| (a) Direct care staff cost center. This cost center
will include compensation for employee and contract labor Registered
Nurses (RNs), including Directors of Nursing (DONs) and Assistant
Directors of Nursing (ADONs); Licensed Vocational Nurses (LVNs), including
DONs and ADONs; medication aides; and nurse aides performing nursing-related
duties for Medicaid contracted beds.
(1) Compensation to be included for these employee
staff types is the allowable compensation defined in §355.103(b)(1)
of this title (relating to Specifications for Allowable and Unallowable
Costs) that is reported as either salaries and/or wages (including
payroll taxes and workers' compensation) or employee benefits. Benefits
required by §355.103(b)(1)(A)(iii) of this title to be reported
as costs applicable to specific cost report line items are not to
be included in this cost center.
(2) Direct care staff who also have administrative
duties not related to nursing must properly direct charge their compensation
to each type of function performed based upon daily time sheets maintained
throughout the entire reporting period.
(3) Nurse aides must meet the qualifications enumerated
under 40 TAC §19.1903 (relating to Required Training of Nurse
Aides) to be included in this cost center. Nurse aides include certified
nurse aides and nurse aides in training as per 40 TAC §94.3(k)
(relating to Nurse Aide Training and Competency Evaluation Program
(NATCEP) Requirements).
(4) Contract labor refers to personnel for whom the
contracted provider is not responsible for the payment of payroll
taxes (such as FICA, Medicare, and federal and state unemployment
insurance) and who perform tasks routinely performed by employees.
Allowable contract labor costs are defined in §355.103(b)(3)
of this title.
(5) For facilities receiving supplemental reimbursement
for children with tracheostomies requiring daily care as described
in §355.307(b)(3)(F) of this title (relating to Reimbursement
Setting Methodology), staff required by 40 TAC §19.901(14)(C)(iii)
(relating to Quality of Care) performing nursing-related duties for
Medicaid contracted beds are included in the direct care staff cost
center.
(6) For facilities receiving supplemental reimbursement
for qualifying ventilator-dependent residents as described in §355.307(b)(3)(E)
of this title, Registered Respiratory Therapists and Certified Respiratory
Therapy Technicians are included in the direct care staff cost center.
(7) Nursing facility administrators and assistant administrators
are not included in the direct care staff cost center.
(8) Staff members performing more than one function
in a facility without a differential in pay between functions are
categorized at the highest level of licensure or certification they
possess. If this highest level of licensure or certification is not
that of an RN, LVN, medication aide, or certified nurse aide, the
staff member is not to be included in the direct care staff cost center
but rather in the cost center where staff members with that licensure
or certification status are typically reported.
(9) Paid feeding assistants are not included in the
direct care staff cost center and are not to be counted toward the
staffing requirements described in subsection (j) of this section.
Paid feeding assistants are intended to supplement certified nurse
aides, not to be a substitute for certified or licensed nursing staff.
(b) Rate year. The standard rate year begins on the
first day of September and ends on the last day of August of the following
year.
(c) Open enrollment. Open enrollment for the enhanced
direct care staff rates will begin on the first day of July and end
on the last day of that same July preceding the rate year for which
payments are being determined. HHSC notifies providers of open enrollment
by electronic mail (e-mail) to an authorized representative per the
signature authority designation form applicable to the provider's
contract or ownership type. If open enrollment has been postponed
or cancelled, the Texas Health and Human Services Commission (HHSC)
will notify providers by e-mail prior to the first day of July. Should
conditions warrant, HHSC may conduct additional enrollment periods
during a rate year.
(d) Enrollment contract amendment. An initial enrollment
contract amendment is required from each facility choosing to participate
in the enhanced direct care staff rate. Participating and nonparticipating
facilities may request to modify their enrollment status (i.e., a
nonparticipant can request to become a participant, a participant
can request to become a nonparticipant, a participant can request
to change its enhancement level) during any open enrollment period.
Nonparticipants and participants requesting to increase their enrollment
levels will be limited to requesting increases of three or fewer enhancement
levels during any single open enrollment period unless such limits
are waived by HHSC. Requests to modify a facility's enrollment status
during an open enrollment period must be received by HHSC Rate Analysis
by the last day of the open enrollment period as per subsection (c)
of this section. If the last day of the open enrollment period falls
on a weekend, a national holiday, or a state holiday, then the first
business day following the last day of the open enrollment period
is the final day the receipt of the enrollment contract amendment
will be accepted. An enrollment contract amendment that is not received
by the stated deadline will not be accepted. A facility from which
HHSC Rate Analysis has not received an acceptable request to modify
their enrollment by the last day of the open enrollment period will
continue at the level of participation in effect during the open enrollment
period within available funds until the facility notifies HHSC in
accordance with subsection (r) of this section that it no longer wishes
to participate or until the facility's enrollment is limited in accordance
with subsection (i) of this section. If HHSC determines that funds
are not available to continue participation at the level of participation
in effect during the open enrollment period, facilities will be notified
as per subsection (ee) of this section. To be acceptable, an enrollment
contract amendment must be completed according to instructions, signed
by an authorized representative as per the Texas Department of Aging
and Disabilities Services (DADS) signature authority designation form
applicable to the provider's contract or ownership type, and be legible.
