| (i) direct care labor;
(ii) total payroll taxes/workers compensation; and
(iii) direct care non-labor for supervision/recreation,
direct services, and other direct care (not CPAs).
(2) The second methodology allocates the following
costs by dividing the total costs by the total number of days of care
for an even distribution by day regardless of level of care. This
amount is multiplied by the number of days served in each level:
(A) direct care non-labor for dietary/kitchen;
(B) building and equipment;
(C) transportation;
(D) tax expense; and
(E) net educational and vocational service costs.
(3) The third methodology allocates the following administrative
costs among the levels of care by totaling the results of the previous
two allocation methods, determining a percent of total among the levels
of care, and applying those percentages:
(A) administrative wages/benefits;
(B) administration (non-salary);
(C) central office overhead; and
(D) foster family development.
(4) The allocation methods described in paragraphs
(1) - (3) of this subsection are applied to each child-placing agency
and residential care facility in the rate-setting population, and
separate rates are calculated for each level of care served. Rate
information is included in the population to set the level of care
rate if the following criteria are met:
(A) Providers must have at least 30% of their service
days within Levels of Care 3 through 6 for residential settings. For
example, for the provider's cost report data to be included for calculating
the Level of Care 3 rate, a provider must provide Level of Care 3
services for at least 30% of their service days.
(B) For Levels of Care 5 and 6, a contracted provider
could provide up to 60% of "private days" services to be included
in the rate-setting population. They must provide at least 40% state-placed
services.
(5) Considering the criteria in paragraph (4) of this
subsection, the rate-setting population is fully defined for each
level of care. Based on this universe, each level of care rate will
be established by the group's central point or central tendency. The
measure of central tendency is defined as the mean, or average, of
the population after applying two standard deviations above and below
the mean of the total population.
(6) The total cost per day for each child-placing agency
and residential care facility is projected using the IPD-PCE Index
from the period covered in the cost report to September 1 of the second
year of the biennium, which is the middle of the biennium that the
rate period covers. Information on inflation factors is specified
in subsection (h) of this section.
(h) For payment rates in effect for state fiscal year
(SFY) 2002 and 2003, DFPS uses the Implicit Price Deflator - Personal
Consumption Expenditures (IPD-PCE) Index, which is a general cost
inflation index, to calculate projected allowable expenses. The IPD-PCE
Index is a nationally recognized measure of inflation published by
the Bureau of Economic Analysis of the United States Department of
Commerce. DFPS uses the lowest feasible IPD-PCE Index forecast consistent
with the forecasts of nationally recognized sources available to DFPS
when the rates are prepared. Upon written request, DFPS will provide
inflation factor amounts used to determine rates.
(i) All reimbursement rates will be equitably adjusted
to the level of appropriations authorized by the Legislature.
(j) There will be a transition period for the fiscal
year 2002-2003 biennium. During this period current rates will not
be reduced, and any increased funding will be applied to those levels
of care that are less adequately reimbursed according to the methodology.
Since increased funding was appropriated at a different percentage
for each year of the 2002-2003 biennium, the rates will be set separately
for each year instead of setting a biennial rate, and inflation factors
will be applied to the middle of each year of the biennium.
(k) For the SFY 2004 through 2005, DFPS determines
payment rates using the rates determined for SFY 2002 and 2003 from
subsections (a) - (h) of this section, with adjustments for the transition
from a six level of care system to a four service level system of
payment rates.
(l) For the state fiscal year 2006 through 2007 biennium,
the 2005 payment rates in effect on August 31, 2005 will be adjusted
by equal percentages based on a prorata distribution of additional
appropriated funds.
(m) For the state fiscal year 2008 through 2009 biennium,
rates are paid for each level of service identified by the DFPS. For
foster homes, the payments effective September 1, 2007 through August
31, 2009 for each level of service will be equal to the minimum rate
paid to foster homes for that level of service in effect August 31,
2007 plus 4.3 percent. For Child Placing Agencies (CPAs), the rates
effective September 1, 2007, through August 31, 2009 for each level
of service will be equal to the rate paid to CPAs for that level of
service in effect August 31, 2007, plus 4.3 percent. Additional appropriated
funds remaining after the rate increase for foster homes and CPAs
shall be distributed proportionally across general residential operations
and residential treatment centers based on each of these provider
type's ratio of costs as reported on the most recently audited cost
report to existing payment rates.
(n) HHSC may adjust payment rates, if determined appropriate,
when federal or state laws, rules, standards, regulations, policies,
or guidelines are changed or adopted. These adjustments may result
in increases or decreases in payment rates. Providers must be informed
of the specific law, rule, standard, regulation, policy or guideline
change and be given the opportunity to comment on any rate adjustment
resulting from the change prior to the actual payment rate adjustment.
(o) To implement Chapter 1022 of the Acts of the 75th
Texas Legislature, §103, the executive director may develop and
implement one or more pilot competitive procurement processes to purchase
substitute care services, including foster family care services and
specialized substitute care services. The pilot programs must be designed
to produce a substitute care system that is outcome-based and that
uses outcome measures. Rates for the pilot(s) will be the result of
the competitive procurement process, but must be found to be reasonable
by the executive director. Rates are subject to adjustment as allowed
in subsections (a) and (m) of this section.
(p) Payment rates for psychiatric step-down services
are determined on a pro forma basis in accordance with §355.105(h)
of this chapter. Payment rates for psychiatric step-down services
effective September 1, 2017, will be equal to the rates in effect
on August 31, 2015.
(q) Definitions.
(1) Child-placing agency (CPA)--Child-placing agencies
as defined in 40 Texas Administrative Code (TAC) §745.21.
(2) Community-based Care--Community-based Care as defined
in 40 TAC §700.108.
(3) CPA retainage--The portion of the rate that includes
the CPA's costs for administering the service, including, but not
limited to recruiting and training foster families, matching children
with foster families, monitoring foster families and foster homes,
and the associated overhead costs.
(4) Emergency Care Services--Emergency care services
as defined in 40 TAC §748.61.
(5) Foster home--Foster home as defined in 40 TAC §749.43
and §750.43.
(6) General Residential Operation (GRO)--General residential
operations as defined in 40 TAC §748.43.
(7) Intensive Psychiatric Transition Program (IPTP)--
Intensive Psychiatric Transition Program as defined in 40 TAC §700.2381.
(8) Levels of service--Levels of service as described
in 40 TAC Chapter 700, Subchapter W.
(9) Residential Treatment Center (RTC)--Residential
treatment center as defined in 40 TAC §748.43.
(10) Temporary Emergency Placement (TEP)--Temporary
Emergency Placement as defined in 40 TAC §700.1337.
(11) Treatment Foster Care (TFF)--Treatment Foster
Care as defined in 40 TAC §700.1335.
(r) Rates effective September 1, 2015. Rates are paid
for each level of service identified by DFPS.
(1) For CPAs, the rate consists of a foster home payment
described in paragraph (2) of this subsection and a CPA retainage.
Effective September 1, 2015, the CPA retainage for each level of service
will be equal CPA retainage for that level of service in effect August
31, 2015:
(A) plus 9.39 percent for the basic level of service;
(B) plus 1.14 percent for the moderate level of service;
Cont'd... |
