service.

(E)

Divide the sum from subparagraph (C) of this paragraph by the facility's total Medicaid days of service, with a day of service for a Medicaid TILE recipient who also qualifies for a supplemental TILE reimbursement counted as one day of service, and multiply the result by the facility's other resident days of service.

(F)

Sum the results of subparagraphs (C), (D) and (E) of this paragraph, divide the sum by the facility's total days of service, with a day of service for a Medicaid TILE recipient who also qualifies for a supplemental TILE reimbursement counted as one day of service. The results of these calculations are the minimum LVN equivalent minutes per resident day a participating facility must provide.

(2)

Enhanced staffing levels. Participating facilities desiring to staff above the minimum requirements from paragraph (1) of this subsection may request staffing enhancements from an array of enhanced staffing options and associated add-on payments during open enrollment.

(3)

Granting of staffing enhancements. DHS divides all requested enhancements into two groups: pre-existing enhancements that facilities request to carry over from the prior year and newly- requested enhancements. Newly-requested enhancements may be enhancements requested by facilities that were nonparticipants in the prior year or by facilities that were participants in the prior year desiring to be granted additional enhancements. For the granting of enhancements to be effective September 1, 2001, and thereafter, for an enhancement to qualify as a pre-existing enhancement, a facility must have actually met the enhancement's staffing requirements during the most recent six month reporting period from which reliable data is available at the time qualification is determined. Enhancements held by nursing facilities whose staffing requirements were not met during the most recent six-month reporting period from which reliable data is available will qualify as pre-existing if the facility submitted, with that staffing report, documentation that demonstrates to the satisfaction of DHS that the facility has been unable, despite diligent efforts (including offering wages at the community prevailing rate for nursing facilities), to recruit appropriate personnel. If the initial six-month report from the subsequent rate year indicates that the staffing requirement was again not met, the unmet staffing will no longer be considered pre-existing. Using the process described herein, DHS first determines the distribution of carry-over enhancements. If funds are available after the distribution of carry-over enhancements, DHS then determines the distribution of newly-requested enhancements.

(A)

DHS determines projected units of service for facilities requesting each enhancement option and multiplies this number by the rate add-on associated with that enhancement as determined in subsection (l) of this section.

(B)

DHS compares the sum of the products from subparagraph (A) of this paragraph to available funds.

(i)

If the product is less than or equal to available funds, all requested enhancements are granted.

(ii)

If the product is greater than available funds, enhancements are granted in a proportional manner. Based upon an examination of existing staffing levels and staffing needs, DHS may grant certain enhancement options priority for proportional distribution.

(4)

Notification of granting of enhancements. Participating facilities are notified, in a manner determined by DHS, as to the disposition of their request for staffing enhancements.

(k)

Determination of direct care staff rates for nonparticipating facilities.

(1)

Determine the sum of recipient care costs from the direct care staff cost center in subsection (a) of this section in all nursing facilities included in the Texas Nursing Facility Cost Report database used to determine the nursing facility rates in effect on January 1, 2000 (hereinafter referred to as the initial database).

(2)

Adjust the sum from paragraph (1) of this subsection in order to account for inflation utilizing the inflation factors used in the determination of the nursing facility rates in effect January 1, 2000.

(3)

Divide the result from paragraph (2) of this subsection by the sum of recipient days of service in all facilities in the initial database and multiply the result by 1.07. The result is the average direct care staff rate component for ineligible facilities.

(4)

To calculate the direct care staff per diem rate component for nonparticipating facilities for each of the 11 TILE case mix groups and for the default group, multiply each of the standardized statewide case mix indices associated with the initial database by the average direct care staff rate component from paragraph (3) of this subsection.

(5)

The direct care staff per diem rates will remain constant except as follows. For rates effective September 1, 2000, the rate derived in paragraph (3) of this subsection will be multiplied by 1.016. Effective September 1, 2001, and thereafter, the direct care staff per diem rate will remain constant except for adjustments necessitated by increases in the personal consumption expenditures (PCE) chain-type price index.

(l)

Determination of direct care staff rates for participating facilities. Direct care staff rates for participating facilities as defined in subsection (i) will be determined as follows:

(1)

Determine the direct care staff rate associated with maintaining LVN equivalent minutes at the minimum levels required for participation.

(A)

Determine the sum of recipient care costs from the direct care staff cost center in subsection (a) in all nursing facilities as included in the initial database from subsection (k)(1) of this section.

(B)

Adjust the sum from subparagraph (A) of this paragraph as specified in §355.108 of this title (relating to Determination of Inflation Indices) to inflate the costs to the prospective rate year.

(C)

Divide the result from subparagraph (B) of this paragraph by the sum of recipient days of service in all facilities in the initial database from subsection (k)(1) of this section and multiply the result by 1.07. The result is the average direct care staff rate associated with maintaining LVN equivalent minutes at the minimum levels required for participation.

