| (a) General information. The Texas Health and Human
Services Commission (HHSC) applies the general principles of cost
determination as specified in §355.101 of this title (relating
to Introduction).
(b) Reimbursement Methodology. Community First Choice
(CFC) rates are established using pre-existing rates as follows.
(1) CFC State Plan Rate--Attendant and Habilitation:
Rates will be equal to a weighted average of rates established for
Community Living Assistance and Support Services (CLASS) habilitation
services according to the reimbursement methodology for the CLASS
program under §355.505 of this title (relating to Reimbursement
Methodology for the Community Living Assistance and Support Services
Waiver Program) and proxy rates for attendant services used in the
calculation of the STAR+PLUS managed care capitation rates for the
Home and Community-based Services (HCBS) risk group. The weighted
average will include applicable attendant compensation rate enhancements.
(A) Proxy rates are equal to rates established for
attendant services under the Community Based Alternatives (CBA) waiver
prior to its termination, updated for changes in allowable reported
expenses and units of service.
(B) Weighting factors assume that 30 percent of personal
attendant services historically provided to existing recipients in
the STAR+PLUS HCBS risk group and 100 percent of personal attendant
services provided to newly eligible recipients under CFC will be for
habilitation.
(2) CLASS--Attendant and Habilitation CFC: Rates will
be equal to rates established for CLASS habilitation services, including
applicable attendant compensation rate enhancements, under §355.505
of this title.
(3) Deaf-Blind with Multiple Disabilities (DBMD)--Attendant
and Habilitation CFC: Rates will be equal to rates established for
DBMD Residential Habilitation, including applicable attendant compensation
rate enhancements, under §355.513 of this title (relating to
Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities
Waiver Program).
(4) Home and Community-Based Services (HCS)--Supported
Home Living (SHL) CFC: Rates will be equal to rates established for
HCS SHL, including applicable attendant compensation rate enhancements,
under §355.723 of this title (relating to Reimbursement Methodology
for Home and Community-Based Services and Texas Home Living Programs).
(5) Texas Home Living (TxHmL)--Community Support Services
(CSS) CFC: Rates will be equal to rates established for TxHmL CSS,
including applicable attendant compensation rate enhancements, under §355.723
of this title.
(6) Personal Care Services (PCS)--Habilitation CFC:
Rates will be equal to rates established for PCS attendant services
for recipients with a behavioral health condition under §355.8441
of this title (relating to Reimbursement Methodologies for Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) Services).
(7) Personal Care Services (PCS)--Attendant CFC: Rates
will be equal to the rates established for PCS attendant services
for recipients without a behavioral health condition under §355.8441
of this title.
(8) Consumer Directed Services (CDS)--CFC: Rates will
be equal to rates established for CDS for the equivalent non-CFC service
under §355.114 of this title (relating to Consumer Directed Services
Payment Option).
(9) Support Consultation Services--CFC: Rates will
be equal to rates established for Support Consultation Services under §355.114
of this title.
(10) CFC State Plan rate for Financial Management Services
Agencies (FMSA) (only authorized for individuals receiving all of
their CDS services under CFC): Rates will be equal to rates established
for FMSAs for an equivalent non-CFC service under §355.114 of
this title.
(11) Emergency Response Services (ERS)--CFC: Rates
will be equal to rates established for ERS under §355.510 of
this title (relating to Reimbursement Methodology for Emergency Response
Services (ERS)).
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