Part 12.
COMMISSION ON STATE EMERGENCY COMMUNICATIONS
Chapter 251.
REGIONAL PLANS--STANDARDS
1 TAC §251.2
The Commission on State Emergency Communications (CSEC) adopts
an amendment to §251.2, concerning guidelines for changing or extending
9-1-1 service arrangements, without changes to the proposed text as published
in the May 7, 2004, issue of the
Texas Register
(29
TexReg 4343).
This action is adopted as part of Rule Review of Chapter 251, pursuant
to Government Code, Section 2001.039. The rule continues to be essential to
the CSEC's operations and per statutory authority.
CSEC adopts the rule with amendments to this rule to streamline reporting
requirements for the regional planning commissions (RPCs). The associated
instructions for reporting are being proposed as a new proposed Program Policy
Statement, a more formal version of the agency's former Program Policies and
Procedures.
No comments were received regarding adoption of the amendment.
The amendment is adopted under Health and Safety Code, Chapter
771, §§771.051, 771.055, 771.056; and Title 1 Texas Administrative
Code, Part 12, Chapter 251, Regional Plan Standards, which provide the Commission
on State Emergency Communications with the authority to plan, develop, fund,
and provide provisions for the enhancement of effective and efficient 9-1-1
service.
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 June 28, 2004.
TRD-200404275
Paul Mallett
Executive Director
Commission on State Emergency Communications
Effective date: July 18, 2004
Proposal publication date: May 7, 2004
For further information, please call: (512) 305-6933
1 TAC §251.5
The Commission on State Emergency Communications (CSEC) adopts
an amendment to §251.5, concerning the use of 9-1-1 funds for equipment
management and disposition, without changes to the proposed text as published
in the May 7, 2004, issue of the
Texas Register
(29
TexReg 4345).
This action is adopted as part of Rule Review of Chapter 251, pursuant
to Government Code, Section 2001.039. The rule continues to be essential to
the CSEC's operations and per statutory authority.
CSEC adopts the rule with amendments to ensure consistency with Texas Uniform
Grant Management Standards (UGMS). Reporting forms attached to the previous
version of this rule have been revised and are now included in a new proposed
Program Policy Statement, a more formal version of the agency's former Program
Policies and Procedures.
The following comments were received regarding adoption of the amendment.
Comments received from the Texas Association of Regional Councils' (TARC)
9-1-1 Coordinators' Committee to 251.5 related to the required annual certification
of assets and notices of equipment disposal are being addressed in the proposed
PPS-014,
Asset Inventory Reporting
, which
will be presented for Commission action at the July 15th meeting.
The amendment is adopted under Health and Safety Code, Chapter
771, §§771.051, 771.055, 771.056, 771.071, 771.0711, 771.072, 771.075,
771.078, 771.079; and Title 1 Texas Administrative Code, Part 12, Chapter
251, Regional Plan Standards, which provide the Commission on State Emergency
Communications with the authority to plan, develop, fund, and provide provisions
for the enhancement of effective and efficient 9-1-1 service.
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 June 28, 2004.
TRD-200404276
Paul Mallett
Executive Director
Commission on State Emergency Communications
Effective date: July 18, 2004
Proposal publication date: May 7, 2004
For further information, please call: (512) 305-6933
1 TAC §251.7
The Commission on State Emergency Communications (CSEC) adopts
an amendment to §251.7, concerning the inclusion of third-party software
applications into the 9-1-1 integrated workstation environment, without changes
to the proposed text as published in the May 7, 2004, issue of the
Texas Register
(29 TexReg 4353).
This action is adopted as part of Rule Review of Chapter 251, pursuant
to Government Code, Section 2001.039. The rule continues to be essential to
the CSEC's operations and per statutory authority.
CSEC adopts the rule with substantive revision to the rule to add a requirement
that mapping of telephone number (TN) data is tested for accuracy prior to
"going live" with Mapped ALI at a PSAP.
The following comments were received regarding adoption of the amendment.
Comments received from the Texas Association of Regional Councils' (TARC)
9-1-1 Coordinators' Committee to 251.7,
Guidelines
for Implementing Integrated Services
related to documentation of testing
for integrated services, are being addressed in the proposed PPS-015, 9-1-1
System Survey, which will be presented for Commission action at the July 15th
meeting.