(D)

Case mix adjustment of direct care staff per diem rate component. To calculate the direct care staff per diem rate component associated with maintaining LVN equivalent minutes at the minimum levels required for participation for each of the 11 TILE case mix groups, for the default group and for each supplemental reimbursement group, multiply each of the standardized statewide case mix indices associated with the initial database from subsection (k)(1) of this section by the average direct care staff rate component from subparagraph (C) of this paragraph.

(E)

The initial database from subsection (k)(1) of this section used in determining the direct care staff rates will not change, except for adjustments for inflation from subparagraph (B) of this paragraph. DHS may also recommend adjustments to the rates in accordance with §355.109 of this title (relating to Adjusting Reimbursement When New Legislation, Regulations, or Economic Factors Affect Costs).

(2)

Determine the direct care staff rate add-on associated with each enhanced staffing level. Taking into consideration the most recently available, reliable data relating to LVN equivalent compensation levels, DHS will determine a per diem add-on payment for each enhanced staffing level.

(3)

Determine each participating facility's total direct care staff rate. Each participating facility's direct care staff rate will be equal to the direct care staff rate associated with maintaining LVN equivalent minutes at the minimum levels required for participation from paragraph (1) of this subsection plus any add-on payments associated with enhanced staffing levels selected by and awarded to the facility during open enrollment.

(m)

Staffing requirements for participating facilities. Each participating facility will be required to maintain LVN equivalent minutes equal to those determined in subsection (j) of this section.

(n)

Staffing accountability. Participating facilities will be responsible for maintaining the staffing levels determined in subsection (j) of this section. Upon receipt of the six-month staffing information described in subsections (f)(1) and (2) of this section, DHS will determine the LVN equivalent minutes maintained by each facility during the six-month reporting period.

(1)

Participating facilities that fail to maintain staffing at their required LVN equivalent minutes will have their direct care staff rates and staffing requirements adjusted to a level consistent with the highest LVN equivalent minutes, as defined in subsection (j) of this section, that they actually attained.

(2)

Determination of staffing levels will be made on a six-month basis with adjustments to direct care staff rates and staffing requirements made upon determination by DHS that a facility is failing to meet its staffing requirement.

(3)

Participating facilities that fail to meet the minimum direct care staff requirements for participation will be removed from participation.

(4)

DHS will recoup all direct care staff revenues associated with unmet staffing goals from participating facilities that fail to meet their staffing requirements during any particular six-month period.

(5)

During the first six months of any rate year, staffing requirements as determined in subsection (j) of this section override any prospective adjustments made to staffing requirements under paragraphs (1)-(4) of this subsection.

(o)

Spending requirements for all facilities. All facilities, participants and non-participants alike, are subject to a direct care staff spending requirement with recoupment calculated as follows:

(1)

At the end of the facility's rate year (with the implementation rate period being treated as a rate year), a spending floor will be calculated by multiplying accrued Medicaid direct care staff revenues (net of revenues recouped by DHS due to the failure of the facility to meet a staffing requirement as per subsection (n)(4) of this section) by 0.85.

(2)

Accrued allowable Medicaid direct care staff expenses for the rate year will be compared to the spending floor from paragraph (1) of this subsection. DHS will recoup the difference between the spending floor and accrued allowable Medicaid direct care staff expenses from facilities whose Medicaid direct care staff spending is less than their spending floor.

(p)

Mitigation of recoupment. Recoupment of funds described in subsection (o) of this section may be mitigated as follows.

(1)

Calculate dietary cost deficit. At the end of the facility's rate year (with the implementation rate period being treated as a rate year), accrued Medicaid dietary per diem revenues will be compared to accrued, allowable Medicaid dietary per diem costs. If costs are greater than revenues, the dietary per diem cost deficit will be equal to the difference between accrued, allowable Medicaid dietary per diem costs and accrued Medicaid dietary per diem revenues. If costs are less than revenues, the dietary cost deficit will be equal to zero.

(2)

Calculate dietary revenue surplus. At the end of the facility's rate year (with the implementation rate period being treated as a rate year), accrued Medicaid dietary per diem revenues will be compared to accrued, allowable Medicaid dietary per diem costs. If revenues are greater than costs, the dietary per diem revenue surplus will be equal to the difference between accrued Medicaid dietary per diem revenues and accrued, allowable Medicaid dietary per diem costs. If revenues are less than costs, the dietary revenue surplus will be equal to zero.

