Part 10.
DEPARTMENT OF INFORMATION RESOURCES
Chapter 201.
PLANNING AND MANAGEMENT OF INFORMATION RESOURCES TECHNOLOGIES
1 TAC §201.1
The Department of Information Resources (department) proposes
an amendment to §201.1, concerning definitions applicable to department
rules. The purpose of the amendment is to add new definitions relating to
geographic information systems, to update the legal citations to the Professional
Services Procurement Act and the Major Consulting Services Act in paragraph
(17) and to the Texas Education Code in paragraph (26) and to amend the definition
of geographic information system in proposed paragraph (7). New definitions
are proposed for Albers equal area conic projection, datum, geospatial data(set),
geospatial dataset enhancement, geospatial dataset maintenance, geospatial
metadata, geoTIFF, GIS map project, JPEG, Lambert conformal conic projection,
map projection, survey product, TIFF and world file.
Mr. Eddie Esquivel, Director of the Enterprise Operations Division, has
determined that for each year of the first five years the amended rule will
be in effect, there will be no fiscal implications for state government as
a result of enforcing or administering the proposed amendment to §201.1.
There will be no foreseeable fiscal implications for local government as a
result of enforcing or administering the proposed amendment.
Mr. Esquivel has determined that for each year of the first five years
the amended rule will be in effect, the benefit to the public will be increased
rule clarity as a result of the definitions of certain terms used in the department's
rules. There will be no effect on small businesses, and that there is no additional
anticipated economic cost to persons who are required to comply with the amended
rule.
Comments on the proposed amendment to §201.1 may be submitted to Renee
Mauzy, General Counsel, Department of Information Resources, via mail to P.O.
Box 13564, Austin, Texas 78711, or electronically to renee.mauzy@dir.state.tx.us
no later than 5:00 p.m., within 30 days after publication.
The amendment is proposed under Texas Government Code §2054.052(a),
which authorizes the department to adopt rules as necessary to carry out its
responsibility under the Information Resources Management Act.
Texas Government Code chapter 2054 is affected by the proposed amendment.
§201.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
Albers equal area conic projection--A
map projection developed by Albers in 1805 and commonly used in mapping of
the United States by the U.S. Geological Survey. While some distortion is
inherent in all map projections, a characteristic of the albers equal area
conic projection is that scale distortion is minimized.
(2)
[
(3)
[
(4)
[
(A)
central processing units, front-end processing units, miniprocessors,
microprocessors, and related peripheral equipment such as data storage devices,
document scanners, data entry equipment, terminal controllers, data terminal
equipment, computer-based word processing systems other than memory typewriters,
and equipment and systems for computer networks;
(B)
all related services, including feasibility studies, systems
design, software development, and time-sharing services, whether provided
by state employees or by others; and
(C)
the programs and routines used to employ and control the
capabilities of data processing hardware, including operating systems, compilers,
assemblers, utilities, library routines, maintenance routines, applications,
and computer networking programs.
(5)
Datum--A smooth mathematical surface that
closely defines the mean sea-level surface of the earth throughout a certain
geographic region of interest (such as North America). Accurate ground positional
measurements must be made with reference to a specific datum appropriate to
the region.
(6)
[
(7)
[
(8)
Geospatial data(set)--Data which describes
some aspect of the earth's surface (or near-surface regions), or which can
be identified with a specific location on or near the earth's surface. A geospatial
dataset employs a defined, earth-based coordinate system which allows its
use in a geographic information system.
(9)
Geospatial dataset enhancement--Substantial
alteration of a geospatial dataset which increases its usefulness through
the addition of attribute (tabular) data fields, improvements in spatial accuracy,
or extension of geographic coverage.
(10)
Geospatial dataset maintenance--Addition
to, or alteration of, a geospatial dataset as part of a routine business process.
(11)
Geospatial metadata--A description of
the characteristics of a geospatial dataset, recorded in a standard format.