The amendment is adopted under Health and Safety Code, Chapter
771, §§771.051, 771.055 and 771.056; and Title 1 Texas Administrative
Code, Part 12, Chapter 251, Regional Plan Standards, which provide the Commission
on State Emergency Communications with the authority to plan, develop, fund,
and provide provisions for the enhancement of effective and efficient 9-1-1
service.
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 June 28, 2004.
TRD-200404277
Paul Mallett
Executive Director
Commission on State Emergency Communications
Effective date: July 18, 2004
Proposal publication date: May 7, 2004
For further information, please call: (512) 305-6933
1 TAC §251.8
The Commission on State Emergency Communications (CSEC) adopts
an amendment §251.8, concerning proposed guidelines for the procurement
of equipment services with 9-1-1 funds, without changes to the proposed text
as published in the May 7, 2004, issue of the
Texas
Register
(29 TexReg 4355).
This action is adopted as part of Rule Review of Chapter 251, pursuant
to Government Code, Section 2001.039. The rule continues to be essential to
the CSEC's operations and per statutory authority.
CSEC adopts the rule with amendments made to ensure consistency with Texas
Uniform Grant Management Standards (UGMS).
No comments were received regarding adoption of the amendment.
The amendment is adopted under Health and Safety Code, Chapter
771, §§771.051, 771.071, 771.0711, 771.072, 771.075; and Title 1
Texas Administrative Code, Part 12, Chapter 251, Regional Plan Standards,
which provide the Commission on State Emergency Communications with the authority
to plan, develop, fund, and provide provisions for the enhancement of effective
and efficient 9-1-1 service.
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 June 28, 2004.
TRD-200404278
Paul Mallett
Executive Director
Commission on State Emergency Communications
Effective date: July 18, 2004
Proposal publication date: May 7, 2004
For further information, please call: (512) 305-6933
Chapter 355.
MEDICAID REIMBURSEMENT RATES
Subchapter A. COST DETERMINATION PROCESS
1 TAC §355.112
The Texas Health and Human Services Commission (HHSC) adopts
an amendment to §355.112, with changes to the proposed text published
in the April 30, 2004, issue of the
Texas Register
(29 TexReg 4037).
The primary purpose of the amendment was to expand the definition of an
attendant in the Residential Care (RC) and Community Based Alternatives Assisted
Living/Residential Care (CBA AL/RC) programs to include drivers as attendants.
This amended definition accurately reflects the fact that attendants also
function as drivers in the majority of RC and CBA AL/RC facilities. While
serving as drivers, attendants provide assistance with activities of daily
living such as doctor and hospital visits, shopping, and outdoor activities.
The amendment also corrected references to the CBA AL/RC Program so they are
consistent throughout the rule.
HHSC received no comments regarding adoption of the amendment.
HHSC, however, has initiated a minor editorial change to the text of §355.112(b)(4)
to clarify and improve the accuracy of the section.
The amendment is adopted under the Government Code, §531.033,
which authorizes the commissioner of HHSC to adopt rules necessary to carry
out the commission's duties, and §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 Human Resources
Code, Chapter 32.
The amendment affects the Government Code, §§531.033 and 531.021(b).
§355.112.Attendant Compensation Rate Enhancement.
(a)
Eligible programs. Providers contracted in the Primary
Home Care, including Family Care (PHC/FC); Day Activity and Health Services
(DAHS); Residential Care (RC); Community Living Assistance and Support Services
(CLASS)--Direct Service Agency; Community Based Alternatives (CBA)--Home and
Community Support Services (HCSS); Deaf-Blind Multiple Disabilities Waiver
(DBMD); and CBA--Assisted Living/Residential Care (AL/RC) programs, are eligible
to participate in the attendant compensation rate enhancement.
(b)
Definition of attendant. An attendant is the unlicensed
caregiver providing direct assistance to the clients with Activities of Daily
Living (ADL) and Instrumental Activities of Daily Living (IADL).
(1)
In the case of DAHS, RC, and CBA AL/RC programs, the attendant
may perform some nonattendant functions. In such cases, the attendant must
perform attendant functions at least 80% of his or her total time worked.