(e) New facilities. For purposes of this section, for
each rate year a new facility is defined as a facility delivering
its first day of service to a Medicaid recipient after the first day
of the open enrollment period, as defined in subsection (c) of this
section, for that rate year. Facilities that underwent an ownership
change are not considered new facilities. For purposes of this subsection,
an acceptable enrollment contract amendment is defined as a legible
enrollment contract amendment that has been completed according to
instructions, signed by an authorized representative as per the DADS
signature authority designation form applicable to the provider's
contract or ownership type, and received by HHSC within 30 days of
the notification to the facility by HHSC that such an enrollment contract
amendment must be submitted. New facilities will receive the direct
care staff base rate as determined in subsection (k) of this section
with no enhancements. For new facilities specifying their desire to
participate on an acceptable enrollment contract amendment, the direct
care staff rate is adjusted as specified in subsection (l) of this
section, effective on the first day of the month following receipt
by HHSC of the acceptable enrollment contract amendment. If the granting
of newly requested enhancements was limited as per subsection (j)(3)
of this section during the most recent enrollment, enrollment for
new facilities will be subject to that same limitation.
(f) Staffing and Compensation Report submittal requirements.
(1) Annual Staffing and Compensation Report. For services
delivered on or before August 31, 2009, providers must file Staffing
and Compensation Reports as follows. All participating facilities
will provide HHSC, in a method specified by HHSC, an Annual Staffing
and Compensation Report reflecting the activities of the facility
while delivering contracted services from the first day of the rate
year through the last day of the rate year. This report will be used
as the basis for determining compliance with the staffing requirements
and recoupment amounts as described in subsection (n) of this section,
and as the basis for determining the spending requirements and recoupment
amounts as described in subsection (o) of this section. Participating
facilities failing to submit an acceptable Annual Staffing and Compensation
Report within 60 days of the end of the rate year will be placed on
vendor hold until such time as an acceptable report is received and
processed by HHSC.
(A) When a participating facility changes ownership,
the prior owner must submit a Staffing and Compensation Report covering
the period from the beginning of the rate year to the date recognized
by HHSC or its designee as the ownership-change effective date. This
report will be used as the basis for determining any recoupment amounts
as described in subsections (n) and (o) of this section. The new owner
will be required to submit a Staffing and Compensation Report covering
the period from the day after the date recognized by HHSC or its designee
as the ownership-change effective date to the end of the rate year.
(B) Participating facilities whose contracts are terminated
either voluntarily or involuntarily must submit a Staffing and Compensation
Report covering the period from the beginning of the rate year to
the date recognized by HHSC or its designee as the contract termination
date. This report will be used as the basis for determining any recoupment
amounts as described in subsections (n) and (o) of this section.
(C) Participating facilities who voluntarily withdraw
from participation as per subsection (r) of this section must submit
a Staffing and Compensation Report within 60 days of the date of withdrawal
as determined by HHSC, covering the period from the beginning of the
rate year to the date of withdrawal as determined by HHSC. This report
will be used as the basis for determining any recoupment amounts as
described in subsections (n) and (o) of this section.
(D) Participating facilities whose cost report year
coincides with the state of Texas fiscal year as per §355.105(b)(5)
of this title (relating to General Reporting and Documentation Requirements,
Methods, and Procedures) are exempt from the requirement to submit
a separate Annual Staffing and Compensation Report. For these facilities,
their cost report will be considered their Annual Staffing and Compensation
Report.
(2) For services delivered on September 1, 2009, and
thereafter, cost reports as described in §355.105(b) of this
title will replace the Staffing and Compensation Report with the following
exceptions:
(A) For services delivered from September 1, 2009,
to August 31, 2010, participating facilities may be required to submit
Transition Staffing and Compensation Reports in addition to required
cost reports. The Transition Staffing and Compensation Report reporting
period will include those days in calendar years 2009 and 2010 not
included in either the 2009 Staffing and Compensation report or the
facility's 2010 cost report.
(B) When a participating facility changes ownership,
the prior owner must submit a Staffing and Compensation Report covering
the period from the beginning of the facility's cost reporting period
to the date recognized by HHSC or its designee as the ownership-change
effective date. This report will be used as the basis for determining
any recoupment amounts as described in subsections (n) and (o) of
this section. The new owner will be required to submit a cost report
covering the period from the day after the date recognized by HHSC
or its designee as the ownership-change effective date to the end
of the facility's fiscal year.
(C) Participating facilities whose contracts are terminated
either voluntarily or involuntarily must submit a Staffing and Compensation
Report covering the period from the beginning of the facility's cost
reporting period to the date recognized by HHSC or its designee as
the contract termination date. This report will be used as the basis
for determining any recoupment amounts as described in subsections
(n) and (o) of this section.
(D) Participating facilities who voluntarily withdraw
from participation as per subsection (r) of this section must submit
a Staffing and Compensation Report within 60 days of the date of withdrawal
as determined by HHSC, covering the period from the beginning of the
facility's cost reporting period to the date of withdrawal as determined
by HHSC. This report will be used as the basis for determining any
recoupment amounts as described in subsections (n) and (o) of this
section. These facilities must still submit a cost report covering
the entire cost reporting period. The cost report will not be used
for determining any recoupment amounts.
(E) For new facilities as defined in subsection (e)
of this section, the cost reporting period will begin with the effective
date of participation in enhancement.
(F) Existing facilities which become participants in
the enhancement as a result of the open enrollment process described
in subsection (c) of this section on any day other than the first
day of their fiscal year are required to submit a Staffing and Compensation
Report with a reporting period that begins on their first day of participation
in the enhancement and ends on the last day of the facility's fiscal
year. This report will be used as the basis for determining any recoupment
amounts as described in subsections (n) and (o) of Cont'd... |
