| (C) supplies and materials used in the nurse aide training
not already covered by the training course fee.
(2) Nurse aide salaries while in training are factored
into the vendor rate and are not to be included on the reimbursement
voucher.
(3) Training program costs that exceed the DADS cost
ceiling must have prior approval from DADS before costs can be reimbursed.
A written request to Provider Billing Services must include:
(A) name and vendor number of facility.
(B) description of training program for which the facility
is seeking reimbursement approval, to include:
(i) name, telephone number and address of the nurse
aide training and competency evaluation program (NATCEP);
(ii) whether the NATCEP program is facility or non-facility-based;
and
(iii) name of the NATCEP program director.
(C) an explanation of why the cost for the NATCEP exceeds
the reimbursement ceiling. The explanation must include:
(i) a completed nurse aide unit cost calculation form
for a facility-based NATCEP; or
(ii) a breakdown of the nurse aide unit cost by the
instructor fees and training materials for a non-facility-based NATCEP.
(D) an explanation of why the nursing facility cannot
utilize a training program at or below the reimbursement ceiling and
what steps the facility has taken to explore more cost efficient training
courses. The explanation must include:
(i) the availability of NATCEPs, such as the location
or the frequency of training offered, in the geographic region of
the facility;
(ii) the name and address of each NATCEP that the facility
has explored as a provider of nurse aide training; and
(iii) the cost per nurse aide for each NATCEP identified
in clause (i) of this subparagraph, as specified in subparagraph (C)(i)
or (ii) of this paragraph.
(4) All prior approval requests as outlined in paragraph
(3) of this subsection must be submitted to DADS, Provider Billing
Services that:
(A) may request additional information in order to
evaluate a reimbursement request; and
(B) will make the final decision on a reimbursement
request.
(5) All nurse aide training courses must be approved
by DADS before costs associated with them can be reimbursed.
(6) Nursing facilities are responsible for tracking
and documenting nurse aide training costs for each nurse aide trained.
All documentation is subject to DADS audits. If substantiating documentation
for amounts billed to DADS cannot be verified, DADS will immediately
recoup funds paid to the facility.
(7) Individuals who have successfully completed a nurse
aide training and competency evaluation program (NATCEP) may be directly
reimbursed for costs incurred in completing a NATCEP. The individual
must meet all of the conditions specified in subparagraphs (A) - (E)
of this paragraph.
(A) The individual must not have been employed at the
time of completing the NATCEP.
(B) The individual must have been employed by, or received
an offer of employment from, a nursing facility not later than 12
months after successfully completing the NATCEP.
(C) The individual must have been employed by the facility
for no less than six months.
(D) The nursing facility must not have claimed reimbursement
for training expenses for the individual.
(E) The individual must be listed on the current Nurse
Aide Registry.
(8) Individuals must submit cost reimbursement vouchers
to DADS with proof that the individual has been employed by a facility
for no less than six months.
(9) Individuals who leave nursing facility employment
before accruing the required six months of employment, as specified
in paragraph (7)(C) of this subsection, may receive 50% reimbursement
as long as the individual was employed for no less than three months.
(10) Reimbursement to individuals may not exceed the
reimbursement ceiling as detailed in paragraph (1)(A) of this subsection.
(e) Oxygen costs. Oxygen costs incurred on or after
January 1, 1995, will not be reimbursed on cost reimbursement vouchers.
Those oxygen costs must be reported as expenses on the cost report.
(f) TILE to RUG-III Hold Harmless Transition. For rates
effective September 1, 2008, payment rates for the direct care staff
component and the other recipient care component will be updated within
available funds, payment rates for the dietary, general/administration
and fixed capital asset rate components will be equal to the rates
in effect on August 31, 2008 times 1.025, payment rates for the professional
and general liability insurance add-on and the professional-only liability
insurance add-on will be equal to the rates in effect on August 31,
2008 times 1.024, and the payment rate for the general-only liability
insurance add-on will be equal to the rate in effect on August 31,
2008 times 1.018.
(1) To calculate the updated direct care staff per
diem rate component for each of the RUG-III case mix groups and for
the default groups, divide each of the standardized statewide case
mix indexes from subsection (b)(3)(C) of this section by 0.9908, which
is the weighted average TILE case mix index for the 1998 cost reporting
period, multiply each quotient by the statewide average TILE case
mix index for the period beginning the first day of December, 2007
and ending the last day of February, 2008 as represented in the Texas
Department of Aging and Disability Services (DADS) Claims Management
System (CMS) on or around June 1, 2008 and multiply each product by
the average updated direct care staff rate component.
(2) To calculate the updated other recipient care per
diem rate component for each of the RUG-III case mix groups and for
the default groups, divide each of the standardized statewide case
mix indexes from subsection (b)(3)(C) of this section by 1.0267, which
is the weighted average TILE case mix index for the 2005 cost reporting
period, multiply each quotient by the statewide average TILE case
mix index for the period beginning the first day of December, 2007
and ending the last day of February, 2008 as represented in the Texas
Department of Aging and Disability Services (DADS) Claims Management
System (CMS) on or around June 1, 2008 and multiply each product by
the average updated other recipient care rate component.
(3) For state fiscal year 2009 only, for each Medicaid-contracted
nursing facility, HHSC will:
(A) Calculate the sum of the weighted average TILE
direct care staff base rate (with no enhancements) and other recipient
care rate based on the TILE rates for these cost areas in effect on
August 31, 2008 and the facility's approved to be paid days of service
by TILE from January 1, 2008 through June 30, 2008 as represented
in the Texas Department of Aging and Disability Services (DADS) Claims
Management System (CMS) on or around November 3, 2008.
(B) Calculate the sum of the weighted average RUG-III
direct care staff base rate (with no enhancements) and other recipient
care rate based on the RUG rates for these cost areas in effect on
September 1, 2008 and the facility's approved to be paid days of service
by RUG-III for those recipients paid under RUG-III from September
1, 2008 through February 28, 2009 as represented in the DADS CMS on
or around March 31, 2009.
(C) Compare the sum from subparagraph (A) of this paragraph
to the sum from subparagraph (B) of this paragraph. If the sum from
subparagraph (A) is greater then the sum from subparagraph (B), DADS
will pay the facility 80 percent of the difference between the sum
from subparagraph (A) and the sum from subparagraph (B) times the
facility's approved to be paid days of service for those recipients
paid under RUG-III from September 1, 2008 through February 28, 2009
as represented in the DADS CMS on or around March 31, 2009.
(D) Calculate the sum of the weighted average RUG-III
direct care staff base rate (with no enhancements) and other recipient
care rate based on the RUG rates for these cost areas in effect on
September 1, 2008 and the facility's approved to be paid days of service
by RUG-III for those recipients paid under RUG-III from March 1, 2009
through August 31, 2009 as represented in the DADS CMS on or around
September 30, 2009.
(E) Compare the sum from subparagraph (A) of this paragraph
to the sum from subparagraph (D) of this paragraph. If sum from subparagraph
(A) is greater then the sum from subparagraph (D), DADS will pay the
facility 80 percent of the difference between the sum from subparagraph
(A) and the sum from subparagraph (D) times the facility's approved
to be paid days of service for those recipients paid under RUG-III
from March 1, 2009 through August 31, 2009 as represented in the DADS
CMS on or around September 30, 2009.
Cont'd... |