(3)

Calculate fixed capital cost deficit. At the end of the facility's rate year (with the implementation rate period being treated as a separate rate year), accrued Medicaid fixed capital per diem revenues will be compared to accrued, allowable Medicaid fixed capital per diem costs as defined in §355.306(a)(2)(B) of this title (relating to Cost Finding Methodology). If costs are greater than revenues, the fixed capital cost per diem deficit will be equal to the difference between accrued, allowable Medicaid fixed capital per diem costs and accrued Medicaid fixed capital per diem revenues. If costs are less than revenues, the fixed capital cost deficit will be equal to zero. For purposes of this paragraph, fixed capital per diem costs of facilities with occupancy rates below 85% are adjusted to the cost per diem the facility would have accrued had it maintained an 85% occupancy rate throughout the rate year.

(4)

Calculate fixed capital revenue surplus. At the end of the facility's rate year (with the implementation rate period being treated as a separate rate year), accrued Medicaid fixed capital per diem revenues will be compared to accrued, allowable Medicaid fixed capital per diem costs as defined in §355.306(a)(2)(B) of this title (relating to Cost Finding Methodology). If revenues are greater than costs, the fixed capital revenue per diem surplus will be equal to the difference between accrued Medicaid fixed capital per diem revenues and accrued, allowable Medicaid fixed capital per diem costs. If revenues are less than costs, the fixed capital revenue surplus will be equal to zero. For purposes of this paragraph, fixed capital per diem costs of facilities with occupancy rates below 85% are adjusted to the cost per diem the facility would have accrued had it maintained an 85% occupancy rate throughout the rate year.

(5)

Facilities with a dietary per diem cost deficit will have their dietary per diem cost deficit reduced by their fixed capital per diem revenue surplus, if any. Any remaining dietary per diem cost deficit will be capped at $2.00 per diem.

(6)

Facilities with a fixed capital cost per diem deficit will have their fixed capital cost per diem deficit reduced by their dietary revenue per diem surplus, if any. Any remaining fixed capital per diem cost deficit will be capped at $2.00 per diem.

(7)

Each facility's recoupment, as calculated in subsection (o) of this section, will be reduced by the sum of that facility's dietary per diem cost deficit as calculated in paragraph (5) of this subsection and its fixed capital per diem cost deficit as calculated in paragraph (6) of this subsection.

(q)

Adjusting staffing requirements. Facilities that determine that they will not be able to meet their staffing requirements from subsection (m) of this section may request a reduction in their staffing requirements and associated rate add-on. These requests will be effective on the first day of the quarter following approval of the request. This option is not available during the implementation rate period.

(r)

Voluntary withdrawal. Facilities wishing to withdraw from participation must notify DHS in writing by certified mail. Facilities voluntarily withdrawing must remain nonparticipants for the remainder of the rate year.

(s)

Notification of recoupment based on Annual Staffing and Compensation Report. Facilities will be notified, in a manner specified by DHS, within 90 days of the due date of their Annual Staffing and Compensation Report or within 90 days of the date the report is submitted, whichever is later, of the amount to be repaid to DHS. If a subsequent review or audit results in adjustments to the Annual Staffing and Compensation Report as described in subsection (f)(1) of this section that changes the amount to be repaid to DHS, the facility will be notified in writing of the adjustments and the adjusted amount to be repaid to DHS. DHS will recoup any amount owed from a facility's vendor payment(s) following the date of the notification letter.

(t)

Notification of recoupment from Quarterly Staffing and Compensation Report. Facilities will be notified in a manner specified by DHS within 60 days of the due date of their Quarterly Staffing and Compensation Report or within 60 days of the date the report is submitted, whichever is later, of the amount to be repaid to DHS. If a subsequent review or audit results in adjustments to the Quarterly Staffing and Compensation Report as described in subsection (f)(2) of this section that changes the amount to be repaid to DHS, the facility will be notified in writing of the adjustments and the adjusted amount to be repaid to DHS. DHS will recoup any amount owed from a facility's vendor payment(s) following the date of the notification letter.

(u)

Vendor hold. Facilities required to submit a Staffing and Compensation Report due to any of the events described in subsection (f) of this section will have a hold placed on their vendor payments from the date they are notified by DHS until an acceptable Staffing and Compensation Report is received by DHS and funds identified for recoupment from subsections (n) or (o) of this section are repaid to DHS. Facilities required to submit a Staffing and Compensation Report due to a change of ownership or contract termination as described in subsection (f)(1)(A)-(B) of this section will have funds held as per 40 TAC §19.2308(2) (relating to Change of Ownership) until an acceptable Staffing and Compensation Report is received by DHS and funds identified for recoupment from subsections (n) or (o) of this section are repaid to DHS. DHS will recoup any amount owed from the facility's vendor payments that are being held. In cases where funds identified for recoupment cannot be repaid from the held vendor payments, the responsible entity from subsection (y) of this section will be jointly and severally liable for any additional payment due to DHS. Failure to repay the amount due or submit an acceptable payment plan within 60 days of notification will result in placement of a vendor hold on all DHS contracts controlled by the responsible entity and will bar the responsible entity from enacting any new contracts with DHS until repayment is made in full.

