1 TAC §355.307
The Texas Health and Human Services Commission (HHSC) adopts
an amendment to §355.307, with changes to the proposed text published
in the November 16, 2001, issue of the
Texas Register
(26 TexReg 9346).
Justification for the amendment is to reimburse nursing facilities which
have distinct pediatric units at a payment rate that reflects the spending
necessary to care for children in these specialized units. To qualify as a
distinct pediatric unit, a portion of a nursing facility must be physically
separate from other units. The pediatric unit must consist of 28 or more Medicaid-
contracted beds. A provider must request to become a member of this special
class in writing by certified mail. A pediatric care facility that is a distinct
unit of a nursing facility must complete a separate cost report for that unit.
The payment rate for recipients in a distinct pediatric unit will be determined
on a facility-specific basis and will not be based on the Texas Index for
Level of Effort (TILE) payment rates. Payment rates for recipients in the
remainder of the facility will be paid based on TILE payment rates. This special
reimbursement class will recognize the increased costs that exist in distinct
pediatric units of nursing facilities that specialize in serving children.
Section 355.307(c)(2)(A) has been revised to increase the requirement for
the average daily census of a distinct pediatric unit for the six months prior
to entry into the pediatric care facility class to 85% or more children for
the six months. This revision also increased to 85% the required percentage
of children that must be served to remain in the pediatric care facility class.
In addition, §355.307(c)(2)(A) has been revised to allow written requests
for entry into the pediatric care facility class be sent by special mail delivery
in which the delivery can be verified, and to specify that the request must
be sent to HHSC.
Comments were received from The Disability Policy Consortium; United Cerebral
Palsy of Texas; Ballantrae Healthcare; and Building Bridges Network, a network
of pediatric residential nursing facilities. In addition, a statement of support
signed by 49 individuals for improved funding for the children residing at
Pumpkin Patch at the Southland Villa Nursing Center was received. A summary
of the comments and the department's responses follows:
Comment: The Texas Department of Human Services (DHS) should ensure that
the pediatric care facility is in compliance with all permanency planning
requirements for all children residing in the facility. The pediatric care
facility must participate and complete the identification and assessment activities
described by the DHS plan to implement Olmstead requirements, as directed
by the Texas Health and Human Services Commission (HHSC) Promoting Independence
Plan.
Response: Senate Bill 368, enacted by the 77th Legislature, requires the
development of permanency plans for every child younger than 22 years of age
who is either admitted to an institution or for whom institutional care is
sought. DHS has proposed nursing facility rules to require uniform procedures
for the development of permanency plans. In addition, DHS is developing and
promoting independence policies, procedures, and guidelines. Through these
DHS initiatives, the determination of compliance with the permanency planning
process will be handled separately from the determination of payment for pediatric
care facilities. HHSC is adopting this section without change.
Comment: HHSC should develop a policy that provides an equal amount of
funding to alternate family/children's waiver services whenever there is an
increase in reimbursement rate for pediatric care facilities. Additional funding
provided to the facility should also be available to the children when transitioning
to families under Rider 7 provisions.
Response: All eligible Medicaid nursing facility residents that transition
to the community will have funding made available for their care if they meet
the eligibility requirements of the community program from which they seek
services. HHSC is adopting this section without change.
Comment: HHSC must carefully review if the increased spending necessary
to care for the children is needed, in light of Medicaid EPSDT that is intended
to provide medically necessary services to eligible children in the nursing
facility. The enhanced pediatric care facility rate should include a component
that requires a certain percentage of the additional funds to be allocated
to direct care staff and to children with high technology support needs.
Response: The payment rate for a pediatric care facility is based on the
actual cost of caring for children in the facility as captured on audited
cost reports. Only allowable, reasonable, and necessary costs incurred in
the provision of nursing facility care can be reported on the cost report
and used to determine the individual pediatric care facility's payment rate.
Any increase in spending on direct care staff or on equipment to support children
with high technology support needs will be reflected in the cost reports and
will be included in the payment rate determined for the facility. The services
reimbursed through the pediatric care facility payment rate are separate from
the services reimbursed by the EPSDT program. HHSC is adopting this section
without change.
