| (F) maternity home.
(e) For payment rates in effect for state fiscal year
(SFY) 2002 and 2003, DFPS develops rate recommendations for Board
consideration for emergency shelters as follows:
(1) DFPS analyzes emergency shelter cost report information
included within the rate-setting population defined in subsection
(f) of this section. Emergency shelter costs are not allocated across
levels of care since, for rate-setting purposes, all children in emergency
shelters are considered to be at the same level of care.
(2) For each cost report in the rate-setting population,
the total costs are divided by the total number of days of care to
calculate a daily rate.
(3) The total cost per day 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.
(4) The emergency shelter rate is established by the
population'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.
(f) For payment rates in effect for state fiscal year
(SFY) 2002 and 2003, level of care rates for contracted providers
including child-placing agencies, residential care facilities, and
emergency shelters are dependent upon provider cost report information.
The following criteria applies to this cost report information:
(1) DFPS excludes the expenses specified in §700.1805
and §700.1806 of this title (relating to Unallowable Costs and
Costs Not Included in Recommended Payment Rates). Exclusions and adjustments
are made during audit desk reviews and on-site audits.
(2) DFPS includes therapy costs in its recommended
payment rates for emergency shelters and for Levels of Care 3 through
6, and these costs will be considered as allowable costs for inclusion
on the provider's annual cost report, only if one of the following
conditions applies. The provider must access Medicaid for therapy
for children in their care unless:
(A) the child is not eligible for Medicaid or is transitioning
from Medicaid Managed Care to fee-for-service Medicaid;
(B) the necessary therapy is not a service allowable
under Medicaid;
(C) service limits have been exhausted and the provider
has been denied an extension;
(D) there are no Medicaid providers available within
45 miles that meet the needs identified in the service plan to provide
the therapy; or
(E) it is essential and in the child's best interest
for a non-Medicaid provider to provide therapy to the child and arrange
for a smooth coordination of services for a transition period not
to exceed 90 days or 14 sessions, whichever is less. Any exception
beyond the 90 days or 14 sessions must be approved by DFPS before
provision of services.
(3) DFPS may exclude from the database any cost report
that is not completed according to the published methodology and the
specific instructions for completion of the cost report. Reasons for
exclusion of a cost report from the database include, but are not
limited to:
(A) receiving the cost report too late to be included
in the database;
(B) low occupancy;
(C) auditor recommended exclusions;
(D) days of service errors;
(E) providers that do not participate in the level
of care system;
(F) providers with no public placements;
(G) not reporting costs for a full year;
(H) using cost estimates instead of actual costs;
(I) not using the accrual method of accounting for
reporting information on the cost report;
(J) not reconciling between the cost report and the
provider's general ledger; and
(K) not maintaining records that support the data reported
on the cost report.
(4) DFPS requires all contracted providers to submit
a cost report unless they meet one or more of the conditions in §355.105(b)(4)(D)
of this chapter (relating to General Reporting and Documentation Requirements,
Methods, and Procedures).
(g) For payment rates in effect for state fiscal year
(SFY) 2002 and 2003, a rate-setting model is applied to child-placing
agencies' and residential care facilities' cost report information
included within the rate-setting population defined in subsection
(f) of this section. Three allocation methodologies are used in the
rate-setting model to allocate allowable costs among the levels of
care of children that are served. The methodologies are explained
below and are applied as follows:
(1) The first methodology is a staffing model, validated
by a statistically valid foster care time study, driven by the number
of direct care and treatment coordination staff assigned to a child-placing
agency or residential care facility to care for the children at different
levels of care. The staffing model produces a staffing complement
that is applied to direct care costs to allocate the costs among the
levels of care.
(A) Staff positions reported on the direct care labor
area of the cost report are grouped into the following categories
to more clearly define the staffing complement required at each level
of care:
(i) case management;
(ii) treatment coordination;
(iii) direct care;
(iv) direct care administration; and
(v) medical.
(B) A categorized staffing complement for each Level
of Care 1 through 6 is derived as follows:
(i) A 14-day foster care time study is applied to a
representative sample of residential care facilities and child-placing
agencies that completed a cost report.
(ii) Contracted staff, or employees, within the sampled
facilities complete a foster care time study daily activity log that
assigns half-hour units of each employee's time to the individual
child(ren) with whom the employee is engaged during the time period.
By correlating the distribution of the employee's time with the level
of care assigned to each child, the employee's time is distributed
across the Levels of Care 1 through 6.
(iii) The foster care time study daily activity log
also captures the type of activity performed. The total amount of
time spent in each of these activities is a component in determining
the number of staff needed in each of the categories included in the
staffing complement. The activities performed include:
(I) care and supervision;
(II) treatment planning and coordination;
(III) medical treatment and dental care; and
(IV) other (administrative, managerial, training functions,
or personal time).
(iv) An analysis of the cumulative frequency distribution
of these time units by level of care of all children served in the
sample population, by category of staff performing the activity, and
by type of activity, establishes appropriate staffing complements
for each level of care in child-placing agencies and in residential
care facilities. These time units by level of care are reported as
values that represent the equivalent of a full-time employee. The
results are reported in the following chart for incorporation into
the rate-setting model:
Attached Graphic
(v) The foster care time study should be conducted
every other biennium, or as needed, if service levels substantially
change.
(C) Staff position salaries and contracted fees are
reported as direct care labor costs on the cost reports. Each staff
position is categorized according to the staffing complement outlined
for the time study. The salaries and contracted fees for these positions
are grouped into the staffing complement categories and are averaged
for child-placing agencies and residential care facilities included
in the rate-setting population. This results in an average salary
for each staffing complement category (case management, treatment
coordination, direct care, direct care administration, and medical).
(D) The staffing complement values, as outlined in
the chart at paragraph (1)(B)(iv) of this subsection, are multiplied
by the appropriate average salary for each staffing complement category.
The products for all of the staffing complement categories are summed
for a total for each level of care for both child-placing agencies
and residential care facilities. The total by level of care is multiplied
by the number of days of service in each level of care, and this product
is used as the primary allocation statistic for assigning each provider's
direct care costs to the various levels of care.
(E) Direct care costs include the following areas from
the cost reports:
Cont'd... |