Characteristics include data content, quality, purpose, condition, format,
spatial coordinate system, availability, etc. The Federal Geographic Data
Committee has defined a formal content standard for digital geospatial metadata
for use by federal agencies.
(12)
GeoTIFF--A TIFF-based image format for
geo-referenced raster imagery.
(13)
GIS map product--A geographic representation,
in paper or electronic format, displaying features from one or more digital
geospatial datasets. Small scale images that are clearly intended only for
graphic illustration within a larger publication are not considered to be
GIS map products.
(14)
JPEG--A standardized image compression
mechanism. JPEG stands for Joint Photographic Experts Group, the original
name of the committee that wrote the standard.
(15)
[
(16)
[
(17)
[
(18)
[
(19)
[
(20)
Lambert conformal conic projection-A
map projection developed by Lambert in 1772 and commonly used in mapping of
the United States by the U.S. Geological Survey. While some distortion is
inherent in all map projections, a characteristic of the lambert conformal
conic projection is that shape distortion is minimized.
(21)
Map projection-A systematic representation
of all or part of a surface of a round body, especially Earth, on a plane.
(22)
[
(23)
Raster--A data structure for representing
spatial data. The raster data structure divides a region of space into a regular,
two-dimensional grid. Each cell in the grid has an associated data value.
A common use of the raster data structure is to represent imagery in a digital
format. In this case, the data value for each cell represents the color exhibited
by that part of the image.
(24)
[
(25)
[
(26)
[
(27)
[
(28)
Survey product--A map, report, letter
or other document produced by a registered professional land surveyor while
engaged in the practice of land surveying.
(29)
[
(30)
[
(31)
TIFF--Tagged Image File Format. A public
domain raster image file format.
(32)
[
(33)
World file--A file that accompanies a
specific raster image file and that contains georeferencing information that
can be used by certain GIS software to correctly display the raster image
in an earth-based coordinate system.
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.
Filed with the Office of
the Secretary of State, on June 5, 2001.
TRD-200103121
Renee Mauzy
General Counsel
Department of Information Resources
Earliest possible date of adoption: July 22, 2001
For further information, please call: (512) 475-2153
Chapter 355.
MEDICAID REIMBURSEMENT RATES
Subchapter C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
1 TAC §355.307
The Texas Health and Human Services Commission (HHSC) proposes
an amendment to §355.307, concerning reimbursement setting methodology,
in its Medicaid Reimbursement Rates chapter. The purpose of the amendment
is to create a special reimbursement class for nursing facilities that specialize
in caring for high need children. To qualify as a pediatric care facility,
the nursing facility must have an average daily census of 80% or more children.
Payment rates for facilities in this pediatric care facility special reimbursement
class will be determined on a facility-specific basis and will not be based
on the Texas Index for Level of Effort (TILE) payment rates. This special
reimbursement class will recognize the increased costs that exist in nursing
facilities that predominately serve children.
Don Green, chief financial officer, has determined that for the first five-year
period the sections are in effect there will be fiscal implications for state
government as a result of enforcing or administering the sections. The effect
on state government for the first five-year period the sections will be in
effect is an estimated additional cost of $199,092 in fiscal year FY 2002;
$206,140 in FY 2003; $206,140 in FY 2004; $206,140 in FY 2005; and $206,140
in FY 2006. There will be no fiscal implications for local government as a
result of enforcing or administering the sections.
Commissioner Don Gilbert has determined that for each year of the first
five years the sections are in effect the public benefit anticipated as a
result of enforcing the sections will be that nursing facilities which predominantly
serve children will receive payment rates that reflect the spending necessary
to care for high need children. There will be no adverse economic effect on
small or micro businesses, because the proposal creates a new reimbursement
class for nursing facilities that serve predominantly high need children.
No changes in practice are required of any business.
Questions about the content of this proposal may be directed to Carolyn
Pratt (512) 438-4057 in DHS's Rate Analysis Department. Written comments on
the proposal may be submitted to Supervisor, Rules and Handbooks Unit-146,
Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
The proposal is available for public review at local offices of DHS. For
further information, contact Carolyn Pratt in DHS's Rate Analysis Department
at (512) 438-4057.
