| per unit of service is multiplied by 1.044.
(III) The attendant cost area and the other attendant
cost area are summed to determine the habilitation attendant cost
per unit of service.
(ix) For out-of-home respite care, the allowable costs
per unit of service are calculated as determined in clauses (i) -
(vi) of this subparagraph. The allowable costs per unit of service
for each contracted provider cost report are multiplied by 1.044.
The costs per unit of service are then arrayed and weighted by the
number of units of service, and the median cost per unit of service
is calculated.
(B) The monthly reimbursement for case management services
is determined in the following manner:
(i) Total allowable costs for each provider will be
determined by analyzing the allowable historical costs reported on
the cost report and other pertinent cost survey information.
(ii) Total allowable costs are reduced by the amount
of administrative expense fee revenues reported.
(iii) Each provider's total allowable costs, excluding
depreciation and mortgage interest, are projected from the historical
cost reporting period to the prospective reimbursement period as described
in §355.108 of this title (relating to Determination of Inflation
Indices).
(iv) Payroll taxes and employee benefits are allocated
to each salary line item on the cost report on a pro rata basis based
on the portion of that salary line item to the amount of total salary
expense for the appropriate group of staff. Employee benefits will
be charged to a specific salary line item if the benefits are reported
separately. The allocated payroll taxes are Federal Insurance Contributions
Act (FICA) or social security, Medicare contributions, Workers' compensation
Insurance (WCI), the Federal Unemployment Tax Act (FUTA), and the
Texas Unemployment Compensation Act (TUCA).
(v) Each provider's projected total allowable costs
are divided by the number of monthly units of service to determine
the projected cost per client month of service.
(vi) Each provider's projected cost per client month
of service is arrayed from low to high and weighted by the number
of units of service and the median cost per client month of service
is calculated.
(vii) The median projected cost per client month of
service is multiplied by 1.044.
(C) The unit of service reimbursement for day activity
and health services is determined in accordance with §355.6907
(Relating to Reimbursement Methodology for Day Activity and Health
Services).
(D) HHSC also adjusts reimbursement according to §355.109
of this title (relating to Adjusting Reimbursement When New Legislation,
Regulations, or Economic Factors Affect Costs) if new legislation,
regulations, or economic factors affect costs.
(5) The reimbursement for support family services and
continued family services will be determined as a per day rate using
a method based on modeled costs which are developed by using data
from surveys, cost report data from other similar programs, payment
rates from other similar programs, consultation with other service
providers and/or professionals experienced in delivering contracted
services, or other sources as determined appropriate by HHSC. The
per day rate will have two parts, one part for the child placing agency
and one part for the support family.
(d) Administrative expense fee determination methodology.
(1) One-time administrative expense fee. Reimbursement
for the pre-enrollment assessment and care planning process required
to determine eligibility for the waiver program will be provided as
a one-time administrative expense fee.
(2) Administrative expense fee determination process.
The recommended administrative expense fee is determined using a method
based on modeled projected expenses which are developed using data
from surveys, cost report data from other similar programs or services,
professionals' experience in delivering similar services, and other
relevant sources.
(e) Requisition fees. Requisition fees are reimbursements
paid to the CLASS direct service agency contracted providers for their
efforts in acquiring adaptive aids, medical supplies, dental services,
specialized therapies, and minor home modifications for CLASS participants.
Reimbursement for requisition fees for adaptive aids, medical supplies,
dental services, specialized therapies, and minor home modifications
will vary based on the actual cost of the adaptive aids, medical supplies,
dental services, specialized therapies, and minor home modifications.
Reimbursements are determined using a method based on modeled projected
expenses which are developed by using data from surveys; cost report
data from similar programs; consultation with other service providers
and/or professionals experienced in delivering contracted services;
and/or other sources.
(f) Allowable and unallowable costs.
(1) Providers must follow the guidelines in determining
whether a cost is allowable or unallowable as specified in §355.102
and §355.103 of this title (relating to General Principles of
Allowable and Unallowable Costs, and Specifications for Allowable
and Unallowable Costs) as well as the following provisions.
(2) Participant room and board expenses are not allowable,
except for those related to respite care.
(3) The actual cost of adaptive aids, medical supplies,
dental services, and home modifications is not allowable for cost
reporting purposes. Allowable labor costs associated with acquiring
adaptive aids, medical supplies, dental services, and home modifications
should be reported in the cost report. Any item purchased for participants
in this program and reimbursed through a voucher payment system is
unallowable. Refer to §355.103(b)(20)(K) of this title (relating
to Specifications for Allowable and Unallowable Costs).
(g) Authority to determine reimbursement. The authority
to determine reimbursement is specified in §355.101 of this title
(relating to Introduction).
(h) Reporting revenue. Revenues must be reported on
the cost report in accordance with §355.104 of this title (relating
to Revenues).
(i) Reviews and field audits of cost reports. Desk
reviews or field audits are performed on all contracted providers'
cost reports. The frequency and nature of the field audits are determined
by HHSC to ensure the fiscal integrity of the program. Desk reviews
and field audits will be conducted in accordance with §355.106
of this title (relating to Basic Objectives and Criteria for Audit
and Desk Review of Cost Reports), and providers will be notified of
the results of a desk review or a field audit in accordance with §355.107
of this title (relating to Notification of Exclusions and Adjustments).
Providers may request an informal review and, if necessary, an administrative
hearing to dispute an action taken under §355.110 of this title
(relating to Informal Reviews and Formal Appeals).
(j) Reporting requirements. The program director's
full salary is to be reported on the line item of the cost report
designated for the director.
|
| Source Note: The provisions of this §355.505 adopted to be effective September 1, 1996, 21 TexReg 7890; transferred effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective June 21, 1998, 23 TexReg 6197; amended to be effective June 25, 2000, 25 TexReg 5867; amended to be effective September 1, 2001, 26 TexReg 6297; amended to be effective April 13, 2003, 28 TexReg 3047; amended to be effective September 1, 2004, 29 TexReg 7667; amended to be effective February 3, 2008, 33 TexReg 667; amended to beeffectiveSeptember 1, 2009, 34 TexReg 5654; amended to be effective June 20, 2011, 36 TexReg 3707; amended to be effective April 1, 2012, 37 TexReg 2068; amended to be effective November 25, 2012, 37 TexReg 9086; amended to be effective April 1, 2014, 39 TexReg 2062; amended to be effective January 1, 2015, 39 TexReg 9193 |