Comment: Regarding §355.307(c)(2)(A), HHSC should change the language
to read, "units consisting of 28 or more beds that are filled by children
under the age of 22." Without this provision, only 22 of the 28 beds are required
to be filled by children under the age of 22.
Response: HHSC has revised this rule language to require a distinct pediatric
unit to maintain an average daily census of 85% or more children for the six
months prior to entry into the pediatric care facility class. The revision
also requires a distinct pediatric unit to maintain an average daily census
of 85% or more children to remain in the pediatric care facility class.
Comment: Regarding §355.307(c)(2)(A), HHSC should change the requirement
that the request to be a member of the pediatric care facility special reimbursement
class must be sent by certified mail. The rule should also specify to whom
the notice is to be addressed.
Response: HHSC has revised this rule language to allow this request to
be sent by certified mail or by special mail delivery in which the delivery
can be verified. The rule language has been changed to specify that the request
is to be mailed to HHSC.
The amendment is adopted under Government Code §531.033,
which authorizes the HHSC commissioner to adopt rules necessary to carry out
the commission's duties, and under §531.021(b), which establishes HHSC
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 Government Code §531.003 and §531.021(b).
§355.307.Reimbursement Setting Methodology.
(a)
Case mix classes. The Texas Department of Human Services
(DHS) reimbursement rates for nursing facilities (NFs) vary according to the
assessed characteristics of recipient. Rates are determined for 11 case mix
classes of service, plus a 12th, temporary classification assigned by default
when assessment data are incomplete or in error.
(b)
Reimbursement determination. DHS applies the general principles
of cost determination as specified in §355.101 of this title (relating
to Introduction).
(1)
Rate Components. Under the case mix methodology, reimbursements
are comprised of five cost-related components: the direct care staff component;
the other recipient care component; the dietary component; the general/administration
component; and the fixed capital asset component. The direct care staff component
is calculated as specified in §355.308 of this title (relating to Enhanced
Direct Care Staff Rate).
(A)
The dietary rate component is constant across all case
mix classes.
(i)
For rates effective May 1, 2000, using the inflation factors
used in determination of the nursing facility rates in effect January 1, 2000,
project the costs in the 1998 Texas Nursing Facility Cost Report data base
to the rate period beginning January 1, 2000, and ending August 31, 2000.
Using these projected costs, determine the median per diem dietary cost (weighted
by Medicaid days of service in the data base) in the array of allowable per
diem costs for all contracted nursing facilities included in the January 1,
2000, data base, multiplied by 1.07.
(ii)
For rates effective September 1, 2000, multiply the dietary
per diem rate from clause (i) of this subparagraph by 1.016.
(iii)
For rates effective September 1, 2001, and thereafter,
the dietary component is calculated at the median cost (weighted by Medicaid
days of service in the rate base) in the array of projected allowable per
diem costs for all contracted nursing facilities included in the rate base,
multiplied by 1.07.
(B)
The general/administration rate component is constant across
all case mix classes.
(i)
For rates effective May 1, 2000, the general/administration
rate component is equal to the difference between the general, administration,
and dietary rate component in effect January 1, 2000, and the dietary rate
component as calculated in paragraph (1)(A)(i) of this subsection.
(ii)
For rates effective September 1, 2000, multiply the general/administration
per diem rate from clause (i) of this subparagraph by 1.016.
(iii)
For rates effective September 1, 2001, and thereafter,
the general/administration component is calculated at the median cost (weighted
by Medicaid days of service in the rate base) in the array of projected allowable
per diem costs for all contracted nursing facilities included in the rate
base, multiplied by 1.07.
(C)
The fixed capital asset component is constant across all
case mix classes.
(i)
For rates effective May 1, 2000, the fixed capital asset
component is equal to the fixed capital asset component in effect January
1, 2000.
(ii)
For rates effective September 1, 2000, the fixed capital
asset component is equal to the fixed capital asset component from clause
(i) of this subparagraph multiplied by 1.016.
(iii)
For rates effective September 1, 2001 and thereafter,
the fixed capital asset component is calculated as follows:
(I)
Determine the 80th percentile in the array of allowable
appraised property values per licensed bed, including land and improvements.