Staff in these settings not providing attendant services at least 80% of their
total time worked are not considered attendants. Time studies must be performed
in accordance with §355.105(b)(2)(B)(i) for staff in the DAHS, RC, and
CBA AL/RC programs that are not full-time attendants but perform attendant
functions to determine if a staff member meets this 80% requirement. Failure
to perform the time studies for these staff will result in the staff not being
considered to be attendants.
(2)
Attendants do not include the director, administrator,
assistant director, assistant administrator, clerical and secretarial staff,
professional staff, other administrative staff, licensed staff, attendant
supervisors, cooks and kitchen staff, maintenance and groundskeeping staff,
activity director, and laundry and housekeeping staff. In the case of PHC/FC,
CLASS, CBA HCSS, and DBMD staff other than attendants may deliver attendant
services and be considered an attendant if they must perform attendant services
that cannot be delivered by another attendant to prevent a break in service.
(3)
An attendant also includes a driver in the DAHS, RC, and
CBA AL/RC programs.
(4)
An attendant also includes medication aides in the RC and
CBA AL/RC programs.
(c)
Attendant compensation cost center. This cost center will
include employee compensation, contract labor costs, and personal vehicle
mileage reimbursement for attendants as defined in subsection (b) of this
section.
(1)
Attendant compensation is the allowable compensation for
attendants defined in §355.103(b)(1) of this title (relating to Specifications
for Allowable and Unallowable Costs) and required to be 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, except
as noted in paragraph (3) of this subsection, are not to be included in this
cost center.
(2)
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 where allowed by program rules. Allowable
contract labor costs are defined in §355.103(b)(2)(C) of this title (relating
to Specifications for Allowable and Unallowable Costs).
(3)
Mileage reimbursement paid to the attendant for the use
of his or her personal vehicle and which is not subject to payroll taxes is
considered compensation for this cost center.
(d)
Rate year. The rate year begins on the first day of September
and ends on the last day of August of the following year.
(e)
Open enrollment. Open enrollment begins on the first day
of July and ends on the last day of that same July preceding the rate year
for which payments are being determined, unless the Texas Health and Human
Services Commission (HHSC) notified providers before the first day of July
that open enrollment has been postponed or cancelled. Should conditions warrant,
HHSC may conduct additional enrollment periods during a rate year.
(f)
Enrollment contract amendment. An initial enrollment contract
amendment is required from each provider choosing to participate in the attendant
compensation rate enhancement. On the initial enrollment contract amendment,
the provider must specify for each contract a desire to participate or not
to participate. The participating provider must specify for each program the
desire to have all participating contracts be considered as a group or as
individuals for purposes related to the attendant compensation rate enhancement.
For the PHC/FC program, the participating provider must also specify if he
wishes to have either priority 1, nonpriority, or both priority 1 and nonpriority
services participating in the attendant compensation rate enhancement. If
the PHC/FC provider selects to have their contracts participating as a group,
then the provider must select to have either priority 1, nonpriority, or both
priority 1 and nonpriority services participate for the entire group of contracts.
For providers delivering services to both RC and CBA AL/RC clients in the
same facility, participation includes both the RC and CBA AL/RC programs.
After initial enrollment, participating and nonparticipating providers may
request to modify their enrollment status during any open enrollment period.
A nonparticipant can request to become a participant; a participant can request
to become a nonparticipant; a participant can request to change its participation
level; a provider whose participating contracts are being considered as a
group can request to have them considered as individuals; and a provider whose
participating contracts are being considered as individuals can request to
have them considered as a group. Requests to modify a provider's enrollment
status during an open enrollment period must be received by HHSC Rate Analysis
by the last day of the open enrollment period as per subsection (e) of this
section. If the last day of open enrollment is on a weekend day, state holiday,
or national holiday, the next business day will be considered the last day
requests will be accepted. Providers from which HHSC Rate Analysis has not
received an acceptable request to modify their enrollment by the last day
of the open enrollment period will continue at the level of participation
and group or individual status in effect during the open enrollment period
within available funds. To be acceptable, an enrollment contract amendment
must be completed according to instructions, signed by an authorized signatory
as per the Texas Department of Human Services (DHS) Corporate Board of Directors
Resolution applicable to the provider's contract or ownership type, and legible.
