| (ii) Medicaid payments for emergency dental, customized
equipment and specialized services are based on Texas specific emergency
dental, customized equipment and specialized services payment data
for Texas Medicaid nursing facility residents during the upper payment
limit calculation period.
(3) Changes of ownership.
(A) For a nursing facility that changed ownership prior
to the first day of the Medicaid supplemental payment limit calculation
period but after the first day of the upper payment limit calculation
period, the data used for the calculations described in paragraphs
(1) and (2) of this subsection will include data from the facility
for the entire upper payment limit calculation period including data
relating to payments for days of service provided under the prior
owner. The inclusion of data relating to payments for days of service
provided under the prior owner will ensure that the calculation of
the supplemental payment amount for the Medicaid supplemental payment
limit calculation period reflects a full quarter of services.
(B) For a nursing facility that changes ownership on
or after the first day of the Medicaid supplemental payment limit
calculation period, the data used for the calculations described in
paragraphs (1) and (2) of this subsection will include data from the
facility for the entire upper payment limit calculation period relating
to payments for days of service provided under the prior owner, pro-rated
to reflect only the number of calendar days during the Medicaid supplemental
payment limit calculation period that the facility is owned by the
new owner.
(g) Payment frequency. HHSC will distribute supplemental
payments to participating non-state government-owned nursing facilities
on a quarterly basis subsequent to the Medicaid supplemental payment
limit calculation period.
(h) Supplemental payment methodology.
(1) HHSC will give notice of the non-state government-owned
nursing facility quarterly Medicaid supplemental payment limits determined
in subsection (f) of this section, the maximum IGT amount that can
be provided for each participating nursing facility based on the Federal
Medical Assistance Percentage (FMAP) in place at the time notice is
given, and the deadline for completing the transfer.
(2) The amount of the supplemental payment to the nursing
facility will be calculated in proportion to the amount transferred
by the non-state governmental entity.
(A) For governmental entities that own a single nursing
facility:
(i) If the non-state governmental entity transfers
the maximum IGT described in paragraph (1) of this subsection, the
nursing facility will receive the Medicaid supplemental payment limit
amount calculated for it in subsection (f) of this section.
(ii) If the non-state governmental entity transfers
less than the maximum IGT described in paragraph (1) of this subsection,
the nursing facility will receive a supplemental payment that is proportionate
to the percentage of the maximum IGT that was actually transferred.
(B) For governmental entities that own multiple nursing
facilities:
(i) If the non-state governmental entity transfers
the maximum IGT described in paragraph (1) of this subsection for
all of the nursing facilities it owns, each of the nursing facilities
will receive the Medicaid supplemental payment limit amount calculated
for it in subsection (f) of this section.
(ii) If the non-state governmental entity transfers
less than the maximum IGT described in paragraph (1) of this subsection
for all of the nursing facilities it owns, each of the nursing facilities
will receive a proportion of the Medicaid supplemental payment limit
amount calculated for it in subsection (f) of this section based on
the proportion of the total maximum IGT for all of the nursing facilities
owned by the non-state governmental entity that was actually transferred.
(C) Supplemental payments to remaining non-state government-owned
nursing facilities will not be increased due to the failure of a non-state
governmental entity to transfer the maximum IGT described in paragraph
(1) of this subsection.
(3) A non-state governmental entity that did not transfer
the maximum IGT described in paragraph (1) of this subsection in one
or more of the first three quarters in a federal fiscal year, but
was eligible to do so will be allowed to fund the remaining Medicaid
supplemental payment limit from those quarters during the fourth quarter
of that fiscal year. HHSC will give notice of the remaining Medicaid
supplemental payment limits and the maximum IGT that can be provided
for each non-state government-owned nursing facility. Such notice
will also contain instructions and deadlines for governmental entities
to notify HHSC of the fourth-quarter transfer amount.
(4) The amount of the payment to the nursing facility
will be calculated using the FMAP in place when HHSC gave notice as
described in paragraph (1) or (3) of this subsection, as applicable.
(i) Recoupment.
(1) If payments under this section result in overpayment
to a nursing facility, or in the event of a disallowance by the federal
Centers for Medicare and Medicaid Services (CMS) of federal participation
related to a nursing facility's receipt or use of supplemental payments
authorized under this section, HHSC may recoup an amount equivalent
to the amount of supplemental payments overpaid or disallowed.
(2) Supplemental payments under this section may be
subject to any adjustments for payments made in error, including,
without limitation, adjustments made under the Texas Administrative
Code, the Code of Federal Regulations and state and federal statutes.
HHSC may recoup an amount equivalent to any such adjustment.
(3) HHSC may recoup from any current or future Medicaid
payments as follows:
(A) HHSC will recoup from the nursing facility to which
an overpayment was made or against which any disallowance was directed.
(B) If, within 30 days of the nursing facility's receipt
of HHSC's written notice of recoupment, the nursing facility has not
paid the full amount of the recoupment or entered into a written agreement
with HHSC to do so, HHSC may withhold any or all Medicaid payments
from the nursing facility until HHSC has recovered an amount equal
to the amount overpaid or disallowed. If funds identified for recoupment
cannot be repaid from the nursing facility's Medicaid payments, the
non-state governmental entity that owns the nursing facility will
be liable for any additional payment due to HHSC or its designee.
Failure to repay the amount due or submit an acceptable payment plan
within 60 days of notification will result in the recoupment of the
owed funds from other Medicaid contracts controlled by the non-state
governmental entity and will bar the non-state governmental entity
from receiving any new contracts with HHSC or its designees until
repayment is made in full.
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