Appraised values for this purpose are determined as follows:
(-a-)
For proprietary facilities, tax exempt facilities provided
an appraisal from their local property taxing authority, and tax exempt facilities
not provided an appraisal from their local property taxing authority because
of an "exempt" status whose independent appraisal is in the first year of
its five-year interval as described in §355.402(f)(2)(B)(ii) of this
title (relating to Cost Report Requirements: 1997 and Subsequent Cost Reports),
allowable appraised values are determined as described in §355.402(f)
of this title (relating to Cost Report Requirements: 1997 and Subsequent Cost
Reports).
(-b-)
For tax exempt facilities not provided an appraisal from
their local property taxing authority because of an "exempt" status whose
independent appraisal is not in the first year of its five- year interval
as described in §355.402(f)(2)(B)(ii) of this title (relating to Cost
Report Requirements: 1997 and Subsequent Cost Reports), allowable appraised
values are determined by indexing the facility's allowable appraised value
as determined in §355.402(f) of this title (relating to Cost Report Requirements:
1997 and Subsequent Cost Reports) to the median increase in appraised values
among contracted facilities in the state as a whole from the reporting period
coinciding with the first year of the facility's five-year interval to the
reporting period upon which reimbursements are to be based.
(-c-)
Those facilities that do not report an allowable appraised
value as described in §355.402(f) of this title (relating to Cost Report
Requirements: 1997 and Subsequent Cost Reports) are not included in the array
for purposes of calculating the use fee.
(II)
Project the 80th percentile of appraised property values
per bed by one-half the forecasted increase in the personal consumption expenditures
(PCE) chain-type price index from the cost reporting year to the rate year.
(III)
Calculate an annual use fee per bed as the projected
80th percentile of appraised property values per bed times an annual use rate
of 14%.
(IV)
Calculate a per diem use fee per bed by dividing the annual
use fee per bed by annual days of service per bed at the higher of 85% occupancy,
or the statewide average occupancy rate during the cost reporting period.
(V)
The use fee is limited to the lesser of the fee as calculated
in subclauses (I)-(IV) of this clause, or the fee as calculated by inflating
the fee from the previous rate period by the forecasted rate of change in
the PCE chain-type price index.
(2)
Case mix classification system. All Medicaid recipients
are classified according to the Texas Index for Level of Effort (TILE) classification
system described in 40 TAC §19.1812 (relating to Case Mix Classification
System). The TILE classification system includes four clinical categories,
which are further subdivided on the basis of an activity of daily living (ADL)
scale, resulting in a total of 11 TILE case mix groups. A 12th group is used
by default when a recipient's case-mix group membership is indeterminate because
of assessment errors or omissions. Each of the 12 case-mix groups, including
the default group, is assigned a case-mix index of effort. This index indicates
the relative amount of staff time required on average to deliver care to recipients
in that group. The case-mix index for each of the 11 TILE groups is determined
through statistical and clinical analyses of recipient resource utilization
data previously collected in Texas NFs. The lowest index for the 11 TILE groups
is used as the case- mix index for the default group.
(3)
Per diem rate methodology. Staff determine per diem rate
recommendations for each of the 11 TILE groups and for the default group according
to the following procedures:
(A)
Determine the statewide average case mix index for all
Medicaid recipients, except those in the default group. Weight the indexes
from paragraph (2) of this subsection, which are based on a sample of nursing
facilities, by the estimated statewide recipient days of service by case mix
group during the cost reporting period covered by the rate base and determine
the weighted average. The statewide average index is based on the most recent
and complete data available indicating recipient days of service by case mix
group that correspond to the period covered by the cost reports included in
the rate base.
(B)
Determine the standardized statewide case mix index for
each of the 11 TILE groups by dividing each of the indexes described under
paragraph (2) of this subsection by the statewide average case mix index described
under subparagraph (A) of this paragraph.
(C)
The other recipient care rate component varies according
to case mix class of service.
(i)
For rates effective May 1, 2000, using the inflation factors
used in determination of the nursing facility rates in effect January 1, 2000,
project the costs in the 1998 Texas Nursing Facility Cost Report data base
to the rate period beginning January 1, 2000, and ending August 31, 2000.