(g)
New contracts. For the purposes of this section, for each
rate year a new contract is defined as a contract delivering its first day
of service to a DHS client on or after the first day of the open enrollment
period, as defined in subsection (e) of this section, for that rate year.
Contracts that underwent a contract assignment are not considered new contracts.
For purposes of this subsection, an acceptable contract amendment is defined
as a legible enrollment contract amendment that has been completed according
to instructions, signed by an authorized signator as per the DHS Corporate
Board of Directors Resolution applicable to the provider's contract or ownership
type, and received by HHSC Rate Analysis within 30 days of the date of notification
to the provider that such an enrollment contract amendment must be submitted.
If the 30th day is on a weekend day, state holiday, or national holiday, the
next business day will be considered the last day requests will be accepted.
The granting of newly requested rate enhancement increments as outlined in
subsection (p) of this section is limited to available funds. New contracts
will receive the nonparticipant attendant compensation rate as specified in
subsection (m) until:
(1)
for new contractors specifying the desire not to participate
on an acceptable enrollment contract amendment, the attendant compensation
rate component is as specified in subsection (m) of this section.
(2)
for new contractors specifying the desire to participate
on an acceptable enrollment contract amendment, the attendant compensation
rate component is adjusted as specified in subsections (l) and (n) of this
section retroactive to the first day of their contract.
(3)
for new contracts from which an acceptable enrollment contract
amendment is not received, the attendant compensation rate component is as
specified in subsection (m) of this section.
(h)
Attendant Compensation Report submittal requirements. Attendant
Compensation Reports must be submitted by participating contracted providers
as follows.
(1)
Contracted providers participating for the full rate year.
Contracted providers participating for the full rate year must provide annual
Attendant Compensation Reports as follows:
(A)
Participating contracted providers will provide HHSC Rate
Analysis, in a method specified by HHSC Rate Analysis, an annual Attendant
Compensation Report reflecting the activities of the provider while delivering
contracted services from the first day of the rate year through the last day
of the rate year. This report must be submitted for each participating contract
if the provider requested participation individually for each contract; or,
if the provider requested participation as a group, the report must be submitted
as a single aggregate report covering all contracts participating at the end
of the rate year within one program of the provider. A participating contract
that has been terminated in accordance with subsection (v) of this section
or that has undergone a contract assignment in accordance with subsection
(w) of this section will be considered to have participated on an individual
basis for compliance with reporting requirements for the owner prior to the
termination or contract assignment. This report will be used as the basis
for determining compliance with the spending requirements and recoupment amounts
as described in subsection (s) of this section. Contracted providers failing
to submit an acceptable annual Attendant 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 HHSC Rate Analysis.
(B)
Contracts whose cost report year, as defined in §355.105(b)(5)
of this title (relating to General Reporting and Documentation Requirements,
Methods and Procedures), coincides with the state of Texas fiscal year, are
exempt from the requirement to submit a separate annual Attendant Compensation
Report. For these contracts, their cost report will be considered their annual
Attendant Compensation Report.
(2)
Contracted providers participating for less than a full
year. Contracted providers participating for less than a full year must provide
Attendant Compensation Reports as follows:
(A)
A participating provider whose contract is terminated either
voluntarily or involuntarily before the end of the rate year must submit an
Attendant 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 recoupment as described
in subsection (s) of this section.
(B)
In cases where a participating provider changes ownership
through a contract assignment, the owner prior to the change of ownership
must submit an Attendant Compensation Report, covering the period from the
beginning of the rate year to the effective date of the contract assignment
as determined by DHS. The owner, after the change of ownership, must submit
an Attendant Compensation Report within 60 days of the end of the rate year,
covering the period from the effective date of the contract assignment as
determined by DHS to the end of the rate year. This report will be used as
the basis for determining recoupment as described in subsection (s) of this
section.
(C)
A participating provider who is excluded from participation
as per subsection (u) of this section must submit an Attendant Compensation
Report within 60 days from the date of notification of the exclusion, covering
the period from the beginning of the rate year to the date of exclusion as
determined by HHSC Rate Analysis. This report will be used as the basis for
determining recoupment as described in subsection (s) of this section.
