Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 352. QUALITY ASSURANCE FEE
The Texas Health and Human Services Commission (HHSC) adopts amendments to §§352.1 - 352.9, concerning the quality assurance fee for the Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) program, without changes to the proposed text as published in the November 2, 2007, issue of the Texas Register (32 TexReg 7789) and will not be republished.
The amendments update the ICF/MR quality assurance fee rules by revising the quality assurance fee percentage to reflect the maximum 5.5 percent fee allowed under the federal Tax Relief and Health Care Act of 2006 (TRHCA), P.L. 109-432, Section 403, which amended Section 1903(w)(4)(C) of the Social Security Act (42 U.S.C. 1396b(w)(4)(C)). This law took effect on January 1, 2008. The 5.5 percent maximum allowed for ICF/MR facilities in the TRHCA represents a 0.5 percent reduction in matchable ICF/MR quality assurance fees. The effect of this law is that contracted ICF/MR providers will pay less in quality assurance fees to the state than they currently pay. In addition, the amendments update administrative procedures relating to the quality assurance fee, remove outdated language, and update references to reflect that the Department of Aging and Disability Services (DADS) has administrative responsibility for the quality assurance fee.
The purpose of the amendments are to revise the ICF/MR quality assurance fee rules to reflect the new maximum quality assurance fee allowed under the TRHCA and to provide clear guidance to agency staff and providers on quality assurance fee reporting requirements and calculations, monitoring and auditing responsibilities, penalties, informal review and formal appeal rights and responsibilities. As part of updating administrative procedures, the amendments clarify how penalties for non-payment of the fee will be calculated and require DADS to collect underpayments and refund overpayments of fees. In addition, the deadlines regarding the submittal of required reports are changed or clarified, and the definition of "gross receipts" is clarified to mean "accrued payments" and not "cash received." Finally, language is added to allow DADS to reconcile overpayments and underpayments of the fee to 5.5 percent of annual gross receipts at the corporate entity level for those entities that control more than one facility.
The 30-day comment period ended December 2, 2007, and HHSC did not receive any comments on the proposed amendments.
The amendments are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and the Human Resource Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.
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 January 14, 2008.
TRD-200800150
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 3, 2008
Proposal publication date: November 2, 2007
For further information, please call: (512) 424-6900
The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.503, concerning Reimbursement Methodology for the Community-Based Alternatives (CBA) Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs; §355.505, concerning Reimbursement Methodology for the Community Living Assistance and Support Services (CLASS) Waiver Program; and §355.5902, concerning Reimbursement Methodology for Primary Home Care (PHC), without changes to the proposed text as published in the November 9, 2007, issue of the Texas Register (32 TexReg 8073) and will not be republished.
One amendment to §355.503(d)(2) adds subparagraph (D), which sets out a reimbursement methodology for Personal Care III that: (1) models the direct care portion of the payment rate using program staffing requirements; and (2) ties the non-direct care portion of the rate to the non-attendant portion of the non-apartment assisted living rate for a provider that does not participate in receiving rate add-ons in the Attendant Compensation Rate Enhancement.
A second amendment to §355.503 adds subsection (f)(3); the amendment to §355.505 amends subsection (c)(2); and the amendment to §355.5902 amends subsection (b)(1). These amendments will allow legal entities to submit a single cost report, by program, per legal entity for all of their contracts participating in the Attendant Compensation Rate Enhancement and a single cost report, by program, per legal entity for all of their contracts not participating in the Attendant Compensation Rate Enhancement.
The purpose of the amendments is to adopt a reimbursement methodology for CBA PC III and to reduce the administrative effort required of providers and HHSC to complete, process, audit, and analyze cost reports.
The 30-day comment period ended December 9, 2007, and HHSC did not receive any comments on the proposed amendments.
Subchapter E. COMMUNITY CARE FOR AGED AND DISABLED
The amendments are adopted under the Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and the Human Resources Code §32.021 and the Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.
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 January 14, 2008.
TRD-200800151
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 3, 2008
Proposal publication date: November 9, 2007
For further information, please call: (512) 424-6900
The amendments are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and the Human Resource Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.
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 January 14, 2008.
TRD-200800152
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 3, 2008
Proposal publication date: November 9, 2007
For further information, please call: (512) 424-6900