Using these projected costs, determine the sum of other recipient care costs
in all nursing facilities included in the 1998 data base. Then divide the
total by the sum of recipient days of service in all facilities in the 1998
data base. Multiply the resulting weighted, average per diem cost of other
recipient care by 1.07. The result is the average other recipient care rate
component. To calculate the other recipient care per diem rate component for
each of the 11 TILE case mix groups and for the default group, multiply each
of the standardized statewide case mix indexes used in determination of the
nursing facility rates in effect January 1, 2000, by the average other recipient
care rate component.
(ii)
For rates effective September 1, 2000, multiply the average
other recipient care per diem rate from clause (i) of this subparagraph by
1.016. To calculate the other recipient care per diem rate component for each
of the 11 TILE case mix groups and for the default group, multiply each of
the standardized statewide case mix indexes used in determination of the nursing
facility rates in effect January 1, 2000, by the average other recipient care
rate component.
(iii)
For rates effective September 1, 2001, and thereafter,
the average other recipient care rate component is calculated as follows.
Adjust the raw sum of other recipient care costs in all nursing facilities
included in the rate base in order to account for disallowed costs and inflation,
as specified in §355.306 of this title (relating to Cost Finding Methodology).
Then divide the adjusted total by the sum of recipient days of service in
all facilities in the current rate base. Multiply the resulting weighted,
average per diem cost of other recipient care by 1.07. The result is the average
other recipient care rate component. To calculate the other recipient care
per diem rate component for each of the 11 TILE case mix groups and for the
default group, multiply each of the standardized statewide case mix indexes
from subparagraph (B) of this paragraph by the average other recipient care
rate component.
(D)
Total case mix per diem rates vary according to case mix
class of service and according to participant status in the Enhanced Direct
Care Staff Rate described in §355.308 of this title (relating to Enhanced
Direct Care Staff Rate).
(i)
For each participating facility, for each of the 11 TILE
case mix groups and for the default group, the recommended total per diem
rate is the sum of the following five rate components:
(I)
the dietary rate component from paragraph (1)(A) of this
subsection;
(II)
the general/administration rate component from paragraph
(1)(B) of this subsection;
(III)
the fixed capital asset use fee component from paragraph
(1)(C) of this subsection;
(IV)
the case mix group's other recipient care per diem rate
component by case mix group from paragraph (3)(C) of this subsection; and
(V)
the case mix group's total direct care staff rate component
for that participating facility as determined in §355.308 of this title
(relating to Enhanced Direct Care Staff Rate).
(ii)
For nonparticipating facilities, for each of the 11 TILE
case mix groups and for the default group, the recommended total per diem
rate is the sum of the following five rate components:
(I)
the dietary rate component from paragraph (1)(A) of this
subsection;
(II)
the general/administration rate component from paragraph
(1)(B) of this subsection;
(III)
the fixed capital asset use fee component from paragraph
(1)(C) of this subsection;
(IV)
the case mix group's other recipient care per diem rate
component by case mix group from paragraph (3)(C) of this subsection; and
(V)
the case mix group's total direct care staff rate component
for non-participants as determined in §355.308 of this title (relating
to Enhanced Direct Care Staff Rate).
(E)
Qualifying ventilator-dependent residents may receive a
supplement to the per diem rate specified in subparagraph (D) of this paragraph.
(i)
To qualify for supplemental reimbursement, a resident must
require artificial ventilation for at least six consecutive hours daily and
the use must be prescribed by a licensed physician.
(ii)
A ventilator-dependent resource differential case mix
index is calculated, based on time- study research data. This resource differential
index reflects the difference between direct nursing services for ventilator-dependent
residents and services for residents in the most severe heavy-care TILE group.
(I)
The per diem rate supplement for participants in the Enhanced
Direct Care Staff Rate described in §355.308 of this title (relating
to Enhanced Direct Care Staff Rate) is calculated by multiplying the resource
differential case mix index times the per diem average other recipient care
rate component, as described in paragraph (3)(C) of this subsection and by
the average direct care staff rate component for participating facilities
staffing at the minimum levels required for participation as described in §355.308(l)
of this title (relating to Enhanced Direct Care Staff Rate) and summing the
products.
(II)
The per diem rate supplement for non-participants in the
Enhanced Direct Care Staff Rate described in §355.308 of this title (relating
to Enhanced Direct Care Staff Rate) is calculated by multiplying the resource
differential case mix index times the per diem average other recipient care
rate component, as described in paragraph (3)(C) of this subsection and by
the average direct care staff rate component for non-participating facilities
as described in §355.308(k) of this title (relating to Enhanced Direct
Care Staff Rate) and summing the products.
