| (2) Contractor-specific reimbursements. For programs
in which reimbursements are contractor-specific, HHSC will hold a
public hearing on the reimbursement determination parameter dollar
amounts (e.g., ceilings, floors, or program reimbursement formula
limits) before HHSC approves parameter dollar amounts. The purpose
of the hearing is to give interested parties an opportunity to comment
on the proposed reimbursement parameter dollar amounts. Notice of
the hearing will be provided to the public. The notice of the public
hearing will identify the name, address, and telephone number to contact
for the materials pertinent to the proposed reimbursement parameter
dollar amounts. At least ten calendar days before the public hearing
takes place, material pertinent to the proposed reimbursement parameter
dollar amounts will be made available to the public. This material
will include the proposed reimbursement parameter dollar amounts,
the inflation adjustments used to determine them, and the impact on
the reimbursement parameter dollar amounts of the major cost limits.
This material will be furnished to anyone who requests it. After the
public hearing, if negative comments are received, a summary of the
comments made during the public hearing will be presented to HHSC.
(h) Insufficient cost data. If an insufficient number
of accurate, full-year cost reports is submitted, as would occur with
a new program, or if there are insufficient available data, as would
occur in changes in program design, changes in the definition of units
of service or changes in regulations or program requirements, reimbursements
may be based on a pro-forma analysis by HHSC staff. A pro-forma analysis
is defined as an item-by-item, or classes-of-items, calculation of
the reasonable and necessary expenses for a provider to operate. The
analysis may involve assumptions about the salary of an administrator
or program director, staff salaries, employee benefits and payroll
taxes, building depreciation, mortgage interest, contracted client
care expenses, and other building or administration expenses. To determine
the cost per unit of service, HHSC adds all the pro-forma expenses
and divides the total by the estimated number of units of service
that a fully operational provider is likely to provide. The pro-forma
analysis is based on available information that is determined to be
sufficient, accurate, and reliable by HHSC, including valid cost report
data and survey data. The pro-forma analysis is conducted in a way
that ensures that the resultant reimbursements are sufficient to support
the requirements of the contracted program. When HHSC staff determine
that sufficient and reliable cost report data have become available,
the pro-forma reimbursement determination may be replaced with a process
based on cost reports.
(i) Limits on related-party compensation. HHSC may
place upper limits or caps on related-party compensation as follows:
(1) For related-party administrators and directors,
the upper limit for compensation is equal to the 90th percentile in
the array of all non-related-party annualized compensation as reported
by all contracted providers within a program. In addition, the hourly
compensation for related-party administrators and directors is limited
to the annualized upper limit for related-party administrators and
directors divided by 2,080.
(2) For related-party assistant administrators and
assistant directors, the upper limit for compensation is equal to
the 90th percentile in the array of all non-related party annualized
compensation as reported by all contracted providers within a program.
In addition, the hourly compensation for related-party assistant administrators
and assistant directors is limited to the annualized upper limit for
related-party assistant administrators and assistant directors divided
by 2,080.
(3) For owners, partners, and stockholders (when the
owner, partner, or stockholder is performing contract level administrative
functions but is not the administrator, director, assistant administrator
or assistant director), the upper limits for compensation are equal
to the upper limits for related-party administrators and directors.
(4) For all other staff types:
(A) For the Intermediate Care Facilities for Individuals
with an Intellectual Disability or Related Conditions, Home and Community-based
Services and Texas Home Living programs, related-party limitations
are specified in §355.457 of this title (relating to Cost Finding
Methodology), and §355.722 of this title (relating to Reporting
Costs by Home and Community-based Services (HCS) and Texas Home Living
(TxHmL) Providers).
(B) For all other programs, related-party compensation
is limited to reasonable and necessary costs as described in §355.102
of this title.
|
| Source Note: The provisions of this §355.105 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 December 29, 1997, 22 TexReg 12485; amended to be effective September 27, 1999, 24 TexReg 7397; amended to be effective June 26, 2000, 25 TexReg 6089; amended to be effective October 1, 2000, 25 TexReg 9924; amended to be effective December 1, 2001, 26 TexReg 9565; amended to be effective August 31, 2004, 29 TexReg 8093; amended to be effective November 2, 2008, 33 TexReg8759; amended to be effective September 1, 2011, 36 TexReg 4795; amended to be effective April 1, 2012, 37 TexReg 2068; amended to be effective November 25, 2012, 37 TexReg 9086; amended to be effective August 1, 2013, 38 TexReg 4743; amended to be effective January 1, 2015, 39 TexReg 9193; amended to be effective March 1, 2018, 43 TexReg 339; amended to be effective January 1, 2019, 43 TexReg 8581 |
