| (z) Contract cancellations. If a facility's Medicaid
contract is cancelled before the first day of an open enrollment period
as defined in subsection (c) of this section and the facility is not
granted a new contract until after the last day of the open enrollment
period, participation in the enhanced direct care staff rate as it
existed prior to the date when the facility's contract was cancelled
will be reinstated when the facility is granted a new contract, if
it remains under the same ownership, subject to the availability of
funding. Any enrollment limitations from subsection (i) of this section
that would have applied to the cancelled contract will apply to the
new contract.
(aa) 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 control 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 person(s) as the commonly owned corporation(s).
(D) Control--greater than 50 percent ownership by the
entity.
(2) Aggregation. For an entity, commonly owned corporation,
or combined entity that controls more than one participating nursing
facility contract, compliance with the spending requirements detailed
in subsection (o) of this section can be determined in the aggregate
for all participating nursing facility contracts 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 NF contract, or the effective date of the termination
of its last participating NF contract rather than requiring each contract
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 Staffing and 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. Nursing facility
contracts 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 (o) of
this section, are excluded from all aggregate spending calculations.
These contracts' 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.
(bb) Medicaid Swing Bed Program for Rural Hospitals.
When a rural hospital participating in the Medicaid swing bed program
furnishes NF nursing care to a Medicaid recipient under 26 TAC §554.2326
(relating to Medicaid Swing Bed Program for Rural Hospitals), HHSC
or its designee makes payment to the hospital using the same procedures,
the same case-mix methodology, and the same RUG-III rates that HHSC
authorizes for reimbursing NFs receiving the direct care staff base
rate with no enhancement levels. These hospitals are not subject to
the staffing and spending requirements detailed in this section.
(cc) Disclaimer. Nothing in these rules should be construed
as preventing facilities from adding direct care staff in addition
to those funded by the enhanced direct care staff rate.
(dd) Notification of lack of available funds. If HHSC
determines that funds are not available to continue participation
for facilities from which it has not received an acceptable request
to modify their enrollment by the last day of an enrollment period
as per subsection (d) of this section or to fund carry-over enhancements
as per subsection (j)(3) of this section, HHSC will notify providers
in a manner determined by HHSC that such funds are not available.
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| Source Note: The provisions of this §355.308 adopted to be effective May 1, 2000, 25 TexReg 3517; amended to be effective January 1, 2001, 25 TexReg 12641; amended to be effective December 1, 2001, 26 TexReg 9565; amended to be effective January 7, 2003, 28 TexReg 59; amended to be effective May 29, 2003, 28 TexReg 4097; amended to be effective September 1, 2003, 28 TexReg 7306; amended to be effective June 6, 2004, 29 TexReg 5594; amended to be effective January 9, 2005, 29 TexReg 12128; amended to be effective August 21, 2008, 33 TexReg 6569; amended to be effective November 8, 2009, 34 TexReg 7594; amended to beeffective September 1, 2011, 36 TexReg 3706; amended to be effective April 1, 2012, 37 TexReg 2068; amended to be effective November 25, 2012, 37 TexReg 9086; amended to be effective January 1, 2015, 39 TexReg 9193; amended to be effective July 1, 2017, 42 TexReg 3267; amended to be effective September 1, 2023, 48 TexReg 4620 |