(iii)
The supplemental reimbursement for residents requiring
continuous artificial ventilation is 100% of the per diem ventilator rate
supplement.
(iv)
The supplemental reimbursement for residents not requiring
continuous artificial ventilation daily but requiring artificial ventilation
for at least six consecutive hours daily is 40% of the per diem ventilator
rate supplement.
(F)
Qualifying children with tracheostomies requiring daily
care may receive a supplement to the per diem rate specified in subparagraph
(D) of this paragraph.
(i)
To qualify for supplemental reimbursement, a resident must
be less than 22 years of age; require daily cleansing, dressing, and suctioning
of a tracheostomy; and be unable to do self care. The daily care of the tracheostomy
must be prescribed by a licensed physician.
(ii)
The supplemental reimbursement for children receiving
daily tracheostomy care is 60% of the per diem ventilator rate supplement
as specified in subparagraph (E) of this paragraph.
(G)
Children with qualifying conditions as specified in subparagraphs
(E) and (F) of this paragraph may receive only one of the supplemental reimbursements.
Therefore, children with tracheostomies who are also ventilator-dependent
are not eligible to receive both supplemental reimbursements.
(4)
Case mix classification effective periods. The effective
periods of case mix classifications are defined as follows.
(A)
A recipient's case mix classification and associated per
diem rate payment remain in effect until the recipient's next required assessment,
unless one of the following events takes place:
(i)
a provider submits an off-cycle assessment as specified
in 40 TAC §19.2412(a)(5) (relating to Texas Index for Level of Effort
(TILE) Assessments);
(ii)
a DHS nurse reviewer revises the recipient's assessment
and TILE classification under the provisions of 40 TAC §19.2412(b) (Texas
Index for Level of Effort (TILE) Assessments); or
(iii)
the recipient is discharged from the Medicaid nursing
facility vendor payment system for more than 30 days prior to receiving a
permanent medical necessity determination.
(B)
The case mix classification and associated per diem payment
rate of a recipient in the default group are changed retroactively when the
provider furnishes DHS with corrected data that permit classification in one
of the 11 TILE case mix groups.
(c)
Special reimbursement class. HHSC 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.
Special classes may be implemented on a statewide basis, may be limited to
a specific region of the state, or may be limited to a selected group of providers.
(1)
Pediatric Care Facility Class. 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 or distinct unit
of a nursing facility that serves predominantly children.
(2)
Definitions.
(A)
Pediatric care facility--A pediatric care facility is an
entire facility that has maintained an average daily census of 80% or more
children for the six-month period prior to its entry into the pediatric care
facility class based on the entire licensed facility. A pediatric care facility
can also be a distinct unit of a facility that has maintained an average daily
census of 85% or more children for the six-month period prior to its entry
into the pediatric care facility class based on the distinct unit of the facility.
To remain a pediatric care facility, the pediatric care facility must maintain
an average daily census of 80% or more children if the pediatric care facility
is an entire facility and 85% or more children if the pediatric care facility
is a distinct unit of the facility. The contracted provider must request in
writing by certified mail or by special mail delivery where the delivery can
be verified to become a member of the pediatric care facility special reimbursement
class. The request must be sent to the Texas Health and Human Services Commission.
(B)
Distinct unit--A portion of a nursing facility that is
physically separate from (beds are not commingled with) other units of the
facility. The distinct unit can be an entire wing, a separate building, an
entire floor, or an entire hallway. The distinct unit consists of all beds
within the designated area. A distinct unit must consist of 28 or more Medicaid-contracted
beds.
(C)
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). A nursing facility
that contains a pediatric care facility distinct unit must complete two cost
reports: one report for the pediatric care facility distinct unit and one
report for the remainder of the facility.
(B)
Payment rates for this class of service will be determined
on a facility-specific basis for the pediatric care facility. 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% of contracted capacity of the pediatric
care facility. 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 HHSC.
(C)
The facility-specific payment rate from paragraph (3)(B)
of this subsection will be paid for all Medicaid residents of a qualifying
pediatric care 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)
Pediatric care facilities are not eligible to participate
in §355.308 (relating to Enhanced Direct Care Staff Rate).
