Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
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 May 18, 2001, issue of the
Texas Register
(26 TexReg 3576). The change to §355.112(a) in the proposed rule
has been removed in the adopted rule. Consumer-Managed Personal Assistance
Services (CMPAS) will not be an eligible program under the adopted version.
The adopted rule also contains minor technical changes that clarify the rule.
Justification for the amendment is to clarify the definition of an attendant,
add the Deaf-Blind with Multiple Disabilities (DB-MD) waiver program, and
clarify the enrollment process. DB-MD has been included as an eligible program
to participate in the Attendant Compensation Rate Enhancement. This will allow
those contracted DB-MD providers the opportunity to receive enhanced funding
for participating in the Attendant Compensation Rate Enhancement.
The department's experience administering the first open enrollment period
for the Attendant Compensation Rate Enhancement lead it to simplify the enrollment
process by allowing providers to "roll over" their participation to the following
year.
The rules that are currently in effect automatically enroll new contracted
providers as participants until they formally choose an enrollment status.
This practice lead to new contracted providers becoming participants while
being unfamiliar with the spending requirements. The rule has been changed
to have new contracted providers enrolled as nonparticipants and allow them
time to make an informed decision with their participation status.
Spending requirements are necessary so the department can determine whether
a provider is spending funds appropriately. The department's experience with
contracted participating providers failing to submit required spending reports
within the specified timeframe warranted a rule change to prompt providers
to submit reports by removing those providers from participation.
Since the job functions of a medication aide are comparable to that of
an attendant, the definition of an attendant has been expanded to include
those staff. Conversely, since the job functions of an activity director do
not compare with those of an attendant, the rule has been revised to not include
those staff members as attendants.
Detail was added to the description of the calculation of the attendant
compensation rate component to better describe the actual process.
The spending requirement for those contracted participating providers who
serve both Residential Care and Community Based Alternatives Assisted Living/Residential
Care clients in a single facility were unclear in the current Attendant Compensation
Rate Enhancement Rules and has been revised to state that the spending requirement
is determined for both programs together and not each program separately.
The rules currently in effect did not explain the participation status
of a new owner who does not have existing participating contracts but accepts
a contract assignment of a participating contract(s). The revised rules clarify
that the individual or group status of participating contracts under the previous
owner will confer to the new owner.
The Texas Department of Human Services (DHS) is simultaneously adopting
a related amendment to 40 TAC §20.112 in this issue of the
Texas Register
.
No comments were received regarding the proposal.
The amendment is adopted under the Human Resources Code, Title
2, Chapters 22 and 32, which authorizes the department to administer public
and medical assistance programs; and under Texas Government Code §531.021,
which provides the Health and Human Services Commission with the authority
to administer federal medical assistance funds.
The amendment implements the Human Resources Code, §§22.001-
22.030 and §§32.001-32.042.
§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 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
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 program.
(4)
An attendant also includes medication aides in the RC and
AL/RC program.
(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. The Texas Department of Human Services
(DHS) 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 DHS's Rate Analysis
Department by the last day of the open enrollment period as per subsection
(e) of this section. Providers from which DHS's Rate Analysis Department 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 DHS 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 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 DHS instructions, signed by an authorized signator as per the Corporate
Board of Directors Resolution applicable to the provider's contract or ownership
type, and received by DHS's Rate Analysis Department within 30 days of DHS's
mailing of notification to the provider that such an enrollment contract amendment
must be submitted. 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)
Annual report. Participating contracted providers will
provide DHS, in a method specified by DHS, 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 participating contracts within one
program of the provider. The aggregate report must include contracts that
are new, excluded from participation, voluntary withdrawal from participation,
and contract assignments, as defined in subparagraphs (B)-(E) of this paragraph,
which were part of the group for any portion of the rate year. 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 DHS. 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 DHS. DHS will use this report 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 DHS, covering the period from the beginning of the rate year through the
date of withdrawal as determined by DHS. DHS will use this report 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 month following receipt by DHS's Rate Analysis Department of an
acceptable enrollment contract amendment as per paragraph (g)(1) of this section
through the end of the rate year.
