1 TAC §352.10
The Texas Health and Human Services Commission adopts new §352.10,
concerning a quality assurance fee for the Home and Community-Based Services
and the Community Living Assistance and Support Services waivers, on an emergency
basis. Elsewhere in this issue of the
Texas Register
the Commission contemporaneously proposes §352.10 for permanent
adoption. Section 352.10 will become effective on September 1, 2005.
Section 352.10 is adopted on an emergency basis to give effect to the requirements
of Senate Bill 1830, Sec. 1, 79th Legislature, R.S. (2005), which became effective
on June 17, 2005. Senate Bill 1830 directs the Commission to impose a quality
assurance fee under the home and community services and community living assistance
and support services waivers. The quality assurance fee will be assessed at
up to 6 percent of revenues received by providers operating these programs
for both Medicaid and private clients. The funds collected from the fee will
be used as matching funds to support increases in Medicaid payments. This
emergency adoption also revises the title of Chapter 352 to reflect the inclusion
of the identified waiver services into the quality assurance fee program.
Section 352.10 is adopted on an emergency basis under Senate
Bill 1830, which directs the Commission to modify the quality assurance fee
program to add a quality assurance fee for home and community services and
community living assistance and support services waivers; Government Code, §531.033,
which authorizes the Executive Commissioner to adopt rules necessary to carry
out the Commission's duties; Government Code, §531.021, which established
the Commission as the agency responsible for adopting reasonable rules governing
the determination of fees, charges, and rates for medical assistance payments
under the Human Resources Code, Chapter 32; and Government Code, §2001.034,
which permits emergency rulemaking.
§352.10.Quality Assurance Fee for the Home and Community-based Services and Community Living Assistance and Support Services.
(a)
Definitions. The following definitions apply to this section.
(1)
Provider. A person or entity that contracts with the Department
of Aging and Disability Services (DADS) as a Home and Community-based Services
Program Provider, Community Living Assistance and Support Services-Direct
Services Agency Provider, or Community Living Assistance and Support Services-Case
Management Agency.
(2)
Gross receipts. Money received as compensation for services
under an intermediate care facilities for the mentally retarded waiver program
such as a home and community services waiver or a community living assistance
and support services waiver. The term does not include a charitable contribution,
revenues received for services or goods other than waivers, or any money received
from consumers or their families as reimbursement for services or goods not
normally covered by the waivers.
(3)
Net operating revenues. Gross receipts less any deducted
amounts for bad debts, charity care, and payer discounts.
(4)
Units of service. The units of service by rate type and
by level of need, where applicable, that were accrued for the reporting period.
Units of service that were delivered and not yet billed or paid to the provider
are to be included as units of service.
(b)
Determination of the fee. The Health and Human Services
Commission (HHSC) shall establish the quality assurance fee as a percentage
of net operating revenues such that the total of all fees collected does not
exceed six percent of the total annual net operating revenues received by
providers in the state under the programs identified in subsection (a)(1)
of this section. The quality assurance fee amount may be adjusted as necessary
for all providers to ensure that the fees collected do not exceed six percent
of the total annual net operating revenues received by providers in the state
under the programs identified in subsection (a)(1) of this section.
(c)
Total monthly fee amount. For each provider, the total
monthly fee amount is equal to the percentage determined in subsection (b)
of this section times the number of units of service delivered under the programs
identified in subsection (a)(1) of this section during the reporting period
times the payment rate in effect on the day the unit of service was delivered
plus the percentage determined in subsection (b) of this section times the
net operating revenues received for private clients during the reporting period.
(d)
Monthly reporting. All contracted providers must file a
report with DADS in a format prescribed by DADS and in accordance with instructions
provided by DADS that includes the accrued units of service delivered to clients
under the programs identified in subsection (a)(1) of this section for the
reporting period and the net operating revenues received for private clients
during the reporting period. A separate report must be completed for each
contract held by the provider. The report must be received by DADS no later
than 30 calendar days following the end of each month unless the 30th calendar
day is a weekend day, national holiday, or state holiday, then the first business
day following the 30th calendar day is the final day for the receipt of the
monthly report. Additional reports may be required as needed at the discretion
of HHSC.
(e)
Payment of the fee. The provider must include with the
monthly report submitted from subsection (d) of this section, payment of the
total fee amount calculated from the monthly report. The payment of the total
fee amount must be received by DADS no later than 30 calendar days following
the end of each month unless the 30th calendar day is a weekend day, national
holiday, or state holiday, then the first business day following the 30th
calendar day is the final day for the receipt of the monthly report. The quality
assurance fee must be paid by this deadline even if an appeal of the fee has
been filed with DADS, the provider's contract has terminated, or the contract
has been assigned. HHSC or DADS will not grant any exceptions from the payment
of the quality assurance fee, monthly reporting requirements related to the
fee, or the collection of other data necessary for the determination of the
fee amount to be paid.
(f)
Audit of monthly reports. HHSC conducts desk reviews and
field audits of monthly reports in order to ensure that all information reported
in the reports conforms to all applicable rules and instructions. HHSC may
require supporting documentation other than that contained in the monthly
report to substantiate reported information. The provider must allow access
to the records of provider or any parent company, affiliate, or related party
for the purposes of verifying the information contained in the monthly report.
For providers contracted with the State of Texas to provide Home and Community-based
Services or Community Living Assistance and Support Services, failure to submit
monthly reports by the due date, to allow auditors access to the records necessary
to verify the amounts reported on the monthly reports, or to complete the
monthly reports according to instructions and rules constitutes an administrative
contract violation. In the case of an administrative contract violation, procedural
guidelines and informal reconsideration and/or appeal processes are specified
in §355.111 of this title (relating to Administrative Contract Violations).
The provider will be notified of any revisions made to their monthly reports
and of any amounts owed or to be returned to the provider based on the revisions.
Amounts owed must be paid within 30 days of notification of the amount that
is owed.
(g)
Penalties. A penalty assessed under this subsection is
in an amount equal to one-half the amount of the estimated outstanding quality
assurance fee amount, not to exceed $20,000. DADS will assess a financial
penalty to be paid by the provider if any of the following occurs:
(1)
The provider fails to pay the total fee amount owed for
the month.
(2)
The provider files a false, erroneous or fraudulent monthly
report that either HHSC or DADS concludes resulted in the assessment of a
quality assurance fee that is less than the provider should have been assessed.
(3)
The provider fails to pay the amounts due from subsection
(f) of this section within 30 days of notification.
(4)
Penalties are in addition to owed quality assurance fees
and are non-refundable.
(h)
Continued responsibility. The assessment of a penalty under
this section does not relieve a provider from:
(1)
Providing services to clients in accordance with its obligations
under contract or the law;
(2)
Paying additional quality assurance fees that may be assessed
to the provider; or
(3)
Otherwise complying with licensure and certification requirements.
(i)
Vendor Hold. A provider that fails to pay the quality assurance
fee by the due date will be placed on vendor hold until all overdue fee amounts
are paid to DADS.
(j)
Informal review and formal appeal. A provider that disagrees
with an adjustment to their monthly report made in accordance with subsection
(f) of this section may request an informal review in accordance with §355.110(c)
of this title (relating to Informal Reviews and Formal Appeals) and an administrative
appeal in accordance with §355.110(d) and (e) of this title (relating
to Informal Reviews and Formal Appeals).
(k)
Sections §352.1 through §352.9 do not apply to
this section.
This agency hereby certifies that the emergency adoption
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 August 8, 2005.
TRD-200503293
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective Date: September 1, 2005
Expiration Date: December 29, 2005
For further information, please call: (512) 424-6576