(d)
Nurse aide training and competency evaluation costs.
(1)
DHS reimburses nursing facilities for the actual costs
of training and testing nurse aides as required under the Omnibus Budget Reconciliation
Act of 1987 (OBRA '87). Payments are based on cost reimbursement vouchers
that are to be submitted quarterly. Allowable costs are limited to those costs
incurred for training provided after October 1, 1990, for:
(A)
actual training course expenses up to a set amount determined
by DHS per nurse aide;
(B)
competency evaluation; or
(C)
supplies and materials used in the nurse aide training
not already covered by the training course fee.
(2)
Nurse aide salaries while in training are factored into
the vendor rate and are not to be included on the reimbursement voucher.
(3)
Training program costs that exceed the DHS cost ceiling
must have prior approval from DHS before costs can be reimbursed. A written
request to Provider Billing Services must include:
(A)
name and vendor number of facility.
(B)
description of training program for which the facility
is seeking reimbursement approval, to include:
(i)
name, telephone number and address of the nurse aide training
and competency evaluation program (NATCEP);
(ii)
whether the NATCEP program is facility or non-facility-based;
and
(iii)
name of the NATCEP program director.
(C)
an explanation of why the cost for the NATCEP exceeds the
reimbursement ceiling. The explanation must include:
(i)
a completed nurse aide unit cost calculation form for a
facility-based NATCEP; or
(ii)
a breakdown of the nurse aide unit cost by the instructor
fees and training materials for a non-facility-based NATCEP.
(D)
an explanation of why the nursing facility cannot utilize
a training program at or below the reimbursement ceiling and what steps the
facility has taken to explore more cost efficient training courses. The explanation
must include:
(i)
the availability of NATCEPs, such as the location or the
frequency of training offered, in the geographic region of the facility;
(ii)
the name and address of each NATCEP that the facility
has explored as a provider of nurse aide training; and
(iii)
the cost per nurse aide for each NATCEP identified in
clause (i) of this subparagraph, as specified in subparagraph (C)(i) of this
paragraph or subparagraph (C)(ii) of this paragraph.
(4)
All prior approval requests as outlined in paragraph (3)
of this subsection must be submitted to DHS, Provider Billing Services that:
(A)
may request additional information in order to evaluate
a reimbursement request; and
(B)
will make the final decision on a reimbursement request.
(5)
All nurse aide training courses must be approved by DHS
before costs associated with them can be reimbursed.
(6)
Nursing facilities are responsible for tracking and documenting
nurse aide training costs for each nurse aide trained. All documentation is
subject to DHS audits. If substantiating documentation for amounts billed
to DHS cannot be verified, DHS will immediately recoup funds paid to the facility.
(7)
Individuals who have successfully completed a nurse aide
training and competency evaluation program (NATCEP) may be directly reimbursed
for costs incurred in completing a NATCEP. The individual must meet all of
the conditions specified in subparagraphs (A)-(E) of this paragraph.
(A)
The individual must not have been employed at the time
of completing the NATCEP.
(B)
The individual must have been employed by, or received
an offer of employment from, a nursing facility not later than 12 months after
successfully completing the NATCEP.
(C)
The individual must have been employed by the facility
for no less than six months.
(D)
The nursing facility must not have claimed reimbursement
for training expenses for the individual.
(E)
The individual must be listed on the current Nurse Aide
Registry.
(8)
Individuals must submit cost reimbursement vouchers to
DHS with proof that the individual has been employed by a facility for no
less than six months.
(9)
Individuals who leave nursing facility employment before
accruing the required six months of employment, as specified in paragraph
(7)(C) of this subsection, may receive 50% reimbursement as long as the individual
was employed for no less than three months.
(10)
Reimbursement to individuals may not exceed the reimbursement
ceiling as detailed in paragraph (1)(A) of this subsection.
(e)
Oxygen costs. Oxygen costs incurred on or after January
1, 1995, will not be reimbursed on cost reimbursement vouchers. Those oxygen
costs must be reported as expenses on the cost report.
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 February 6, 2002.
TRD-200200798
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Effective date: February 26, 2002
Proposal publication date: November 16, 2001
For further information, please call: (512) 438-3734