| (iii) Sum the products from clauses (i) and (ii) of
this subparagraph.
(iv) Divide the sum from clause (iii) of this subparagraph
by the sum of the most recently available, reliable Medicaid days
of service utilization data for the entire reporting period used in
clauses (i) and (ii) of this subparagraph.
(2) Enhanced staffing levels. Facilities desiring to
participate in the enhanced direct care staff rate are required to
staff above the minimum requirements from paragraph (1) of this subsection.
These facilities may request LVN-equivalent staffing enhancements
from an array of LVN-equivalent enhanced staffing options and associated
add-on payments during open enrollment under subsection (d) of this
section.
(3) Granting of staffing enhancements. HHSC divides
all requested enhancements, after applying any enrollment limitations
from subsection (i) of this section, into two groups: pre-existing
enhancements that facilities request to carry over from the prior
year and newly-requested enhancements. Newly-requested enhancements
may be enhancements requested by facilities that were nonparticipants
in the prior year or by facilities that were participants in the prior
year desiring to be granted additional enhancements. Using the process
described herein, HHSC first determines the distribution of carry-over
enhancements. If HHSC determines that funds are not available to carry
over some or all pre-existing enhancements, facilities will be notified
as per subsection (ee) of this section. If funds are available after
the distribution of carry-over enhancements, HHSC then determines
the distribution of newly requested enhancements. HHSC may not distribute
newly requested enhancements to facilities owing funds identified
for recoupment from subsections (n) and/or (o) of this section.
(A) HHSC determines projected Medicaid units of service
for facilities requesting each enhancement option, and multiplies
this number by the rate add-on associated with that enhancement option
as determined in subsection (l) of this section.
(B) HHSC compares the sum of the products from subparagraph
(A) of this paragraph to available funds.
(i) If the product is less than or equal to available
funds, all requested enhancements are granted.
(ii) If the product is greater than available funds,
enhancements are granted beginning with the lowest level of enhancement
and granting each successive level of enhancement until requested
enhancements are granted within available funds. Based upon an examination
of existing staffing levels and staffing needs, HHSC may grant certain
enhancement options priority for distribution.
(4) Notification of granting of enhancements. Participating
facilities are notified, in a manner determined by HHSC, as to the
disposition of their request for staffing enhancements.
(5) In cases where more than one enhanced staffing
level is in effect during the reporting period, the staffing requirement
will be based on the weighted average enhanced staffing level in effect
during the reporting period calculated as follows:
(A) Multiply the first enhanced staffing level in effect
during the reporting period by the most recently available, reliable
Medicaid days of service utilization data for the time period the
first enhanced staffing level was in effect.
(B) Multiply the second enhanced staffing level in
effect during the reporting period by the most recently available,
reliable Medicaid days of service utilization data for the time period
the second enhanced staffing level was in effect.
(C) Sum the products from subparagraphs (A) and (B)
of this paragraph.
(D) Divide the sum from subparagraph (C) of this paragraph
by the sum of the most recently available, reliable Medicaid days
of service utilization data for the entire reporting period used in
subparagraphs (A) and (B) of this paragraph.
(k) Determination of direct care staff base rate.
(1) Determine the sum of recipient care costs from
the direct care staff cost center in subsection (a) of this section
in all nursing facilities included in the Texas Nursing Facility Cost
Report database used to determine the nursing facility rates in effect
on January 1, 2000 (hereinafter referred to as the initial database).
(2) Adjust the sum from paragraph (1) of this subsection
as specified in §355.108 of this title (relating to Determination
of Inflation Indices) to inflate the costs to the prospective rate
year.
(3) Divide the result from paragraph (2) of this subsection
by the sum of recipient days of service in all facilities in the initial
database and multiply the result by 1.07. The result is the average
direct care staff base rate component for all facilities.
(4) For rates effective September 1, 2009 and thereafter,
to calculate the direct care staff per diem base rate component for
all facilities for each of the RUG-III case mix groups and for the
default groups, divide each RUG-III index from §355.307(b)(3)(C)
of this title (relating to Reimbursement Setting Methodology) by 0.9908,
which is the weighted average Texas Index for Level of Effort (TILE)
case mix index associated with the initial database, and then multiply
each of the resulting quotients by the average direct care staff base
rate component from paragraph (3) of this subsection.
(5) The direct care staff per diem base rates will
remain constant except for adjustments for inflation from paragraph
(2) of this subsection. HHSC may also recommend adjustments to the
rates in accordance with §355.109 of this title (relating to
Adjusting Reimbursement When New Legislation, Regulations, or Economic
Factors Affect Costs).
(l) Determine each participating facility's total direct
care staff rate. Each participating facility's total direct care staff
rate will be equal to the direct care staff base rate from subsection
(k) of this section plus any add-on payments associated with enhanced
staffing levels selected by and awarded to the facility during open
enrollment. HHSC will determine a per diem add-on payment for each
enhanced staffing level taking into consideration the most recently
available, reliable data relating to LVN equivalent compensation levels.
(m) Staffing requirements for participating facilities.
Each participating facility will be required to maintain adjusted
LVN-equivalent minutes equal to those determined in subsection (j)
of this section. Each participating facility's adjusted LVN-equivalent
minutes maintained during the reporting period will be determined
as follows.
(1) Determine unadjusted LVN-equivalent minutes maintained.
Upon receipt of the staffing and spending information described in
subsection (f) of this section, HHSC will determine the unadjusted
LVN-equivalent minutes maintained by each facility during the reporting
period.
(2) Determine adjusted LVN-equivalent minutes maintained.
Compare the unadjusted LVN-equivalent minutes maintained by the facility
during the reporting period from paragraph (1) of this subsection
to the LVN-equivalent minutes required of the facility as determined
in subsection (j) of this section. The adjusted LVN-equivalent minutes
are determined as follows:
(A) If the number of unadjusted LVN-equivalent minutes
maintained by the facility during the reporting period is greater
than or equal to the number of LVN-equivalent minutes required for
the facility or less than the minimum LVN-equivalent minutes required
for participation as determined in subsection (j)(1) of this section;
the facility's adjusted LVN-equivalent minutes maintained is equal
to its unadjusted LVN-equivalent minutes; or
(B) If the number of unadjusted LVN-equivalent minutes
maintained by the facility during the reporting period is less than
the number of LVN-equivalent minutes required of the facility, but
greater than or equal to the minimum LVN-equivalent minutes required
for participation as determined in subsection (j)(1) of this section,
the following steps are performed.
(i) Determine what the facility's accrued Medicaid
fee-for-service direct care revenue for the reporting period would
have been if their staffing requirement had been set at a level consistent
with the highest LVN-equivalent minutes that the facility actually
maintained, as defined in subsection (j) of this section.
(ii) Determine the facility's adjusted accrued direct
care revenue by multiplying the accrued direct care revenue from clause
(i) of this subparagraph by 0.85.
(iii) Determine the facility's accrued allowable Medicaid
fee-for-service direct care staff expenses for the rate year.
(iv) Determine the facility's direct care spending
surplus for the reporting period by subtracting the facility's adjusted
accrued direct care revenue from clause (ii) of this subparagraph
from the facility's accrued allowable direct care expenses from clause
(iii) of this subparagraph.
Cont'd... |
