| (ii) Type Two Contract Assignment--A contract assignment
by which the assignee is a new Community Care contract.
(2) Participation after a contract assignment. Participation
after a contract assignment is determined as follows:
(A) Type One Contract Assignments. For Type One contract
assignments, the assignee's level of participation remains the same
while the assignor's level of participation changes to the assignee's.
(B) Type Two Contract Assignments. For Type Two contract
assignments, the level of participation of the assignor contract(s)
will continue unchanged under the assignee contract(s).
(3) Reporting requirements. The assignee is responsible
for the reporting requirements in subsection (i) of this section for
any reporting period days occurring after the contract assignment
effective date. If the contract assignment occurs during an open enrollment
period as defined in subsection (f) of this section, the owner recognized
by HHSC, or its designee, on the last day of the enrollment period
may request to modify the enrollment status of the contract in accordance
with subsection (g) of this section.
(4) Vendor holds. For contracted providers required
to submit an Attendant Compensation Report due to contract assignment,
as described in subsection (i) of this section, HHSC, or its designee,
will place a vendor hold on the payments of the existing contracted
provider until HHSC receives an acceptable Attendant Compensation
Report, as specified in subsection (i) of this section, and until
funds identified for recoupment from subsection (t) of this section
are repaid to HHSC or its designee. HHSC, or its designee, will recoup
any amount owed from the provider's vendor payments that are being
held. In cases where funds identified for recoupment cannot be repaid
from the held vendor payments, the responsible entity from subsection
(dd) of this section will be jointly and severally liable for any
additional payment due to HHSC or its designee. Failure to repay the
amount due within 60 days of notification will result in the recoupment
of the owed funds from other HHSC contracts controlled by the responsible
entity, placement of a vendor hold on all HHSC contracts controlled
by the responsible entity, and will bar the responsible entity from
enacting new contracts with HHSC until repayment is made in full.
The responsible entity for these contracts will be notified, as described
in subsection (u) of this section, prior to the recoupment of owed
funds, placement of vendor hold on additional contracts, and barring
of new contract.
(y) Voluntary withdrawal. Participating contracts or
component codes wishing to withdraw from the attendant compensation
rate enhancement must notify HHSC in writing by certified mail and
the request must be signed by an authorized representative as designated
per the HHSC signature authority designation form applicable to the
provider's contract or ownership type. The requests will be effective
the first of the month following the receipt of the request. Contracts
or component codes voluntarily withdrawing must remain nonparticipants
for the remainder of the rate year. Providers whose contracts are
participating as part of a component code must request withdrawal
of all the contracts in the component code.
(z) Adjusting attendant compensation requirements.
Providers that determine that they will not be able to meet their
attendant compensation requirements may request to reduce their attendant
compensation requirements and associated enhancement payment to a
lower participation level by submitting a written request to HHSC
by certified mail, and the request must be signed by an authorized
representative as designated per the HHSC signature authority designation
form applicable to the provider's contract or ownership type. These
requests will be effective the first of the month following the receipt
of the request. Providers whose contracts are participating as part
of a component code must request the same reduction for all of the
contracts in the component code.
(aa) All other rate components. All other rate components
will continue to be calculated as specified in the program-specific
reimbursement methodology and will be uniform for all providers.
(bb) Failure to document spending. Undocumented attendant
compensation expenses will be disallowed and will not be used in the
determination of the attendant compensation spending per unit of service
in subsection (t) of this section.
(cc) Appeals. Subject matter of informal reviews and
formal appeals is limited as per §355.110 of this title.
(dd) Responsible entities. The contracted provider,
owner, or legal entity which received the attendant compensation rate
enhancement is responsible for the repayment of the recoupment amount.
(1) HCS and TxHmL providers required to repay enhancement
funds will be jointly and severally liable for any repayment.
(2) Failure to repay the amount due or submit an acceptable
payment plan within 60 days of notification will result in placement
of a vendor hold on all HHSC contracts controlled by the responsible
entity.
(ee) Manual Repayment. For the HCS and TxHmL programs,
if HHSC, or its designee, is unable to recoup owed funds using an
automated system, providers will be required to repay some or all
of the enhancement funds to be recouped through a check, money order,
or other non-automated method. Providers will be required to submit
the required repayment amount within 60 days of notification.
(ff) Determination of compliance with spending requirements
in the aggregate.
(1) Definitions. The following words and terms have
the following meanings when used in this subsection.
(A) Commonly owned corporations--two or more corporations
where five or fewer identical persons who are individuals, estates,
or trusts own greater than 50 percent of the total voting power in
each corporation.
(B) Entity--a parent company, sole member, individual,
limited partnership, or group of limited partnerships controlled by
the same general partner.
(C) Combined entity--one or more commonly owned corporations
and one or more limited partnerships where the general partner is
controlled by the same identical persons as the commonly owned corporation(s).
(D) Control--greater than 50 percent ownership by the
entity.
(2) Aggregation. For an entity, for two or more commonly
owned corporations, or for a combined entity that controls more than
one participating contract or component code in a program (with HCS
and TxHmL considered a single program), compliance with the spending
requirements detailed in subsection (t) of this section can be determined
in the aggregate for all participating contracts or component codes
in the program controlled by the entity, commonly owned corporations,
or combined entity at the end of the rate year, the effective date
of the change of ownership of its last participating contract or component
code in the program, or the effective date of the termination of its
last participating contract or component code in the program rather
than requiring each contract or component code to meet its spending
requirement individually. Corporations that do not meet the definitions
under paragraph (1)(A) - (C) of this subsection are not eligible for
aggregation to meet spending requirements.
(A) Aggregation Request. To exercise aggregation, the
entity, combined entity, or commonly owned corporations must submit
an aggregation request in a manner prescribed by HHSC at the time
each Attendant Compensation Report or cost report is submitted. In
limited partnerships in which the same single general partner controls
all the limited partnerships, the single general partner must make
this request. Other such aggregation requests will be reviewed on
a case-by-case basis.
(B) Frequency of Aggregation Requests. The entity,
combined entity, or commonly owned corporations must submit a separate
request for aggregation for each reporting period.
(C) Ownership changes or terminations. For the ICF/IID,
HCS, TxHmL, DAHS, RC, and DBMD programs, contracts or component codes
that change ownership or terminate effective after the end of the
applicable reporting period, but prior to the determination of compliance
with spending requirements as per subsection (t) of this section,
are excluded from all aggregate spending calculations. These contracts'
or component codes' compliance with spending requirements will be
determined on an individual basis, and the costs and revenues will
not be included in the aggregate spending calculation.
(gg) Conditions of participation for ICF/IID day habilitation
and HCS/TxHmL individualized skills and socialization services. The
following conditions of participation apply to each ICF/IID, HCS,
and TxHmL provider specifying its wish to have day habilitation services
or individualized skills and socialization services participate in
the attendant compensation rate enhancement.
Cont'd... |