(2)
Six-month report. Within 60 days of the end of the first
six months of the rate year, participating contracted providers will provide
DHS, in a method specified by DHS, a six-month 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 February of the
rate year. The 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 participating contracts within one
program of the provider. Participating providers will use this six-month report
to assist them in determining their level of compliance with the spending
requirements and to take any appropriate action necessary to come into compliance
with the spending requirements. The provider is responsible for the management
of attendant compensation expenditures in compliance with the spending requirements
stated in subsection (s) of this section.
(3)
Other reports. DHS may require other reports from all contracts
as needed.
(4)
Vendor hold. DHS 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
an acceptable Attendant Compensation Report is received by DHS. Participating
contractors who do not submit an annual Attendant Compensation Report completed
in accordance with all applicable rules and instructions within 60 days of
the vendor hold being placed will become nonparticipants until the first day
of the month after all of the following conditions are met:
(A)
the provider submits an acceptable annual Attendant Compensation
Report;
(B)
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;
(C)
the provider repays to DHS funds that are identified for
recoupment from subsection (s) of this section; and
(D)
DHS receives, in writing by certified mail, a request from
the provider to be restored to the participant status.
(i)
Attendant Compensation Report contents. Each Attendant
Compensation Report will include any information required by DHS 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).
(k)
Enrollment. Providers choosing to participate in the attendant
compensation rate enhancement must submit to DHS a signed enrollment contract
amendment as described in subsection (f) of this section, before the end of
the enrollment period. 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 DHS, in accordance with subsection (x) of this section, that it no
longer wishes to participate or until DHS 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 DHS. Contracts excluded from
participation will have their participation end effective on the date determined
by DHS.
(l)
Determination of attendant compensation rate component
for participating contracts. For each of the programs identified in subsection
(a) of this section attendant compensation rate enhancement increments associated
with each enhanced attendant compensation level will be determined for participating
contracts from subsection (k) of this section. 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.
(m)
Determination of attendant compensation rate component
for nonparticipating contracts. For each of the programs identified in subsection
(a) of this section DHS 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 hour 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 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.
DHS 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. DHS 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 or by
providers who were participants during the prior year desiring to be granted
additional rate enhancement increments. Using the process described herein,
DHS first determines the distribution of carry-over rate enhancement increments.
If funds are available after the distribution of carry-over rate enhancement
increments, DHS determines the distribution of newly requested rate enhancement
increments as follows:
(1)
DHS 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)
DHS 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, DHS may grant certain enhancement options priority
for distribution.
(q)
Notification of granting of enhancements. Participating
contracts are notified, in a manner determined by DHS, 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. DHS
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. DHS will calculate
recoupment, if any, as follows.
(1)
For the rate year beginning September 1, 2000, the attendant
compensation spending per unit of service will be multiplied by 1.09 to determine
the adjusted attendant compensation per unit of service. For the rate year
beginning September 1, 2001, and thereafter, the attendant compensation spending
per unit of service will be multiplied by 1.07 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 by DHS.
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 DHS within 90 days of the due date of their annual
Attendant Compensation Report as described in subsection (h)(1) of this section
or within 90 days of the date the report is submitted, whichever is later,
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 to DHS, 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. If the attendant compensation
report described in subsection (h)(1) of this section indicates that the participating
provider did not spend 90% of the accrued total attendant compensation rate
described in subsection (r) of this section on attendant compensation spending
as determined from subsection (s) of this section, DHS will notify the provider
of the noncompliance. If the subsequent six-month compensation report from
subsection (h) (2) of this section indicates that the provider has not spent
90% of the attendant compensation revenue on attendant compensation spending,
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 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 DHS
will place a vendor hold on the payments of the contracted provider until
DHS receives an acceptable Attendant Compensation Report, as specified in
subsection (h)(1)(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 new owner
has no contracts participating, the individual or group status of participating
contracts under the old owner will transfer to the new owner.