Under §2007.003 of the Texas Government Code, HHSC has determined
that Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
the department is not required to complete a takings impact assessment regarding
these rules.
The amendment is proposed under the Government Code, §531.033,
which authorizes the commissioner of the Health and Human Services Commission
to adopt the 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 implements the Government Code, §§531.033 and 531.021(b).
§355.307.Reimbursement Setting Methodology.
(a)-(b)
(No change.)
(c)
Special
[
(1)
Pediatric Care Facility. The
purpose of this special class is to recognize, through the adoption of a facility-specific
payment rate, the cost differences that exist in a nursing facility that serves
predominantly children.
(2)
Definitions.
(A)
Pediatric care facility - To qualify as a pediatric
care facility, a facility must have had an average daily census of 80% of
more children for the six month period prior to its entry into the pediatric
care facility class. The census must be based on the entire licensed facility
and not a distinct part. In addition, to remain a pediatric care facility,
the facility must maintain an average daily census of 80% or more children.
(B)
Children - For the purposes of this pediatric
care facility class, children are defined as being at or below 22 years of
age.
(3)
Payment rate determination.
Payment rates will be determined in the following manner:
(A)
Cost reports and payment rate determination
for pediatric care facilities are governed by the requirements specified in
Subchapter A of this chapter (relating to Cost Determination Process).
(B)
Payment rates for this class of service will
be determined on a facility-specific basis. The total allowable costs from
the most recent cost report deemed acceptable are adjusted for inflation from
the cost report period to the rate period. The adjusted cost is divided by
the greater of total patient days of service reported on the cost report or
the days of service at 85 percent of contracted capacity. The resulting cost
per day is multiplied by a factor of 1.03 to determine the final facility-specific
rate. If no acceptable cost report is available, the provider will be required
to submit a cost report covering the time period specified by DHS.
(C)
The facility-specific payment rate from paragraph
(3)(B) of this subsection will be paid for all Medicaid eligible residents
of a qualifying facility regardless of the TILE level of the resident.
(D)
Residents of the pediatric care facility will
not be eligible to receive the ventilator-dependent or the children with tracheostomies
supplemental reimbursements.
(E)
Facilities in the pediatric care facility class
are not eligible to participate in §355.308 (relating to Enhanced Direct
Care Staff Rate).
(d)-(e)
(No change.)
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.
Filed with the Office of
the Secretary of State, on June 6, 2001.
TRD-200103185
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: July 22, 2001
For further information, please call: (512) 438-3734
The Texas Health and Human Services Commission (HHSC) proposes amendments
to §355.503, concerning reimbursement methodology for the community-based
alternatives waiver program--a 1915(c) Medicaid home and community-based waiver
for aged and disabled adults who meet criteria for alternatives to nursing
facility care; §355.505, reimbursement methodology for the community
living assistance and support services waiver program--a 1915(c) Medicaid
home and community-based waiver for persons with related conditions; and §355.9022,
reimbursement methodology for community-based services provided to people
who are deaf-blind with multiple disabilities, in its Medicaid Reimbursement
Rates chapter. For the Community-Based Alternatives (CBA), Community Living
Assistance and Support Services (CLASS), and Deaf-Blind Multiple Disabilities
(DB-MD) programs, the purpose of the amendments is to more closely match payment
rates to the cost of the services delivered. The payment rate for Registered
Nurses (RNs) and Licensed Vocational Nurses (LVNs) will be separated into
two distinct rates to more closely match the cost of the type of nursing service
delivered to the payment rate. These two rates eliminate the current method
of blending RN and LVN average costs into a single rate. For the CLASS and
CBA programs, the amendment deletes a separate rate for the annual reassessment
of clients that is conducted by an RN. Currently the reassessment fee is determined
by estimating the average amount of nursing time required to complete a reassessment.