(v)

Failure to document spending. Undocumented direct care staff and contract labor compensation costs will be disallowed and will not be used in the determination of direct care staff costs per unit of service.

(w)

All other rate components. All other rate components will be calculated as specified in §355.307 of this title (relating to Reimbursement Setting Methodology) and will be uniform for all providers.

(x)

Appeals. Subject matter of informal reviews and formal appeals is limited as per §355.110(a)(3)(B) of this title (relating to Informal Reviews and Formal Appeals).

(y)

Responsible entities. The contracted provider, owner, or legal entity that received the revenue to be recouped upon is responsible for the repayment of any recoupment amount.

(z)

Change of ownership. Participation in the enhanced direct care staff rate confers to the new owner as defined in 40 TAC §19.2308 (relating to Change of Ownership) when there is a change of ownership. The new owner is responsible for the reporting requirements in subsection (f) of this section for any reporting period days occurring after the change.

(aa)

Disclaimer. Nothing in these rules should be construed as preventing facilities from adding direct care staff in addition to those funded by the enhanced direct care staff rate.

(bb)

Effective date. All rules enumerated in this section are effective as of May 1, 2000.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002491

Marina Henderson

Executive Deputy Commissioner

Texas Health and Human Services Commission

Effective date: May 1, 2000

Proposal publication date: February 25, 2000

For further information, please call: (512) 438-3108


1 TAC §355.307

The repeal is adopted under the Government Code, §531.033, which authorizes the commissioner of the Health and Human Services Commission to adopt rules necessary to carry out the commission's duties, and §531.021(b), which establishes the commission as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under Chapter 32, Human Resources Code.

The repeal implements the Government Code, §§531.033 and 531.021(b).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 7, 2000.

TRD-200002490

Marina Henderson

Executive Deputy Commissioner

Texas Health and Human Services Commission

Effective date: May 1, 2000

Proposal publication date: February 25, 2000

For further information, please call: (512) 438-3108


Chapter 371. MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY

Subchapter C. UTILIZATION REVIEW

1 TAC §371.208

The Health and Human Services Commission adopts the repeal of §371.208, relating to Appeals Requirements under the Texas Medical Review Program (TMRP) and Tax Equity and Fiscal Responsibility Act (TEFRA) and Hospital Notification concerning the appeal of medical utilization review decisions by the Health and Human Services Commission, without changes to the proposed text as published in the February 18, 2000, issue of the Texas Register (25 TexReg 1229).

The repeal is consistent with the legislative assignment of utilization review functions to the Health and Human Services Commission and the retention of medical appeals functions by the Texas Department of Health. The repeal also eliminates inconsistencies between the repealed rule and procedures implemented by the Texas Department of Health through its Medicaid Provider Procedures Manual. The repeal also supports the realization of cost savings anticipated from a streamlining of appeal procedures implemented by the department.

The Texas Hospital Association commented on the proposed repeal of §371.208. The commenter expressed a concern that the proposed repeal of the entire rule would eliminate the desk review process and the appeal decisions made by the Bureau of Medical Appeals within the Texas Department of Health. The commenter also expressed a preference that the appeals process be in the form of a rule, rather than simply be a part of the hospital's contract with the Medicaid program by inclusion in the Texas Medicaid Provider Procedures Manual.

The commission agrees that the appeal of a utilization review decision should be conducted under a process regulated by administrative rule. However, because the administration of such appeals currently resides with the Texas Department of Health, the commission believes that the department should conduct any rule making in this regard. The review of utilization review decisions of the commission is conducted by the Medical Appeals and Provider Resolution Division at the department under the process described in chapter 5, section 5.3.3, of the current edition of Texas Medicaid Provider Procedures Manual. This process will be reflected in the written notification sent by the commission to a provider regarding an adverse utilization review decision.

The commission has received assurances from the department that the repeal of the rule will not affect these procedures. The commission has also committed to involving appropriate stakeholders, including the commenter and the department, in future discussions regarding the appropriate codification of appeals procedures.

The repeal is proposed under the Human Resources Code, §32.021, and the Government Code, §531.021 and §531.033, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds and the state's medical assistance program and authorize HHSCer to adopt rules necessary to carry out its statutory duties.

The repeal affects Government Code, §531.021 and §531.033, which provide the Health and Human Services Commission with the authority to administer federal medical assistance funds and the state's medical assistance program and authorize HHSC to adopt rules necessary to carry out its statutory duties.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 10, 2000.

TRD-200002511

Marina S. Henderson

Executive Deputy Commissioner

Health and Human Services Commission

Effective date: April 30, 2000

Proposal publication date: February 18, 2000

For further information, please call: (512) 424-6576