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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355REIMBURSEMENT RATES
SUBCHAPTER ACOST DETERMINATION PROCESS
RULE §355.109Adjusting Reimbursement When New Legislation, Regulations, or Economic Factors Affect Costs

(a) In conducting reimbursement reviews for adjustments the Texas Health and Human Services Commission takes into consideration changes in laws, rules, regulations, policies, guidelines, or economic factors which will have a demonstrable material impact on most contracted providers' costs of providing services meeting federal and state standards.

  (1) HHSC may recommend adjustments to reimbursement when federal or state laws, rules, regulations, policies, or guidelines are adopted, promulgated, judicially interpreted, or otherwise changed in ways that affect allowable costs. The law, rule, regulation, policy, or guideline change must result in necessary changes in allowable costs that:

    (A) affect most, if not all, contracted providers; and

    (B) require contracted providers to take definitive action to incur additional allowable costs not included in the cost data base used to determine reimbursements and which would not otherwise be covered in reimbursements.

  (2) HHSC may recommend adjustments to reimbursement when it can be clearly demonstrated that changes in economic factors will result in changes in allowable costs. The changes in economic factors must result in changes in allowable costs that:

    (A) affect most, if not all, providers; and

    (B) are allowable cost changes that the providers have little or no control over and are allowable costs that are not included in the cost data base used to determine reimbursements and which would not otherwise be covered in reimbursements.

(b) HHSC may recommend adjustments to reimbursement for the reasons stated in subsection (a)(1) of this section at the earliest feasible opportunity in order for the adjustment to become effective on the effective date of the federal or state laws, rules, regulations, policies, or guidelines. In the case of Medicaid state plan program reimbursements, the adjustments will not be effective until after the federal requirements for notice are met.

(c) HHSC may recommend adjustments to reimbursement when federal or state funding is changed in ways that affect the available funding for programs.


Source Note: The provisions of this §355.109 adopted to be effective September 1, 1996, 21 TexReg 7866; duplicated effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective August 31, 2004, 29 TexReg 8093

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