1 TAC §355.110, §355.112
The Texas Health and Human Services Commission (HHSC) proposes
to amend §355.110, concerning informal reviews and formal appeals, and §355.112,
concerning attendant compensation rate enhancement, in its Medicaid Reimbursement
Rates chapter.
The purpose of the amendment to §355.110 is to modify the amount of
time a provider is allowed to submit a request for an informal review. The
amendment grants providers an additional 15 calendar day extension beyond
the 30 calendar day deadline to submit required information related to the
provider's request for an informal review.
The purpose of the amendment to §355.112 is to lower the spending
requirement for participating providers by amending the calculation used to
determine the adjusted attendant compensation per unit of service. Beginning
September 1, 2003, the attendant compensation spending per unit of service
has been multiplied by 1.10 to determine the adjusted attendant compensation
per unit of service.
The Texas Department of Human Services (DHS) is proposing related policy
in its Chapter 20 in this issue of the
Texas Register
.
Tom Suehs, Deputy Commissioner for Financial Services, has determined that
for the first five-year period the proposed sections are in effect, there
are no fiscal implications for state government or local government as a result
of enforcing or administering the sections.
David Palmer, Director, Rate Analysis, has determined that for each year
of the first five years the section is in effect, the public benefit anticipated
as a result of enforcing §355.110 is that providers will be allowed additional
time, if it proves necessary, to collect the necessary information and evidence
to support an efficient resolution of matters in dispute. The public benefit
anticipated as a result of enforcing §355.112 is that participating providers
will be allowed more flexibility in spending in other cost areas of the total
reimbursement rate.
There is no adverse economic effect on small or micro businesses as a result
of enforcing or administering the sections, because the proposal increases
flexibility for providers and does not add any new requirements for businesses.
There is no anticipated economic cost to persons who are required to comply
with the proposed sections. There is no anticipated effect on local employment
in geographic areas affected by these sections.
Questions about the content of this proposal may be directed to Carolyn
Pratt at (512) 685-3127 in HHSC's Rate Analysis Department. Written comments
on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-009,
Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030,
within 30 days of publication in the
Texas Register
. For further information regarding the proposal or to make the proposal
available for public review, contact local offices of DHS or Carolyn Pratt
at (512) 685-3127 in HHSC's Rate Analysis Department.
Under §2007.003(b) of the Government Code, HHSC has determined that
Chapter 2007 of the Government Code does not apply to these rules. Accordingly,
HHSC is not required to complete a takings impact assessment regarding these
rules.
The amendments are proposed under the Government Code, §531.033,
which authorizes the commissioner of HHSC to adopt rules necessary to carry
out the commission's duties; §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 the Human
Resources Code, Chapter 32; and Government Code, §2001.006(b), which
allows state agencies to adopt rules in preparation for the implementation
of legislation.
The amendments affect the Government Code, §531.033 and §531.021(b).
§355.110.Informal Reviews and Formal Appeals.
(a) - (b)
(No change.)
(c)
Informal review.
(1)
An interested party who disputes an action or determination
under this chapter may request an informal review under this section. The
purpose of an informal review is to provide for the informal and efficient
resolution of the matters in dispute. An informal review is not a formal administrative
hearing, but is a prerequisite to obtaining a formal administrative hearing
and is conducted according to the following procedures:
(A)
HHSC Rate Analysis must receive a written request for an
informal review by hand delivery,
United States (
U.S.
)
mail,
or special mail delivery no later than 30 calendar days from the date on the
written notification of the adjustments. If 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 the receipt of the written request
will be accepted.
HHSC Rate Analysis will extend this deadline if it
receives a written request for the extension by hand delivery, U.S. mail,
or special mail delivery no later than 30 calendar days from the date of the
written notice of adjustments. The extension gives the requester a total of
45 calendar days from the date of the written notice of adjustment to file
a request for an informal review. If the 45th calendar day is a weekend day,
national holiday, or state holiday, then the 45th day is considered the next
business day following the 45th calendar day.
A request for an informal
review
or extension
that is not received by the stated deadline
will not be accepted.
(B) - (C)
(No change.)
(2)
(No change.)
(d) - (e)
(No change.)
§355.112.Attendant Compensation Rate Enhancement.
(a) - (r)
(No change.)
(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
[
will be
]
multiplied by 1.09 to determine the adjusted attendant compensation per unit
of service. For the rate
years
[
year
] beginning September
1, 2001, and
September 1, 2002
[
thereafter
], the attendant
compensation spending per unit of service
is
[
will be
]
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) - (3)
(No change.)
(t) - (dd)
(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 December 22, 2003.
TRD-200308853
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: February 8, 2004
For further information, please call: (512) 438-3734