| to the middle of each year of the biennium.
(k) For the SFY 2004 through 2005, DFPS determines
payment rates using the rates determined for SFY 2002 and 2003 from
subsections (a) - (h) of this section, with adjustments for the transition
from a six level of care system to a four service level system of
payment rates.
(l) For the state fiscal year 2006 through 2007 biennium,
the 2005 payment rates in effect on August 31, 2005 will be adjusted
by equal percentages based on a prorata distribution of additional
appropriated funds.
(m) For the state fiscal year 2008 through 2009 biennium,
rates are paid for each level of service identified by the DFPS. For
foster homes, the payments effective September 1, 2007 through August
31, 2009 for each level of service will be equal to the minimum rate
paid to foster homes for that level of service in effect August 31,
2007 plus 4.3 percent. For Child Placing Agencies (CPAs), the rates
effective September 1, 2007, through August 31, 2009 for each level
of service will be equal to the rate paid to CPAs for that level of
service in effect August 31, 2007, plus 4.3 percent. Additional appropriated
funds remaining after the rate increase for foster homes and CPAs
shall be distributed proportionally across general residential operations
and residential treatment centers based on each of these provider
type's ratio of costs as reported on the most recently audited cost
report to existing payment rates.
(n) HHSC may adjust payment rates, if determined appropriate,
when federal or state laws, rules, standards, regulations, policies,
or guidelines are changed or adopted. These adjustments may result
in increases or decreases in payment rates. Providers must be informed
of the specific law, rule, standard, regulation, policy or guideline
change and be given the opportunity to comment on any rate adjustment
resulting from the change prior to the actual payment rate adjustment.
(o) To implement Chapter 1022 of the Acts of the 75th
Texas Legislature, §103, the executive director may develop and
implement one or more pilot competitive procurement processes to purchase
substitute care services, including foster family care services and
specialized substitute care services. The pilot programs must be designed
to produce a substitute care system that is outcome-based and that
uses outcome measures. Rates for the pilot(s) will be the result
of the competitive procurement process, but must be found to be reasonable
by the executive director. Rates are subject to adjustment as allowed
in subsections (a) and (m) of this section.
(p) Payment rates for psychiatric step-down services
are determined on a pro forma basis in accordance with §355.105(h)
of this chapter. Payment rates for psychiatric step-down services
effective September 1, 2017, will be equal to the rates in effect
on August 31, 2015.
(q) Definitions.
(1) Child-placing agency (CPA)--Child-placing agencies
as defined in 40 Texas Administrative Code (TAC) §745.21.
(2) Community-based Care--Community-based Care as
defined in 40 TAC §700.108.
(3) CPA retainage--The portion of the rate that includes
the CPA's costs for administering the service, including, but not
limited to recruiting and training foster families, matching children
with foster families, monitoring foster families and foster homes,
and the associated overhead costs.
(4) Emergency Care Services--Emergency care services
as defined in 40 TAC §748.61.
(5) Foster home--Foster home as defined in 40 TAC §749.43
and §750.43.
(6) General Residential Operation (GRO)--General residential
operations as defined in 40 TAC §748.43.
(7) Integrated Care Coordination (ICC)--Integrated
Care Coordination as defined in 40 TAC §700.110.
(8) Levels of service--Levels of service as described
in 40 TAC Chapter 700, Subchapter W.
(9) Residential Treatment Center (RTC)--Residential
treatment center as defined in 40 TAC §748.43.
(10) Temporary Emergency Placement (TEP)--Temporary
Emergency Placement as defined in 40 TAC §700.1337.
(11) Treatment Foster Care (TFF)--Treatment Foster
Care as defined in 40 TAC §700.1335.
(r) Rates effective September 1, 2015. Rates are paid
for each level of service identified by DFPS.
(1) For CPAs, the rate consists of a foster home payment
described in paragraph (2) of this subsection and a CPA retainage.
Effective September 1, 2015, the CPA retainage for each level of service
will be equal CPA retainage for that level of service in effect August
31, 2015:
(A) plus 9.39 percent for the basic level of service;
(B) plus 1.14 percent for the moderate level of service;
(C) plus 0.42 percent for the specialized level of
service; and
(D) plus 0.01 percent for the intense level of service.
(2) For foster homes, the minimum daily rate to be
paid to a foster home effective September 1, 2015, for each level
of service will be equal to the rate for that level of service in
effect August 31, 2015.