The amendment would eliminate the separate rate for reassessment fees and
require providers to bill the RN payment rate for reassessment services, based
on the actual time spent by the RN.
Don Green, Chief Financial Officer, has determined that for the first five-year
period the sections are in effect there will be no fiscal implications for
state or local government as a result of enforcing or administering the sections,
because any change in RN or LVN payment rates as compared to the currently
used combined nursing payment rate would be the result of recalculating the
rate components based on actual provider cost.
Commissioner Don Gilbert has determined that for each year of the first
five years the sections are in effect the public benefit anticipated as a
result of enforcing the sections will be that the cost of services delivered
will be more closely matched to the corresponding payment rate. There is no
anticipated economic cost to persons who are required to comply with the proposed
sections. For the CBA and CLASS programs, the proposal will require the provider
to bill for RN time performing assessments at the RN payment rate and eliminates
the modeled reassessment fee. For the CBA, CLASS, and DB-MD programs, contracted
providers will be required to separately track and bill nursing services delivered
by RNs and LVNs.
Questions about the content of this proposal may be directed to Carolyn
Pratt (512) 438-4057 in DHS's Rate Analysis Department. Written comments on
the proposal may be submitted to Supervisor, Rules and Handbooks Unit-145,
Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
.
Under §2007.003 of the Texas Government Code, HHSC has determined
that Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
the department is not required to complete a takings impact assessment regarding
these rules.
Subchapter E. COMMUNITY CARE FOR AGED AND DISABLED
1 TAC §355.503, §355.505
The amendments are proposed under the Government Code, §531.033,
which authorizes the commissioner of the Health and Human Services Commission
to adopt the 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 amendments implement the Government Code, §531.033 and §531.021(b).
§355.503.Reimbursement Methodology for the Community-based Alternatives Waiver Program--a 1915(c) Medicaid Home and Community-based Waiver for Aged and Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care.
(a)-(c)
(No change.)
(d)
Waiver reimbursement determination. Recommended reimbursements
are determined in the following manner.
(1)
Unit of service reimbursement. Reimbursement for personal
assistance services, nursing
services provided by an RN, nursing services
provided by and LVN
, physical therapy, occupational therapy, speech
pathology, and in-home respite care services will be determined on a fee-for-service
basis in the following manner.
(A)
(No change.)
(B)
Total allowable costs are reduced by the amount of the
pre-enrollment expense fee
and
[
(C)-(G)
(No change.)
(2)-(4)
(No change.)
[(5)
Reassessment fees. Reassessment fees
are reimbursements paid to CBA home and community support services contracted
providers for performing annual reassessments. Reimbursements are determined
using a method based on modeled projected expenses which are developed by
using data from surveys; cost report data from similar programs; consultation
with other service providers and/or professionals experienced in delivering
contracted services; and/or other sources.]
(5)
[
(6)
[
(e)-(h)
(No change.)
§355.505.Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program--a 1915(c) Medicaid Home and Community-based Waiver for Persons with Related Conditions.
(a)-(c)
(No change.)
(d)
Waiver reimbursement determination methodology.
(1)
Unit of service reimbursement or reimbursement ceiling
by unit of service. Reimbursement or reimbursement ceilings for related-conditions
waiver services, habilitation, nursing
services provided by an RN, nursing
services provided by an LVN
, physical therapy, occupational therapy,
speech pathology, and psychological and respite care services will be determined
on a fee-for-service basis. These services are provided under the §1915(c)
of the Social Security Act Medicaid waiver for persons with related conditions.
(2)-(3)
(No change.)
(4)
Reimbursement determination. Recommended unit of service
reimbursements are determined in the following manner.
(A)
Unit of service reimbursement for habilitation, nursing
services provided by an RN, nursing services provided by an LVN
, physical
therapy, occupational therapy, speech pathology, and psychological services
are determined in the following manner:
(i)
(No change.)
(ii)
Total allowable costs are reduced by the amount of the
administrative expense fee,
and
requisition fee[
(iii)-(v)
(No change.)
