1 TAC §§355.307, 355.401
The Health and Human Services Commission (HHSC) proposes
amendments to §355.307, concerning reimbursement methodology for nursing
facilities; and §355.401, concerning allowable and unallowable costs,
in its Medicaid Reimbursement Rates chapter. The purpose of the amendments
is to allow nursing facilities to receive supplemental Medicaid reimbursement
for children who qualify for the Texas Index for Level of Effort (TILE) heavy-care
case mix classification and require daily care of a tracheostomy. Qualifying
residents will be eligible to receive 60% of the total ventilator-dependent
supplemental reimbursement. Children with tracheostomies who also are ventilator-dependent
will not be eligible to receive both a ventilator-dependent and a tracheostomy
supplemental reimbursement.
Gary Bego, Associate Commissioner for Fiscal Policy, has determined that
for the first five-year period the proposed section will be 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 section will be in effect is an estimated additional
cost of $150,482 in fiscal year (FY) 1998; $230,596 in FY 1999; $240,481
in FY 2000; $249,431 in FY 2001; and $259,404 in FY 2002.
Mr. Bego, also 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 providers of these specialized services
for children will receive Medicaid payments more closely aligned with the
costs of delivering these services. There will be no effect on small businesses.
There is no anticipated economic cost to persons who are required to comply
with the proposed sections.
Questions about the content of this proposal may be directed to Pamela
Lawrie at (512) 438-4051 in the Texas Department of Human Services' Rate
Analysis Department. Written comments on the proposal may be submitted to
Stephen Svadlenak, Health and Human Services Commission, P.O. Box 13247,
Austin, Texas 78711, within 30 days of publication in the
Texas Register
.
The amendments are proposed under the Texas Government Code,
Chapter 531, §531.033, which authorizes the Commissioner of Health and
Human Services to adopt rules necessary to carry out the Health and Human
Services Commission's duties under Chapter 531; and under Texas Government
Code, §531.021, which provides the commission with the authority to
administer federal medical assistance funds.
The amendments implement Government Code, §531.021 and Human Resources
Code §§32.001-32.042.
§355.307. Reimbursement Setting Methodology.
(a)
(No change.)
(b)
Reimbursement determination. For reimbursements calculated
using cost reports pertaining to providers' fiscal years ending in calendar
year 1995 or 1996, the Texas Board of Human Services (board) determines general
reimbursements for medical assistance programs for Medicaid recipients under
provisions of the Human Resources Code, Chapter 24 (concerning Reimbursement
Methodology). For reimbursements calculated using cost reports pertaining
to providers' fiscal years ending in 1997 and subsequent years, the board
determines general reimbursements for medical assistance programs for Medicaid
recipients under provisions of Subchapter A of this chapter (relating to
Cost Determination Process). The board determines reimbursements for nursing
facilities based on consideration of Texas Department of Human Services (DHS)
staff recommendations. To develop reimbursement rate recommendations for
nursing facilities, DHS staff apply the following procedures.
(1)-(2)
(No change.)
(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)-(F)
(No change.)
(G)
Supplemental reimbursement for children
with tracheostomies requiring daily care. As of January 1, 1998, qualifying
residents may receive a supplement to the per diem rate specified in subparagraph
(E) 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 (specified in subparagraph (F)(ii) of this paragraph).
(H)
Children with qualifying conditions as
specified in subparagraphs (F) and (G) of this paragraph may receive only
one of the supplemental reimbursements. Therefore, children with tracheostomies
who also are ventilator-dependent are not eligible to receive both supplemental
reimbursements.
§355.401.Allowable and Unallowable Costs: 1997 and Subsequent Cost Reports.
(a)-(b)
(No change.)
(c)
In addition to the requirements of §355.102 and §355.103
of this title (relating to General Principles of Allowable and Unallowable
Costs, and Specifications for Allowable and Unallowable Costs), the following
apply to costs for the NF program.
(1)-(2)
(No change.)
(3)
Voucherable costs. Except as detailed in subparagraphs
(A) and (B) of this paragraph, any expenses directly reimbursable to the
provider through a voucher payment and any expenses in excess of the limit,
or ceiling, for a voucher payment system are unallowable costs.
(A)
The ventilator dependent supplemental voucher system
and the children with tracheostomies supplemental voucher system are
[
is
] not subject to the cost reporting restrictions described
in this paragraph.
(B)
(No change.)
(4)-(6)
(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
February 2, 1998.
TRD-9801448
Marina Henderson
Executive Deputy Commissioner
Health and Human Services Commission
Earliest possible date of adoption: March 15, 1998
For further information, please call: (512) 424-6576