(D)
A participating provider who voluntarily withdraws from
participation as per subsection (x) of this section must submit an Attendant
Compensation Report within 60 days from the date of withdrawal as determined
by HHSC, covering the period from the beginning of the rate year through the
date of withdrawal as determined by HHSC. This report will be used as the
basis for determining recoupment as described in subsection (s) of this section.
(E)
A participating provider who is a new contractor as per
subsection (g) of this section must submit an Attendant Compensation Report
within 60 days of the end of the rate year, covering the period from the first
day of the contract as determined by DHS through the end of the rate year.
This report will be used as the basis for determining recoupment as described
in subsection (s) of this section.
(3)
Other reports. HHSC may require other reports from all
contracts as needed.
(4)
Vendor hold. HHSC will place on hold the vendor payments
for any contractor who does not submit an Attendant Compensation Report completed
in accordance with all applicable rules and instructions by the due dates
described in this subsection. This vendor hold will remain in effect until
HHSC Rate Analysis receives an acceptable Attendant Compensation Report.
(A)
Contractors participating at the end of the rate year who
do not submit an Attendant Compensation Report in accordance with paragraphs
(1), (2)(B), and (2)(E) of this subsection, completed in accordance with all
applicable rules and instructions, within 60 days of the vendor hold being
placed will become a nonparticipant retroactive to the first day of the reporting
period until the first day of the month after all of the following conditions
are met:
(i)
the provider submits an acceptable annual Attendant Compensation
Report;
(ii)
the provider submits a separate Attendant Compensation
Report from the beginning of the current rate year to the date they were disenrolled
as a participant;
(iii)
the provider repays to DHS funds that are identified
for recoupment from subsection (s) of this section; and
(iv)
HHSC Rate Analysis receives, in writing by certified mail,
a request from the provider to be restored to the participant status.
(B)
Contractors not participating at the end of the rate year
who do not submit an Attendant Compensation Report in accordance with paragraph
(2)(A) - (D) of this subsection, completed in accordance with all applicable
rules and instructions, within 60 days of the vendor hold being placed will
become nonparticipants from the beginning of the rate year to the date of
ownership change, exclusion, or withdrawal.
(i)
Attendant Compensation Report contents. Each Attendant
Compensation Report will include any information required by HHSC to implement
this attendant compensation rate enhancement.
(j)
Completion of compensation reports. All Attendant Compensation
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).
Beginning with the rate year that starts September 1, 2002, all Attendant
Compensation Reports must be completed by preparers who have attended the
required cost report training for the applicable program under §355.102(d)
of this title (relating to General Principles of Allowable and Unallowable
Costs).
(k)
Enrollment. Providers choosing to participate in the attendant
compensation rate enhancement must submit to HHSC a signed enrollment contract
amendment as described in subsection (f) of this section. Participation is
determined separately for each program specified in subsection (a) of this
section, except that for providers delivering services to both RC and CBA
AL/RC clients in the same facility, participation includes both the RC and
CBA AL/RC programs. For PHC/FC, participation is also determined separately
for priority 1 and nonpriority services. Participation will remain in effect,
subject to availability of funds, until the provider notifies HHSC, in accordance
with subsection (x) of this section, that it no longer wishes to participate
or until HHSC excludes the contract from participation for reasons outlined
in subsection (u) of this section. Contracts voluntarily withdrawing from
participation will have their participation end effective with the date of
withdrawal as determined by HHSC. Contracts excluded from participation will
have their participation end effective on the date determined by HHSC.
(l)
Determination of attendant compensation rate component
for participating contracts. For each of the programs identified in subsection
(a) of this section, an attendant compensation rate component will be determined
for participating contracts from subsection (k) of this section. The attendant
compensation rate enhancement component will be determined by taking into
consideration quality of care, labor market conditions, economic factors,
and budget constraints. The attendant compensation rate enhancement component
will be determined on a per-unit-of-service basis applicable to each program
or service.
(m)
Determination of attendant compensation rate component
for nonparticipating contracts. For each of the programs identified in subsection
(a) of this section, HHSC will calculate an attendant compensation rate component
for nonparticipating contracts as follows.
(1)
Determine for each contract included in the cost report
data base used in determination of rates in effect on September 1, 1999, the
attendant compensation cost center from subsection (c) of this section.