(3) For GROs and RTCs, the rates effective September
1, 2015, will be equal to the rates paid to GROs and RTCs in effect
August 31, 2015:
(A) plus 9.58 percent for the specialized level of
service;
(B) plus 0.3 percent for the intense level of service;
and
(C) unchanged for other levels of service.
(4) For emergency care services the rates effective
September 1, 2015, will be equal to the rates in effect August 31,
2015, plus 6.0 percent.
(s) Rates effective September 1, 2017. Rates are paid
for each level of service identified by DFPS.
(1) For CPAs, the rate consists of a foster home payment
described in paragraph (2) of this subsection and a CPA retainage.
Effective September 1, 2017, the combined CPA retainage and foster
home payment for each level of service will be:
(A) $48.47 for the basic level of service;
(B) $85.46 for the moderate level of service;
(C) $109.08 for the specialized level of service; and
(D) $186.42 for the intense level of service.
(2) For foster homes, the minimum daily rate to be
paid to a foster home effective September 1, 2017, for each level
of service will be:
(A) $27.07 for the basic level of service;
(B) $47.37 for the moderate level of service;
(C) $57.86 for the specialized level of service; and
(D) $92.43 for the intense level of service.
(3) For GROs and RTCs, the rates effective September
1, 2017, will be:
(A) $45.19 for the basic level of service;
(B) $103.03 for the moderate level of service;
(C) $197.69 for the specialized level of service;
(D) $277.37 for the intense level of service; and
(E) $400.72 for the intense plus level of service.
(4) For emergency care services, the rate effective
September 1, 2017, will be $129.53.
(5) For treatment foster care, the rate effective September
1, 2017, will be $277.37.
(t) Community-based Care.
(1) Initial payment rates for a defined rate period
for Single Source Continuum Contractors under Community-based Care
are determined on a pro forma basis in accordance with §355.105(h)
of this chapter using the official forecast of case mix for paid foster
care for each specific catchment area for the rate period available
at the time the payment rates are calculated.
(2) HHSC will recalculate payments rates whenever a
new official forecast of case mix for paid foster care is available.
(3) HHSC will compare the payment rates calculated
using actual paid foster care case mix data for each catchment area
to the payment rates in place for the rate period to determine the
percentage difference between the two sets of payment rates.
(4) If the payment rates calculated using actual paid
foster care case mix data for a catchment area are at least 1% greater
than the initial payment rates for the rate period, HHSC will increase
the catchment area payment rates.
(5) If the payment rates calculated using actual paid
foster care case mix for a catchment area are at least 1% less than
the initial payment rates for the rate period, HHSC will reduce the
catchment area payment rates;
(6) Calculations and rate adjustments, if any, will
be performed separately for each catchment area.
(u) Treatment Foster Family, Integrated Care Coordination
Placement, Integrated Care Coordination Case Management, and Temporary
Emergency Placement.
(1) The payment rates for these services are developed
based on rates determined for other programs that provide similar
services. If payment rates are not available from other programs that
provide similar services, payment rates are determined using a pro
forma approach in accordance with §355.105(h) of this chapter.
The information in §355.101 of this chapter (relating to Introduction)
and §355.105(g) of this chapter also applies.
(2) Reporting of cost. To gather adequate financial
and statistical information upon which to base reimbursement, HHSC
may require a contracted provider to submit a cost report for one
or more of these services.
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| Source Note: The provisions of this §700.1753 adopted to be effective September 13, 2001, 26 TexReg 6962; transferred effective September 1, 2004, as published in the Texas Register September 17, 2004, 29 TexReg 9014; amended to be effective November 27, 2005, 30 TexReg 7723; amended to be effective September 1, 2007, 32 TexReg 5342; amended to be effective September 1, 2009, 34 TexReg 5659; amended to be effective August 31, 2010, 35 TexReg 7726; amended to be effective September 1, 2011, 36 TexReg 5334;amended to be effective September 1, 2013, 38 TexReg 5436;amendedtobe effective September 1, 2015, 40 TexReg 5302; amended to be effective June 11, 2017, 42 TexReg 3001; amended to be effective August 30, 2017, 42 TexReg 4275; transferred effective November 15, 2017, as published in the Texas Register November 3, 2017, 42 TexReg 6201 |
