| (v) If the facility's direct care spending surplus
from clause (iv) of this subparagraph is less than or equal to zero,
the facility's adjusted LVN-equivalent minutes maintained is equal
to the unadjusted LVN-equivalent minutes maintained as calculated
in paragraph (1) of this subsection.
(vi) If the facility's direct care spending surplus
from clause (iv) of this subparagraph is greater than zero, the adjusted
LVN-equivalent minutes maintained by the facility during the reporting
period is set equal to the facility's direct care spending surplus
from clause (iv) of this subparagraph divided by the per diem enhancement
add-on as determined in subsection (l) of this section plus the unadjusted
LVN-equivalent minutes maintained by the facility during the reporting
period from paragraph (1) of this subsection according to the following
formula: (Direct Care Spending Surplus/Per Diem Enhancement Add-on
for One LVN-equivalent Minute) + Unadjusted LVN-equivalent Minutes.
(C) For adjusted LVN-equivalent minutes calculated
on or after March 1, 2004, requirements relating to the minimum LVN-equivalent
minutes required for participation in subparagraphs (A) and (B) of
this paragraph do not apply.
(n) Staffing accountability. Participating facilities
will be responsible for maintaining the staffing levels determined
in subsection (j) of this section. HHSC will determine the adjusted
LVN-equivalent minutes maintained by each facility during the reporting
period by the method described in subsection (m) of this section.
HHSC or its designee will recoup all direct care staff revenues associated
with unmet staffing goals from participating facilities that fail
to meet their staffing requirements during the reporting period.
(o) Spending requirements for participants. Participating
facilities are subject to a direct care staff spending requirement
with recoupment calculated as follows:
(1) At the end of the rate year, a spending floor will
be calculated by multiplying accrued Medicaid fee-for-service direct
care staff revenues (net of revenues recouped by HHSC or its designee
due to the failure of the facility to meet a staffing requirement
as per subsection (n) of this section) by 0.85.
(2) Accrued allowable Medicaid direct care staff fee-for-service
expenses for the rate year will be compared to the spending floor
from paragraph (1) of this subsection. HHSC or its designee will recoup
the difference between the spending floor and accrued allowable Medicaid
direct care staff fee-for-service expenses from facilities whose Medicaid
direct care staff spending is less than their spending floor.
(3) At no time will a participating facility's direct
care rates after spending recoupment be less than the direct care
base rates.
(p) Dietary and Fixed Capital Mitigation. Recoupment
of funds described in subsection (o) of this section may be mitigated
by high dietary and/or fixed capital expenses as follows.
(1) Calculate dietary cost deficit. At the end of the
facility's rate year, accrued Medicaid dietary per diem revenues will
be compared to accrued, allowable Medicaid dietary per diem costs.
If costs are greater than revenues, the dietary per diem cost deficit
will be equal to the difference between accrued, allowable Medicaid
dietary per diem costs and accrued Medicaid dietary per diem revenues.
If costs are less than revenues, the dietary cost deficit will be
equal to zero.
(2) Calculate dietary revenue surplus. At the end of
the facility's rate, accrued Medicaid dietary per diem revenues will
be compared to accrued, allowable Medicaid dietary per diem costs.
If revenues are greater than costs, the dietary per diem revenue surplus
will be equal to the difference between accrued Medicaid dietary per
diem revenues and accrued, allowable Medicaid dietary per diem costs.
If revenues are less than costs, the dietary revenue surplus will
be equal to zero.
(3) Calculate fixed capital cost deficit. At the end
of the facility's rate year, accrued Medicaid fixed capital per diem
revenues will be compared to accrued, allowable Medicaid fixed capital
per diem costs as defined in §355.306(b)(2)(A) of this title
(relating to Cost Finding Methodology). If costs are greater than
revenues, the fixed capital cost per diem deficit will be equal to
the difference between accrued, allowable Medicaid fixed capital per
diem costs and accrued Medicaid fixed capital per diem revenues. If
costs are less than revenues, the fixed capital cost deficit will
be equal to zero. For purposes of this paragraph, fixed capital per
diem costs of facilities with occupancy rates below 85% are adjusted
to the cost per diem the facility would have accrued had it maintained
an 85% occupancy rate throughout the rate year.