(2)
Adjust the cost center data from paragraph (1) of this
subsection in order to account for inflation utilizing the inflation factors
used in the determination of the September 1, 1999 rates.
(3)
For each contract included in the cost report database
used to determine rates in effect on September 1, 1999, divide the result
from paragraph (2) of this subsection by the corresponding units of service.
Provider projected costs per unit of service are rank-ordered from low to
high, along with the provider's corresponding units of service. For DAHS,
the median cost per unit of service is selected. For all other programs, the
units of service are summed until the median unit of service is reached. The
corresponding projected cost per unit of service is the weighted median cost
component. The result is multiplied by 1.044 for all programs in subsection
(a) of this section except for RC and CBA AL/RC, which is multiplied by 1.07.
The result is the attendant compensation rate component for nonparticipating
contracts.
(4)
The attendant compensation rate component will remain constant
over time, except for adjustments necessitated by increases in the minimum
wage. In such cases, adjustments to the nonparticipating rates are limited
to ensuring that these rates are adequate to cover mandated minimum wage levels.
(n)
Determination of attendant compensation rate enhancements.
HHSC will determine attendant compensation rate enhancement increments associated
with each enhanced attendant compensation level. The attendant compensation
rate enhancement increments will be determined by using data from sources
such as cost reports, surveys, and/or other relevant sources. The attendant
compensation rate enhancement increments will be determined by taking into
consideration quality of care, labor market conditions, economic factors,
and budget constraints. The attendant compensation rate enhancement increments
will be determined on a per-unit-of-service basis applicable to each program
or service.
(o)
Enhanced attendant compensation. Participating contracts
desiring to provide attendant compensation above the level included in subsection
(l) of this section may request attendant compensation increments from an
array of enhanced attendant compensation options and associated add-on payments
determined in subsection (n) of this section during open enrollment. Participating
providers who select to have all of their contracts participate in a program
as a group must request a single attendant compensation increment for the
entire group of contracts. PHC/FC providers participating as a group must
select a single attendant compensation increment for their entire group of
contracts for the priority 1 and/or nonpriority services they have selected
for participation.
(p)
Granting additional attendant compensation rate enhancement
increments. HHSC divides all requests for attendant compensation rate enhancement
increments into two groups: pre- existing rate enhancement increments which
providers requested to carry over from the prior year and newly requested
rate enhancement increments. Newly requested rate enhancement increments may
be requested by providers who were nonparticipants in the prior year, by providers
who were participants during the prior year desiring to be granted additional
rate enhancement increments or by new contracts as described in subsection
(g) of this section. Using the process described herein, HHSC first determines
the distribution of carry-over rate enhancement increments. If funds are available
after the distribution of carry-over rate enhancement increments, HHSC determines
the distribution of newly requested rate enhancement increments as follows:
(1)
HHSC determines projected units of service for contracts
requesting each enhancement increment and multiplies this number by the enhancement
rate add-on amount associated with that enhancement increment as determined
in subsection (n) of this section.
(2)
HHSC compares the sum of the products from paragraph (1)
of this subsection to available funds.
(A)
If the product is less than or equal to available funds,
all requested enhancements are granted.
(B)
If the product is greater than available funds, enhancements
are granted beginning with the lowest level of enhancement and granting each
successive level of enhancement until requested enhancements are granted within
available funds. Based upon an examination of existing compensation levels
and compensation needs, HHSC may grant certain enhancement options priority
for distribution.
(q)
Notification of granting of enhancements. Participating
contracts are notified, in a manner determined by HHSC, as to the disposition
of their request for additional attendant compensation rate enhancement increments.
(r)
Total attendant compensation rate for participating contracts.
Each participating contract will receive an attendant compensation rate equal
to the attendant compensation rate component for participating contracts from
subsection (l) of this section, plus any additional attendant compensation
rate enhancement payments granted to the contract.
(s)
Spending requirements for participating contracts. HHSC
will determine from the Attendant Compensation Report, as specified in subsection
(h) of this section and other appropriate data sources, the amount of attendant
compensation spending per unit of service delivered. The provider's compliance
with the spending requirement is determined based on the total attendant compensation
spending as reported on the Attendant Compensation Report for each participating
contract if the provider requested participation individually for each contract.
