| (F) 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 August 31, 2009, as represented in the DADS CMS on
or around January 4, 2010.
(G) Compare the sum from subparagraph (A) of this paragraph
to the sum from subparagraph (F) of this paragraph.
(i) If the sum from subparagraph (A) is greater than
the sum from subparagraph (F), determine the difference between the
sum from subparagraph (A) and the sum from subparagraph (F) times
the facility's approved to be paid days of service for those recipients
paid under RUG-III from September 1, 2008, through August 31, 2009,
as represented in the DADS CMS on or around January 4, 2010, and subtract
the hold harmless payments made under subparagraphs (C) and (E) from
the product calculated in this clause.
(I) If the result is a positive number, DADS will pay
the facility the difference.
(II) If the result is a negative number, DADS will
recoup the difference from the facility.
(ii) If the sum from subparagraph (A) is less than
the sum from subparagraph (F) and the facility received a hold harmless
payment under subparagraph (C) and/or (E), DADS will recoup from the
facility the hold harmless payments made under these subparagraphs.
(4) "On or around" as used in this subsection means
the date that the state pulls the information as described in the
subsection as close to the dates specified in subsection as feasible
and determined by the state. Once the state does the data pull, no
other pulls will be made for the purpose of calculating the values
described in this subsection. This means that once the paid days of
service for a paragraph have been determined for purposes of calculating
the TILE to RUG-III hold harmless transition, they will not be updated
for late Minimum Data Set (MDS) submissions, Utilization Review RUG-III
changes, retroactive eligibility or any other reason.
|
| Source Note: The provisions of this §355.307 adopted to be effective May 1, 2000, 25 TexReg 3517; amended to be effective September 1, 2001, 26 TexReg 6296; amended to be effective February 26, 2002, 27 TexReg 1311; amended to be effective September 1, 2003, 28 TexReg 7306; amended to be effective January 9, 2005, 29 TexReg 12121; amended to be effective August 21, 2008, 33 TexReg 6569; amended to be effective July 29, 2009, 34 TexReg 4857; amended to be effective September 1, 2013, 38 TexReg 5434; amended to be effective January 25, 2015, 40 TexReg 325 |
