| this section. These
facilities must still submit a cost report covering the entire cost
reporting period. The cost report will not be used for determining
any recoupment amounts.
(G) A participating provider that is required to submit
a cost report or Attendant Compensation Report under this paragraph
will be excused from the requirement to submit a report if the provider
did not provide any billable services to DADS recipients during the
reporting period.
(3) Other reports. HHSC may require other Staffing
and Compensation Reports from all facilities as needed.
(4) Vendor hold. HHSC or its designee will place on
hold the vendor payments for any participating facility that does
not submit a timely report as described in paragraph (1) of this subsection,
or for services delivered on or after September 1, 2009, a timely
report as described in paragraph (2) of this subsection completed
in accordance with all applicable rules and instructions. This vendor
hold will remain in effect until HHSC receives an acceptable report.
(A) Participating facilities that do not submit an
acceptable report completed in accordance with all applicable rules
and instructions within 60 days of the due dates described in this
subsection or, for cost reports, the due dates described in §355.105(b)
of this title, will become nonparticipants retroactive to the first
day of the reporting period in question and will be subject to an
immediate recoupment of funds related to participation paid to the
facility for services provided during the reporting period in question.
These facilities will remain nonparticipants and recouped funds will
not be restored until they submit an acceptable report and repay to
HHSC, or its designee, funds identified for recoupment from subsections
(n) and/or (o) of this section. If an acceptable report is not received
within 365 days of the due date, the recoupment will become permanent
and, if all funds associated with participation during the reporting
period in question have been recouped by HHSC or its designee, the
vendor hold associated with the report will be released.
(B) Participating facilities with an ownership change
or contract termination that do not submit an acceptable report completed
in accordance with all applicable rules and instructions within 60
days of the change in ownership or contract termination will become
nonparticipants retroactive to the first day of the reporting period
in question and will be subject to an immediate recoupment of funds
related to participation paid to the facility for services provided
during the reporting period in question. These facilities will remain
nonparticipants and recouped funds will not be restored until they
submit an acceptable report and repay to HHSC or its designee funds
identified for recoupment from subsections (n) and/or (o) of this
section. If an acceptable report is not received within 365 days of
the change of ownership or contract termination date, the recoupment
will become permanent and if all funds associated with participation
during the reporting period in question have been recouped by HHSC
or its designee, the vendor hold associated with the report will be
released.
(5) Provider-initiated amended accountability reports
and cost reports functioning as Staffing and Compensation Reports.
Reports must be received prior to the date the provider is notified
of compliance with spending and/or staffing requirements for the report
in question as per subsections (n) and/or (o) of this section.
(g) Report contents. Annual Staffing and Compensation
Reports and cost reports functioning as Staffing and Compensation
Reports will include any information required by HHSC to implement
this enhanced direct care staff rate.
(h) Completion of Reports. All Staffing and Compensation
Reports and cost reports functioning as Staffing and Compensation
Reports must be completed in accordance with the provisions of §§355.102
- 355.105 of this title (relating to General Principles of Allowable
and Unallowable Costs; Specifications for Allowable and Unallowable
Costs; Revenues; and General Reporting and Documentation Requirements,
Methods, and Procedures) and may be reviewed or audited in accordance
with §355.106 of this title (relating to Basic Objectives and
Criteria for Audit and Desk Review of Cost Reports). Beginning with
the state fiscal year 2002 report, all Staffing and Compensation Reports
and cost reports functioning as Staffing and Compensation Reports
must be completed by preparers who have attended the required nursing
facility cost report training as per §355.102(d) of this title.
(i) Enrollment limitations. A facility will not be
enrolled in the enhanced direct care staff rate at a level higher
than the level it achieved on its most recently available, audited
Staffing and Compensation Report or cost report functioning as its
Staffing and Compensation Report. HHSC will notify a facility of its
enrollment limitations (if any) prior to the first day of the open
enrollment period.
(1) Notification of enrollment limitations. The enrollment
limitation level is indicated in the State of Texas Automated Information
Reporting System (STAIRS), the online application for submitting cost
reports and accountability reports. STAIRS will generate an e-mail
to the entity contact, indicating that the facility's enrollment limitation
level is available for review. The entity contact is the provider's
authorized representative per the signature authority designation
form applicable to the provider's contract or ownership type.
(2) Requests for revision. A facility may request a
revision of its enrollment limitation if the facility's most recently
available, audited Staffing and Compensation Report or cost report
functioning as its Staffing and Compensation Report does not represent
its current staffing levels.
(A) A request for revision of enrollment limitation
must include the documentation specified in subparagraph (B) of this
paragraph and must be received by HHSC Rate Analysis no later than
the deadline indicated in the notification of open enrollment specified
in subsection (c). A request for revision that is not received by
the stated deadline will not be accepted and the enrollment limitation
specified in STAIRS will apply.
(B) A facility that requests a revision of its enrollment
limitation must submit documentation that shows that, for the period
beginning September 1 of the current rate year and ending April 30
of the current rate year, the facility met a higher staffing level
than STAIRS indicates. In such cases, the facility's enrollment limitation
will be established at the level supported by its request for revision
documentation. It is the responsibility of the provider to render
all required documentation at the time of its request for revision.
Requests that fail to support a staffing level different than indicated
in STAIRS will result in a rejection of the request and the enrollment
limitation specified in STAIRS will apply.
(C) A request for revision must be signed by an individual
legally responsible for the conduct of the provider or legally authorized
to bind the facility, such as the sole proprietor, a partner, a corporate
officer, an association officer, a governmental official, a limited
liability company member, a person authorized by the applicable DADS
signature authority designation form for the interested party on file
at the time of the request, or a legal representative for the interested
party. A request for revision that is not signed by an individual
legally responsible for the conduct of the interested party will not
be accepted and the enrollment limitation specified in STAIRS will
apply.
(D) If the facility's Staffing and Compensation Report
or cost report functioning as its Staffing and Compensation Report
for the rate year that included the open enrollment period described
in subsection (d) of this section shows the facility staffed below
the level it presented in its request for revision, HHSC will immediately
recoup all enhancement payments associated with the request for revision
documents and the facility will be limited to the level supported
by the report for the remainder of the rate year.
(E) At no time will a facility be allowed to enroll
in the enhancement program at a level higher than its current level
of enrollment plus three additional levels unless otherwise instructed
by HHSC Rate Analysis.
(3) New owners after a change of ownership. Enhancement
levels for a new owner after a change of ownership will be determined
in accordance with subsection (y) of this section. A new owner will
not be subject to enrollment limitations based upon the prior owner's
performance. This exemption from enrollment limitations does not apply
in cases where HHSC or its designee has approved a successor-liability-agreement
that transfers responsibility from the former owner to the new owner.
Cont'd... |