A participating contract that has been terminated in accordance with subsection
(v) of this section or that has undergone a contract assignment in accordance
with subsection (w) of this section will be considered to have participated
on an individual basis for compliance with the spending requirement for the
owner prior to the termination or contract assignment. If the provider specified
that he wished to have all participating contracts be considered as a group
for purposes related to the attendant compensation rate enhancement, as specified
in subsection (f) of this section, compliance with the spending requirement
is based on the total attendant compensation as reported on the single aggregate
Attendant Compensation Report described in subsection (h) of this section.
Compliance with the spending requirement is determined separately for each
program specified in subsection (a) of this section, except for providers
delivering services to both RC and CBA AL/RC clients in the same facility
whose compliance is determined by combining both programs. HHSC will calculate
recoupment, if any, as follows.
(1)
For the rate year beginning September 1, 2000, the attendant
compensation spending per unit of service is multiplied by 1.09 to determine
the adjusted attendant compensation per unit of service. For the rate years
beginning September 1, 2001, and September 1, 2002, the attendant compensation
spending per unit of service is multiplied by 1.07 to determine the adjusted
attendant compensation per unit of service. For the rate year beginning September
1, 2003, and thereafter, the attendant compensation spending per unit of service
is multiplied by 1.10 to determine the adjusted attendant compensation per
unit of service.
(2)
The adjusted attendant compensation per unit of service
from paragraph (1) of this subsection will be subtracted from the accrued
attendant compensation revenue to determine the amount to be recouped. If
the adjusted attendant compensation per unit of service is greater than or
equal to the accrued attendant compensation revenue per unit of service, there
is no recoupment.
(3)
The amount paid for attendant compensation per unit of
service after adjustments for recoupment must not be less than the amount
determined in subsection (m) of this section.
(t)
Notification of recoupment. Providers will be notified
in a manner specified by HHSC of the amount to be repaid to DHS. If a subsequent
review or audit results in audit adjustments to the annual Attendant Compensation
Report that changes the amount to be repaid, the provider 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 provider's vendor payment(s) following
the date of the notification letter.
(u)
Exclusion from participation. Effective with the rate year
that begins September 1, 2002, if the Attendant Compensation Report described
in subsection (h) of this section indicates that the participating provider
did not meet their spending requirement as determined from subsection (s)
of this section, HHSC will notify the provider of the noncompliance. If the
subsequent compensation report from subsection (h) of this section indicates
that the provider has not met their spending requirement, the contract will
be excluded from participation in the attendant rate enhancement effective
immediately upon notice of failure to meet the spending requirement. The contract
will be excluded from participation in the attendant compensation rate enhancement
and will remain a nonparticipant for the remainder of the rate year in which
the determination was made plus an additional rate year. Providers whose contracts
are participating as a group must meet the requirements of this subsection
as a group or all the contracts of the group will be excluded.
(v)
Contract terminations. For terminating participants, HHSC
will place a vendor hold on the payments of the contracted provider until
HHSC receives an acceptable Attendant Compensation Report, as specified in
subsection (h)(2)(A) of this section, and funds identified for recoupment
from subsection (s) of this section are repaid to DHS. DHS will recoup any
amount owed from the provider's vendor payments that are being held. In cases
where funds identified for recoupment cannot be repaid by the terminating
provider's last vendor payment, the responsible entity from subsection (cc)
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 new contracts with DHS until repayment is
made in full.
(w)
Contract assignments. The following applies to contract
assignments.
(1)
Contracts participating under the prior legal entity will
continue participation under the legal entity accepting the contract assignment.
When the provider or legal entity accepting the contract assignment has their
contracts participating as individuals, participation in the attendant compensation
rate enhancement confers to the provider or legal entity accepting the contract
assignment. When the provider or legal entity accepting the contract assignment
has their contracts participating as a group, the contract will participate
with the group of the legal entity accepting the contract assignment for purposes
related to the attendant compensation rate enhancement. When the provider
or legal entity accepting the contract assignment has no contracts participating,
the individual or group status of participating contracts under the old owner
will transfer to the new owner. When the provider or legal entity accepting
the contract assignment has its contracts participating as individuals or
has no contracts participating, the provider or legal entity may submit an
enrollment contract amendment to modify the enrollment of the assigned contract.