(vi)
For nursing
services provided by and RN, nursing
services provided by and LVN
, physical therapy, occupational therapy,
speech pathology, and psychological services:
(I)-(II)
(No change.)
(vii)
(No change.)
(B)-(D)
(No change.)
(e)-(f)
(No change.)
[(g)
Reassessment fees. Reassessment fees
are reimbursements paid to CLASS direct service agency contracted providers
for performing annual reassessments. Reimbursements are determined using a
method based on modeled projected expenses which are developed by using data
from surveys; cost report data from similar programs, consultation with other
service providers and/or professionals experienced in delivering contracted
services; and/or other sources.]
(g)
[
(1)
Providers must follow the guidelines in determining whether
a cost is allowable or unallowable as specified in §355.102 and §355.103
of this title (relating to General Principles of Allowable and Unallowable
Costs, and Specifications for Allowable and Unallowable Costs) as well as
the following provisions.
(2)
Participant room and board expenses are not allowable,
except for those related to respite care.
(3)
The cost of adaptive aids and home modifications is not
allowable. Allowable labor costs associated with acquiring adaptive aids and
home modifications should be reported in the cost report. Any item purchased
for participants in this program and reimbursed through a voucher payment
system is unallowable. Refer to §355.103(b)(17)(K) of this title (relating
to Specifications for Allowable and Unallowable Costs).
(h)
[
(i)
[
(j)
[
(k)
[
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.
Filed with the Office of
the Secretary of State, on June 11, 2001.
TRD-200103275
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: July 22, 2001
For further information, please call: (512) 438-3734
2.
MEDICAID WAIVER PROGRAM FOR PEOPLE WITH DEAF-BLINDNESS AND MULTIPLE DISABILITIES
1 TAC §355.9022
The amendment is proposed under the Government Code, §531.033,
which authorizes the commissioner of the Health and Human Services Commission
to adopt the 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 implements the Government Code, §531.033 and §531.021(b).
§355.9022.Reimbursement Methodology for Community-based Services Provided to People Who Are Deaf-Blind with Multiple Disabilities.
(a)-(c)
(No change.)
(d)
Waiver rate determination methodology. Recommended reimbursements
for waiver services will be determined on a fee-for-service basis in the following
manner for each of the services provided:
(1)-(4)
(No change.)
(5)
For physical therapy, occupational therapy, speech/hearing/language,
case management, [
(6)-(9)
(No change.)
(e)-(h)
(No change.)
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.
Filed
with the Office of the Secretary of State, on June 11, 2001.
TRD-200103274
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: July 22, 2001
For further information, please call: (512) 438-3734
28.
PHARMACY SERVICES: REIMBURSEMENT
The Health and Human Services Commission (HHSC) proposes the repeal
of current §355.8541 and new §355.8541 concerning reimbursement
of product cost in the Vendor Drug Program (VDP). Currently, the rule describes
the industry sources used to estimate the cost of product acquisition for
providers of Medicaid outpatient pharmacy services, and how these sources
are used to arrive at the HHSC's best estimate of the provider's acquisition
costs. The current rule specifies mark-ups and discounts from published pricing
data that result from the methodology that is used to price products.
The proposed new section will eliminate the specific percentages. Additional
market resources that may be used when determining prices for outpatient drugs
will be added.
Don Green, Chief Financial Officer, has determined that for each year of
the first five years the section is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
section.
Steve Lorenzen, Director of Medicaid Rate Setting, has determined that
for each year of the first five years the section is in effect, the public
benefit anticipated as a result of enforcing the section will be to allow
the HHSC to use percentages that more accurately reflect current market practices
in determining product cost reimbursement for the VDP, to allow more timely
response to market fluctuations in the product cost area, and to use all appropriate
market sources in determining these costs in the future. Use of these resources
will allow more accurate estimates of the actual cost of the products dispensed
in the VDP and better meet the requirements contained in federal regulations
(42 CFR, §447.331), concerning estimating drug product acquisition costs.