(2)
When the contract assignment is an ownership change from
one legal entity to a different legal entity, DHS will place a vendor hold
on the payments of the existing contracted provider until DHS receives an
acceptable Attendant Compensation Report specified in subsection (h)(1)(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 DHS
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 DHS 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.
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 August 10, 2001.
TRD-200104622
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Effective date: September 1, 2001
Proposal publication date: May 18, 2001
For further information, please call: (512) 438-3734
1 TAC §355.307
The Texas Health and Human Services Commission (HHSC) adopts
an amendment to §355.307 in its Medicaid Reimbursement Rates chapter.
The amendment is adopted without changes to the proposed text published in
the June 22, 2001 issue of the
Texas Register
(26 TexReg 4573).
Justification for the amendment is to create a special reimbursement class
for nursing facilities that specialize in caring for high need children. This
special reimbursement class will recognize the increased costs that exist
in nursing facilities that predominately serve children.
The Texas Department of Human Services (DHS) received comments regarding
this rule. A summary of the comments and the department's responses follow.
Several of the parties had similar concerns, so where appropriate, questions
and concerns are combined and one response is given. Comments were received
from the Children's Long Term Care Policy Council, United Cerebral Palsy of
Texas, and Brown and Carls.
Comment: DHS should revise the proposed rule to extend the special reimbursement
class to distinct pediatric units in nursing facilities.
Response: These rules apply to nursing facilities that serve only children,
not facilities that serve both adults and children. These rules address the
higher costs of serving children in a facility that specializes in serving
only high need children. HHSC is adopting this section without change.
Comment: The pediatric care facility must be in compliance with all permanency
planning requirements for all children residing in the facility. The pediatric
care facility must also complete the identification and assessment activities
described by the DHS plan to implement Olmstead requirements as directed by
the HHSC Promoting Independence Plan.
Response: DHS will refine the definition for the permanency planning process
and requirements. Determination of compliance with the permanency planning
process will be handled separately from determination of payment rates for
pediatric care facilities. HHSC is adopting this section without change.
Comment: DHS must add a provision to the rules to avoid punishing an eligible
facility by reducing rates when, by implementing permanency planning, the
census drops below the required percentage.
Response: In order for a facility to remain in this special class, it must
maintain an average census of 80% children. HHSC is adopting this section
without change.
Comment: DHS must define "high needs children" or the specific services
that will be purchased on their behalf.
Response: This comment does not apply to the proposed section. The term
"high needs children" is not used in the proposed rule section and does not
need further definition. Children in a pediatric care facility will be governed
by the rules that apply to nursing facilities outside the scope of this rule
section. HHSC is adopting this section without change.
Other comments received were not specific to the proposed rules.
The amendment is adopted under the Government Code, §531.033,
which authorizes the commissioner of the Health and Human Services Commission
to adopt the rules necessary to carry out the commission's duties, and §531.021(b),
which establishes the commission as the agency responsible for adopting reasonable
rules governing the determination of fees, charges, and rates for medical
assistance payments under Chapter 32, Human Resources Code.
The amendment implements the Government Code, §531.033 and §531.021(b).
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 August 10, 2001.
TRD-200104646
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Effective date: September 1, 2001
Proposal publication date: June 22, 2001
For further information, please call: (512) 438-3734
1 TAC §355.451, §355.456
The Health and Human Services Commission (HHSC) adopts amendments
to §355.451, concerning definitions and general reimbursement information,
and §355.456, concerning rate setting methodology without changes to
the text of the proposed rules published in the May 18, 2001 issue of the
Section 531.021, Government Code, entitled "Administration of Medicaid
Program," provides, among other things, that HHSC adopt rules and standards
to govern the determination of fees, charges, and rates for medical assistance
payments under Chapter 32, Human Resources Code, in consultation with the
agencies that operate the Medicaid program. The adopted rules describe how
interim rates for state-operated facilities in the Intermediate Care Facilities
for Persons with Mental Retardation (ICF/MR) Program in Texas will be established.