To be acceptable, an enrollment contract amendment must be completed according
to instructions, signed by an authorized signatory as per the DHS Corporate
Board of Directors Resolution applicable to the provider's contract or ownership
type, and be legible.
(2)
When the contract assignment is an ownership change from
one legal entity to a different legal entity, HHSC will place a vendor hold
on the payments of the existing contracted provider until HHSC receives an
acceptable Attendant Compensation Report specified in subsection (h)(2)(B)
of this section and until funds identified for recoupment from subsection
(s) of this section are repaid to DHS. DHS will recoup any amount owed from
the provider's vendor payments that are being held. In cases where funds identified
for recoupment cannot be repaid by the existing contracted provider's vendor
payments that are being held, the responsible entity from subsection (cc)
of this section will be jointly and severally liable for any additional payment
due to DHS. Failure to repay the amount due 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
new contracts with DHS until repayment is made in full.
(x)
Voluntary withdrawal. Participating contracts wishing to
withdraw from the attendant compensation rate enhancement must notify HHSC
Rate Analysis in writing by certified mail. The requests will be effective
the first of the month following the receipt of the request. Contracts voluntarily
withdrawing must remain nonparticipants for the remainder of the rate year.
Providers whose contracts are participating as a group must request withdrawal
of all the contracts in the group.
(y)
Adjusting attendant compensation requirements. Providers
that determine that they will not be able to meet their attendant compensation
requirements may request to reduce their attendant compensation requirements
and associated enhancement payment to a lower participation level by submitting
a written request to HHSC Rate Analysis by certified mail. These requests
will be effective the first of the month following the receipt of the request.
Providers whose contracts are participating as a group must request the same
reduction for all of the contracts in the group.
(z)
All other rate components. All other rate components will
continue to be calculated as specified in the program-specific reimbursement
methodology and will be uniform for all providers.
(aa)
Failure to document spending. Undocumented attendant compensation
expenses will be disallowed and will not be used in the determination of the
attendant compensation spending per unit of service in subsection (s) of this
section.
(bb)
Appeals. Subject matter of informal reviews and formal
appeals is limited as per §355.110 of this title (relating to Informal
Reviews and Formal Appeals).
(cc)
Responsible entities. The contracted provider, owner,
or legal entity which received the attendant compensation rate enhancement
is responsible for the repayment of the recoupment amount.
(dd)
Reinvestment. HHSC will reinvest recouped funds in the
attendant compensation rate enhancement to the extent there are qualifying
contracts.
(1)
Identify qualifying contracts. Contracts that meet the
following criteria during the most recently completed reporting period are
qualifying contracts for reinvestment purposes.
(A)
The contract was a participant in the attendant compensation
rate enhancement.
(B)
The contract's attendant compensation spending per unit
of service was greater than the total attendant compensation rate per unit
of service granted to the contract.
(C)
HHSC Rate Analysis has received an acceptable Attendant
Compensation Report completed in accordance with all applicable rules and
instructions.
(2)
Distribution of available reinvestment funds. Available
funds are distributed as follows:
(A)
HHSC determines units of service provided during the most
recently completed reporting period by each qualifying contract and multiplies
this number by the attendant compensation spending per unit of service minus
the attendant compensation rate per unit of service for the reporting period.
(B)
HHSC compares the sum of the products from subparagraph
(A) of this paragraph to funds available for reinvestment.
(i)
If the product is less than or equal to available funds,
all enhancements for qualifying contracts are retroactively awarded for the
reporting period.
(ii)
If the product is greater than available funds, retroactive
enhancements are granted beginning with the lowest level of enhancement and
granting each successive level of enhancement until enhancements are granted
within available funds.
(3)
Non-qualification as pre-existing enhancements. Retroactively
awarded enhancements do not qualify as pre-existing enhancements for enrollment
purposes.
(4)
Notification of reinvested enhancements. Qualifying facilities
are notified of the award of reinvested enhancements in a manner determined
by HHSC.
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 June 24, 2004.
TRD-200404224
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Effective date: July 14, 2004
Proposal publication date: April 30, 2004
For further information, please call: (512) 438-3734
Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Subchapter J. PURCHASED HEALTH SERVICES