There will be no costs to small business or micro-businesses to comply with
this section as proposed. These businesses will not be required to alter their
business practices in order to comply with the rules as proposed. There are
no costs to persons who are required to comply with the section. There will
be no impact on local employment.
A public hearing will be held at 9:00 a.m., Central Standard Time, on Thursday,
July 12, 2001, in the Public Hearing Room, Building 3, first floor of the
Riata Crossing Facility, 12555 Riata Vista Circle, Austin, Texas 78727-6404,
to accept comments on the proposal.
Comments on the proposal may be submitted to Jeff Phelps, Program Administrator,
Medicaid Reimbursement Division, Texas Health and Human Services Commission,
P.O. Box 13247, Austin Texas 78711-3247 or at (512) 424-6657, within 30 days
of publication of this proposal in the
Texas Register
. To comply with federal regulations, a copy of the proposal is being
sent to each Texas Department of Human Services (DHS) Office, where it will
be available for public review upon request.
(1)
] Application--A separately identifiable
and interrelated set of information resources technologies that allows a state
agency to manipulate information resources to support specifically defined
objectives.
(2)
] Board--The governing board
of the Department of Information Resources.
(3)
] Data processing--Information
technology equipment and related services designed for the automated storage,
manipulation, and retrieval of data by electronic or mechanical means, or
both. The term includes:
(4)
] Department--The Department
of Information Resources.
(5)
] Geographic information system
(GIS)--A system of computer hardware, software and procedures used to store,
analyze and display geospatial data and related tabular data in a geographic
context to solve complex planning and management problems in a wide variety
of applications.
[
A computer hardware and software system designed
to collect, manage, manipulate, analyze, and display spatially referenced
data; includes attribute data (usually in an associated data base), as well
as graphic data which may be in vector (line) or raster (image) form; may
include cartographic and geographic data such as earth science, natural resource,
engineering, demographic, or socioeconomic data; and will include for purposes
of these rules all types of automated mapping, facilities management, and
mapping applications from a computer-aided design system.
]
(6)
] Imaging systems--Information
resources technologies with video, scanning, and computer graphics capabilities
(including raster formats) which are used to capture, process, create, output,
store, and/or archive images, excluding process-control systems for medical
diagnostic applications.
(7)
] Information resources--The
procedures, equipment, and software that are designed, built, operated, and
maintained to collect, record, process, store, retrieve, display, and transmit
information, and associated personnel including consultants and contractors.
(8)
] Information resources services--Services
provided under contract to a state agency by an individual or firm, or by
a consultant or professional engineer under Texas
Government Code, Chapter
2254, the Professional Services Procurement Act, and Texas Government Code,
Chapter 2254, Consulting Services,
[
Civil Statutes Articles 664-4
and 6252-11c,
] which
includes
[
include
]: studying
agency's existing information resources; advising on necessary changes or
additions to the information resources environment; performing information
resources feasibility studies; information resources training; or recommending,
managing, converting, designing, procuring, developing, documenting, programming,
testing, implementing, or installing new information resources, including
systems development methodologies and disaster recovery capabilities.
(9)
] Information resources technologies--Data
processing and telecommunications hardware, software, services, supplies,
personnel, facility resources, maintenance, and training.
(10)
] Interagency application--An
information resources project implemented or used by multiple agencies.
(11)
] Project--A program to provide
information resources technologies support to functions within or among elements
of a state agency, which should be characterized by well-defined parameters,
specific objectives, common benefits, planned activities, a scheduled completion
date, and an established budget with a specified source of funding.
(12)
] Risk--The possibility of
an act or event occurring that would have an adverse effect on the state,
an organization or an information system. Risk involves both the probability
of failure and the possible consequences of a failure.
(13)
] Risk analysis--Risk analysis
is the evaluation of planned project events and deliverables in regards to
various factors to consider the possibility or probability of failure and
the consequences of such a failure. Risk analysis will yield an identification
of the areas of greater and lower risk.