The adopted rules will maximize the state's opportunity to draw federal
funds to cover allowable costs in state-operated facilities. The adopted rules
will simplify the rate setting process for state-operated facilities. Currently,
the state sets a separate rate for each state-operated facility, resulting
in 54 different rates. The adopted rules will result in one rate for large
state-operated facilities (Medicaid certified capacity of 17 or more) and
another rate for small state-operated facilities (Medicaid certified capacity
of 16 or less).
Subsection (a) of §355.451 is amended to add a definition of "interim
rate." Subsection (b) is amended to specify that interim rates for state-operated
facilities are uniform statewide by class.
The amendments are adopted under §531.021(b), Government
Code, which requires HHSC to adopt reasonable rules and standards to govern
the determination of fees, charges, and rates for medical assistance payments
under Chapter 32, Human Resources Code, in consultation with the agencies
that operate the Medicaid program; and §531.033, Government Code, which
provides the commissioner of health and human services with authority to adopt
rules necessary to carry the duties of HHSC under Chapter 531, Government
Code.
The adopted amended rules implement §531.021(b), Government Code,
concerning the adoption of rules and standards to govern the determination
of fees, charges, and rates for medical assistance payments under Chapter
32, Human Resources Code, and §32.0281, Human Resources Code, concerning
the adoption of rules regarding Medicaid reimbursement rates.
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 August 8, 2001.
TRD-200104554
Marina S. Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Effective date: August 28, 2001
Proposal publication date: May 18, 2001
For further information, please call: (512) 424-6576
The Texas Health and Human Services Commission (HHSC) adopts amendments
to §355.503, §355.505, and §355.9022 in its Medicaid Reimbursement
Rates chapter. The amendments are adopted without changes to the proposed
text published in the June 22, 2001 issue of the
Texas Register
(26 TexReg 4574).
For the Community-Based Alternatives (CBA), Community Living Assistance
and Support Services (CLASS), and Deaf-Blind Multiple Disabilities (DB-MD)
programs, justification for the amendments is to more closely match payment
rates to the cost of the services delivered. The payment rate for Registered
Nurses (RNs) and Licensed Vocational Nurses (LVNs) will be separated into
two distinct rates to more closely match the type of nursing service delivered
to the payment rate. For the CLASS and CBA programs, justification for the
amendment is the deletion of a separate rate for the annual reassessment of
clients that is conducted by an RN.
No comments were received regarding the proposal.
Subchapter E. COMMUNITY CARE FOR AGED AND DISABLED
1 TAC §355.503, §355.505
The amendments are adopted under the Government Code, §531.033,
which authorizes the commissioner of the Health and Human Services Commission
to adopt the rules necessary to carry out the commission's duties, and §531.021(b),
which establishes the commission as the agency responsible for adopting reasonable
rules governing the determination of fees, charges, and rates for medical
assistance payments under Chapter 32, Human Resources Code.
The amendments implement the Government Code, §531.033 and §531.021(b).
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 August 10, 2001.
TRD-200104639
Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Effective date: September 1, 2001
Proposal publication date: June 22, 2001
For further information, please call: (512) 438-3734
2.
MEDICAID WAIVER PROGRAM FOR PEOPLE WITH DEAF-BLINDNESS AND MULTIPLE DISABILITIES
Subchapter C. REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES
Subchapter D. REIMBURSEMENT METHODOLOGY FOR THE INTERMEDIATE CARE FACILITIES FOR PERSONS WITH MENTAL RETARDATION (ICF/MR) PROGRAM
Chapter 355.
MEDICAID REIMBURSEMENT RATES
Subchapter M. MISCELLANEOUS MEDICAID PROGRAMS