(4) Calculate fixed capital revenue surplus. At the
end of the facility's rate year, accrued Medicaid fixed capital per
diem revenues will be compared to accrued, allowable Medicaid fixed
capital per diem costs as defined in §355.306(b)(2)(A) of this
title. If revenues are greater than costs, the fixed capital revenue
per diem surplus will be equal to the difference between accrued Medicaid
fixed capital per diem revenues and accrued, allowable Medicaid fixed
capital per diem costs. If revenues are less than costs, the fixed
capital revenue surplus will be equal to zero. For purposes of this
paragraph, fixed capital per diem costs of facilities with occupancy
rates below 85% are adjusted to the cost per diem the facility would
have accrued had it maintained an 85% occupancy rate throughout the
rate year.
(5) Facilities with a dietary per diem cost deficit
will have their dietary per diem cost deficit reduced by their fixed
capital per diem revenue surplus, if any. Any remaining dietary per
diem cost deficit will be capped at $2.00 per diem.
(6) Facilities with a fixed capital cost per diem deficit
will have their fixed capital cost per diem deficit reduced by their
dietary revenue per diem surplus, if any. Any remaining fixed capital
per diem cost deficit will be capped at $2.00 per diem.
(7) Each facility's recoupment, as calculated in subsection
(o) of this section, will be reduced by the sum of that facility's
dietary per diem cost deficit as calculated in paragraph (5) of this
subsection and its fixed capital per diem cost deficit as calculated
in paragraph (6) of this subsection.
(q) Adjusting staffing requirements. Facilities that
determine that they will not be able to meet their staffing requirements
from subsection (m) of this section may request a reduction in their
staffing requirements and associated rate add-on. These requests will
be effective on the first day of the month following approval of the
request.
(r) Voluntary withdrawal. Facilities wishing to withdraw
from participation must notify HHSC in writing by certified mail and
the request must be signed by an authorized representative as designated
per the DADS signature authority designation form applicable to the
provider's contract or ownership type. Facilities voluntarily withdrawing
must remain nonparticipants for the remainder of the rate year. Facilities
that voluntarily withdraw from participation will have their participation
end effective on the date of the withdrawal, as determined by HHSC.
(s) Notification of recoupment based on Annual Staffing
and Compensation Report or cost report and request for recalculation.
(1) Notification of recoupment. The estimated amount
to be recouped is indicated in STAIRS. STAIRS will generate an e-mail
to the entity contact, indicating that the facility's estimated recoupment
is available for review. If a subsequent review by HHSC or audit results
in adjustments to the Annual Staffing and Compensation Report or cost
report as described in subsection (f) of this section that changes
the amount to be repaid to HHSC or its designee, the facility will
be notified by e-mail to the entity contact that the adjustments and
the adjusted amount to be repaid are available in STAIRS for review.
HHSC or its designee will recoup any amount owed from a facility's
vendor payment(s) following the date of the initial or subsequent
notification.
(2) Request for recalculation. Providers notified of
a recoupment based on an Annual Staffing and Compensation Report described
in subsection (f)(2)(A) or (f)(2)(F) of this section may request that
HHSC recalculate their recoupment after combining the Annual Staffing
and Compensation Report with the provider's next cost report or Staffing
and Compensation Report, as appropriate. The request must be received
by HHSC Rate Analysis no later than 30 days after the date on the
e-mail notification of recoupment. If the 30th calendar day is a weekend
day, national holiday, or state holiday, then the first business day
following the 30th calendar day is the final day the receipt of the
request will be accepted.
(A) The request must be made by e-mail to the e-mail
address specified in STAIRS, by hand delivery, United States (U.S.)
mail, or special mail delivery. An e-mail request must be typed on
the provider's letterhead, signed by a person indicated in subparagraph
(B) of this paragraph, then scanned and sent by e-mail to HHSC.
Cont'd... |