(14)
] State agency--A department,
commission, board, office, council, or other agency in the executive or judicial
branch of government that is created by the constitution or a statute of this
state, including a university system or institution of higher education as
defined by the
Texas
Education Code, §61.003.
(15)
] Statewide application--An
information resources project implemented or used throughout state government.
(16)
] Telecommunications--Any transmission,
emission, or reception of signs, signals, writings, images, and sounds of
intelligence of any nature by wire, radio, optical, or other electromagnetic
systems and includes all facilities and equipment performing those functions
that are owned, leased, or used by state agencies and branches of state government.
(17)
] Telecommunications services--Intercity
communications facilities or services. "Telecommunications services" does
not include single agency point-to-point radio systems or facilities or services
of criminal justice information systems.
(18)
] Wide area network--A network
that interconnects geographical boundaries (such as buildings, campuses, cities,
regions, and/or states) which has a total distance (first node to last node)
of two or more miles and might be connected using common carrier services.
Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Experimental
] reimbursement
class. DHS may define
special reimbursement classes including
experimental
reimbursement classes of service to be used in research and demonstration
projects on new reimbursement methods
and reimbursement classes of service
to address the cost differences of a select group of recipients
. [
Demonstration or pilot projects based on experimental reimbursement
]
Special
classes may be implemented on a statewide basis or may be limited
to a specific region of the state or to a selected group of providers.
Chapter 355.
MEDICAID REIMBURSEMENT RATES
,
] requisition fee[
, and reassessment fee
] revenues accrued for the reporting period.
(6)
] Pre-enrollment expense fee.
Reimbursement for pre-enrollment assessment is determined using a method based
on modeled projected expenses which are developed by using data from surveys;
cost report data from other similar programs, consultation with other service
providers and/or professionals experienced in delivering contracted services;
and other sources.
(7)
] Exceptions to the reimbursement
determination methodology. DHS may adjust reimbursement if new legislation,
regulations, or economic factors affect costs, according to §355.109
of this title (relating to Adjusting Reimbursement When New Legislation, Regulations,
or Economic Factors Affect Costs).
, and reassessment
fee
] revenues accrued for the reporting period.
(h)
] Allowable and unallowable
costs.
(i)
] Authority to determine reimbursement.
The authority to determine reimbursement is specified in §355.101 of
this title (relating to Introduction).
(j)
] Reporting revenue. Revenues
must be reported on the cost report in accordance with §355.104 of this
title (relating to Revenues).
(k)
] Reviews and field audits of
cost reports. DHS staff perform desk reviews or field audits on all contracted
providers. The frequency and nature of the field audit are determined by DHS
to ensure the fiscal integrity of the program. Desk reviews and field audits
will be conducted in accordance with §355.106 of this title (relating
to Basic Objectives and Criteria for Audit and Desk Review of Cost Reports),
and providers will be notified of the results of a desk review or a field
audit in accordance with §355.107 of this title (relating to Notification
of Exclusions and Adjustments). Providers may request an informal review and,
if necessary, an administrative hearing to dispute an action taken by DHS
under §355.110 of this title (relating to Informal Reviews and Formal
Appeals).
(l)
] Reporting requirements. The
program director's full salary is to be reported on the line item of the cost
report designated for the director.
Subchapter M. MISCELLANEOUS MEDICAID PROGRAMS
skilled
] nursing
services provided by an
RN, nursing services provided by an LVN
, and behavior communication
specialist services, an allowable cost per unit of service is calculated for
each contracted provider for each service. The allowable costs per unit of
service for each contracted provider are arrayed. The units of service for
each contracted provider in the array are summed until the median unit of
service is reached. The corresponding expense to the median unit of service
is determined and is multiplied by 1.044. The allowable costs per unit of
service may be combined into an array with the allowable costs per unit of
service of similar services provided by other programs in determining the
median cost per unit of service.
Subchapter J. PURCHASED HEALTH SERVICES