| vendor hold on additional
contracts, and barring of new contract.
(x) Voluntary withdrawal. Participating contracts or
component codes wishing to withdraw from the attendant compensation
rate enhancement must notify HHSC Rate Analysis in writing by certified
mail and the request must be signed by an authorized representative
as designated per the DADS 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.
(y) 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
Rate Analysis by certified mail and the request must be signed by
an authorized representative as designated per the DADS 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.
(z) 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.
(aa) 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 (s) of this section.
(bb) Appeals. Subject matter of informal reviews and
formal appeals is limited as per §355.110 of this title.
(cc) 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 or DADS contracts controlled by the responsible
entity.
(dd) 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.
(ee) 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 RC
and CBA AL/RC considered a single program, and HCS and TxHmL considered
a single program), compliance with the spending requirements detailed
in subsection (s) 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, DBMD, CBA--AL/RC 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 (s) 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.
(ff) Conditions of participation for day habilitation.
The following conditions of participation apply to each ICF/IID, HCS
and TxHmL provider specifying its wish to have day habilitation services
participate in the attendant compensation rate enhancement.
(1) A provider who provides day habilitation in-house
or who contracts with a related party to provide day habilitation
will report job trainer and job coach compensation and hours on the
required cost report items (e.g., hours, salaries and wages, payroll
taxes, employee benefits/insurance/workers' compensation, contract
labor costs, and personal vehicle mileage reimbursement). Day habilitation
costs cannot be combined and reported in one cost report item.
(2) A provider who contracts with a non-related party
to provide day habilitation will report its payments to the contractor
in a single cost report item as directed in the instructions for the
cost report or Attendant Compensation Report as described in subsection
(h)(2) and (3) of this section. HHSC will allocate 50 percent of reported
payments to the attendant compensation cost area for inclusion with
other allowable day habilitation attendant costs in order to determine
the total attendant compensation spending for day habilitation services
as described in subsection (s) of this section.
(3) The provider must ensure access to any and all
records necessary to verify information submitted to HHSC on Attendant
Compensation Reports and cost reports functioning as an Attendant
Compensation Report.
(4) HHSC will require each ICF/IID, HCS and TxHmL provider
specifying their wish to have day habilitation services participate
in the attendant compensation rate enhancement to certify during the
enrollment process that it will comply with the requirements of paragraphs
(1) - (3) of this subsection.
(gg) New contracts within existing component codes.
For ICF/IID, HCS and TxHmL, new contracts within existing component
codes will be assigned a level of participation equal to the existing
component code's level of participation effective on the start date
of the contract as recognized by HHSC or its designee.
(hh) Disclaimer. Nothing in these rules should be construed
as preventing providers from compensating attendants at a level above
that funded by the enhanced attendant compensation rate.
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| Source Note: The provisions of this §355.112 adopted to be effective June 25, 2000, 25 TexReg 5867; amended to be effective September 1, 2001, 26 TexReg 6291; amended to be effective January 1, 2003, 27 TexReg 11915; amended to be effective September 1, 2003, 28 TexReg 7301; amended to be effective April 1, 2004, 29 TexReg 3173; amended to be effective July 14, 2004, 29 TexReg 6622; amended to be effective January 19, 2006, 31 TexReg 285; amended to be effective October 28, 2007, 32 TexReg 7461; amended to be effective November 8, 2009, 34 TexReg 7593; amended to be effective September 1, 2010, 35 TexReg 5015; amended to be effectiveDecember 13, 2010, 35 TexReg 10943; amended to be effective September 1, 2011, 36 TexReg 3705; amended to be effective April 1, 2012, 37 TexReg 2068; amended to be effective November 25, 2012, 37 TexReg 9086; amended to be effective September 1, 2013, 38 TexReg 5433; amended to be effective September 1, 2014, 39 TexReg 5881; amended to be effective August 1, 2017, 42 TexReg 3359; amended to be effective March 1, 2018, 43 TexReg 339; amended to be effective January 1, 2019, 43 TexReg 8581; amended to be effective September 2, 2019, 44 TexReg 4691; amended to be effective June 25, 2020, 45 TexReg 4177; amended to be effective January 10, 2021, 46 TexReg 299 |
