| facility, HCS OHR
in another setting not listed above, TxHmL in-home DH, TxHmL out-of-home
DH, TxHmL IHR, TxHmL OHR in a respite facility, TxHmL OHR in a setting
where HCS SL/RSS is provided, TxHmL OHR in a setting where HH/CC services
are provided, TxHmL OHR in a camp, TxHmL OHR in a DH facility, and
TxHmL out-of-home respite in another setting not listed above.
(A) For each service, for each LON, determine the percent
of the fully-funded model rate in effect on August 31, 2019 for that
service accruing from attendants. For HCS and TxHmL, the fully-funded
model is the model as calculated under §355.723(d) of this chapter
before any adjustments made in accordance with §355.101 and §355.109
of this subchapter for the rate period.
(B) For each service, for each LON, multiply the percent
of the fully-funded model rate in effect on August 31, 2019 for that
service accruing from attendants from subparagraph (A) of this paragraph
by the total adopted reimbursement rate for that service in effect
on August 31, 2019.
(i) The result is multiplied by 1.044 for HCS in-home
DH, HCS IHR, HCS OHR in a respite facility, HCS OHR in a setting where
HH/CC services are provided, HCS OHR in a camp, and HCS OHR in another
setting.
(ii) The result is multiplied by 1.07 for HCS out-of-home
DH, HCS OHR in a DH facility, and HCS OHR in a setting where HCS SL/RSS
is provided.
(m) Determination of attendant compensation base rate
for participating contracts.
(1) For each of the programs identified in subsection
(a) of this section except for CBA AL/RC, the attendant compensation
base rate is equal to the attendant compensation rate component for
nonparticipating contracts from subsection (l) of this section.
(2) For CBA AL/RC, the attendant compensation base
rate will be determined by taking into consideration quality of care,
labor market conditions, economic factors, and budget constraints.
(n) Determination of attendant compensation rate enhancements.
HHSC will determine a per diem add-on payment for each enhanced attendant
compensation level using data from sources such as cost reports, surveys,
and/or other relevant sources and taking into consideration quality
of care, labor market conditions, economic factors, and budget constraints.
The attendant compensation rate enhancement add-ons will be determined
on a per-unit-of-service basis applicable to each program or service.
Add-on payments may vary by enhancement level.
(o) Enhanced attendant compensation. Contracts or component
codes desiring to participate in the enhanced attendant compensation
rate may request attendant compensation levels from an array of enhanced
attendant compensation options and associated add-on payments determined
in subsection (n) of this section during open enrollment.
(1) ICF/IID providers must select a single attendant
compensation level for all contracts within a component code for the
day habilitation and/or residential services they have selected for
participation.
(2) HCS and TxHmL must select a single attendant compensation
level for all contracts within a component code for the non-day habilitation
and/or day habilitation services they have selected for participation.
(p) Granting attendant compensation rate enhancements.
Eligible programs are divided into two populations for purposes of
granting attendant compensation rate enhancements. The first population
includes the PHC; DAHS; RC; CLASS--DSA; CBA--HCSS; DBMD; CBA--AL/RC;
and ICM AL/RC programs and the second population includes the ICF/IID;
HCS; and TxHmL programs. Enhancements for the two populations are
funded separately; funds intended for enhancements for the first population
of programs will never be used for enhancements for the second population
and funds intended for enhancements for the second population of programs
will never be used for enhancements for the first population. For
each population of programs, HHSC divides all requested enhancements,
after applying any enrollment limitations from subsection (u) of this
section, into two groups: pre-existing enhancements, which providers
request to carry over from the prior year, and newly-requested enhancements.
Newly-requested enhancements may be enhancements requested by providers
who were nonparticipants in the prior year or by providers who were
participants in the prior year who seek additional enhancements. Using
the process described herein separately for each population of programs,
HHSC first determines the distribution of carry-over enhancements.
If funds are available after the distribution of carry-over enhancements,
HHSC determines the distribution of newly-requested enhancements.
HHSC may not distribute newly-requested enhancements to providers
owing funds identified for recoupment under subsection (s) of this
section.
(1) For all programs and levels except for CBA AL/RC
Level 1, HHSC determines projected units of service for contracts
and/or component codes requesting each enhancement level and multiplies
this number by the enhancement rate add-on amount associated with
that enhancement level as determined in subsection (n) of this section.
For CBA AL/RC Level 1, HHSC determines projected units of service
for CBA AL/RC contracts requesting Level 1 and multiplies this number
by the sum of the difference between the base rate and the nonparticipant
rate and the enhancement add-on amount associated with enhancement
Level 1 as follows: (Base Rate - Nonparticipant Rate) + Level 1 add-on
amount.
(2) HHSC compares the sum of the products from paragraph
(1) of this subsection to available funds.
(A) If the sum of the products is less than or equal
to available funds, all requested enhancements are granted.
(B) If the sum of the products 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 compensation levels and compensation needs,
HHSC may grant certain enhancement options priority for distribution.
(q) Notification of granting of enhancements. Participating
contracts and component codes are notified, in a manner determined
by HHSC, as to the disposition of their request for attendant compensation
rate enhancements.
(r) Total attendant compensation rate for participating
providers. Each participating provider's total attendant compensation
rate will be equal to the attendant compensation base rate from subsection
(m) of this section plus any add-on payments associated with enhanced
attendant compensation levels selected by and awarded to the provider
during open enrollment.
(s) Spending requirements for participating contracts
and component codes. HHSC will determine from the Attendant Compensation
Report or cost report functioning as an Attendant Compensation Report,
as specified in subsection (h) of this section and other appropriate
data sources, the amount of attendant compensation spending per unit
of service delivered. The provider's compliance with the spending
requirement is determined based on the total attendant compensation
spending as reported on the Attendant Compensation Report or cost
report functioning as an Attendant Compensation Report for each participating
contract or component code. Compliance with the spending requirement
is determined separately for each program specified in subsection
(a) of this section, except for providers delivering both RC and CBA
AL/RC services in the same facility whose compliance is determined
by combining both programs and providers delivering services in both
the HCS and TxHmL programs whose compliance is determined by combining
both programs. HHSC will calculate recoupment, if any, as follows.
(1) The accrued attendant compensation revenue per
unit of service is multiplied by 0.90 to determine the spending requirement
per unit of service. The accrued attendant compensation spending per
unit of service will be subtracted from the spending requirement per
unit of service to determine the amount to be recouped. If the accrued
attendant compensation spending per unit of service is greater than
or equal to the spending requirement per unit of service, there is
no recoupment.
(2) The amount paid for attendant compensation per
unit of service after adjustments for recoupment must not be less
than the amount determined for nonparticipating contracts or component
codes in subsection (l) of this section.
(3) In cases where more than one enhancement level
is in effect during the reporting period, the spending requirement
will be based on the weighted average enhancement level in effect
during the reporting period calculated as follows:
(A) Multiply the first enhancement level in effect
during the reporting period by the most recently available, reliable
Medicaid units of service utilization data for the time period the
first enhancement level was in effect.
(B) Multiply the second enhancement level in effect
during the reporting period by the most recently available, reliable
Medicaid units of service utilization data for the time period the
second enhancement level was in effect.
Cont'd... |
