| represent a statistically valid sample of participating
providers.
(C) The Attendant Compensation Report must be submitted
for each participating contract if the provider requested participation
individually for each contract; or, if the provider requested participation
as a group, the report must be submitted as a single aggregate report
covering all contracts participating at the end of the rate year within
one program of the provider. A participating contract that has been
terminated in accordance with subsection (w) of this section or that
has undergone a contract assignment in accordance with subsection
(x) of this section will be considered to have participated on an
individual basis for compliance with reporting requirements for the
owner prior to the termination or contract assignment.
(D) If required to submit a report by HHSC, contracted
providers failing to submit an acceptable annual Attendant Compensation
Report within 60 days of the end of the rate year will be placed on
vendor hold until such time as an acceptable report is received and
processed by HHSC.
(E) When a participating provider changes ownership
through a contract assignment, the prior owner may be required to
submit an Attendant Compensation Report covering the period from the
beginning of the rate year to the effective date of the contract assignment
as determined by HHSC, or its designee. If required, this report will
be used as the basis for determining any recoupment amounts as described
in subsection (t) of this section. The new owner may be required to
submit an Attendant Compensation Report covering the period from the
day after the date recognized by HHSC, or its designee, as the contract-assignment
effective date to the end of the rate year.
(F) Participating providers whose contracts are terminated
voluntarily or involuntarily may be required to submit an Attendant
Compensation Report covering the period from the beginning of the
rate year to the date recognized by HHSC or its designee as the contract
termination date. If required, this report will be used as the basis
for determining recoupment as described in subsection (t) of this
section.
(G) Participating providers who voluntarily withdraw
from participation, as described in subsection (y) of this section,
may be required to submit an Attendant Compensation Report within
60 days from the date of withdrawal as determined by HHSC. If required,
this report must cover the period from the beginning of the rate year
through the date of withdrawal as determined by HHSC and will be used
as the basis for determining any recoupment amounts as described in
subsection (t) of this section.
(H) Participating providers whose cost report year,
as defined in §355.105(b)(5) of this subchapter (relating to
General Reporting and Documentation Requirements, Methods, and Procedures),
coincides with the state of Texas fiscal year, are exempt from the
requirement to submit a separate Attendant Compensation Report. For
these contracts, their cost report will be considered their Attendant
Compensation Report.
(3) Cost Reports. Cost reports as described in §355.105(b)
- (c) of this subchapter will serve as the Attendant Compensation
Report with the following exceptions.
(A) When a participating provider changes ownership
through a contract assignment or change of ownership, the previous
owner may be required to submit an Attendant Compensation Report covering
the period from the beginning of the provider's cost reporting period
to the date recognized by HHSC, or its designee, as the contract-assignment
or ownership-change effective date. If required, this report will
be used as the basis for determining any recoupment amounts as described
in subsection (t) of this section. The new owner may be required to
submit a cost report covering the period from the day after the date
recognized by HHSC or its designee as the contract-assignment or ownership-change
effective date to the end of the provider's fiscal year.
(B) When one or more contracts or, for the ICF/IID,
HCS, and TxHmL programs, component codes of a participating provider
are terminated, either voluntarily or involuntarily, the provider
may be required to submit an Attendant Compensation Report for the
terminated contract(s) or component code(s) covering the period from
the beginning of the provider's cost reporting period to the date
recognized by HHSC, or its designee, as the contract or component
code termination date. This report will be used as the basis for determining
any recoupment amounts as described in subsection (t) of this section.
(C) When one or more contracts or, for the ICF/IID,
HCS and TxHmL programs, component codes of a participating provider
are voluntarily withdrawn from participation as per subsection (y)
of this section, the provider may be required to submit an Attendant
Compensation Report within 60 days of the date of withdrawal as determined
by HHSC, covering the period from the beginning of the provider's
cost reporting period to the date of withdrawal as determined by HHSC.
If required, this report will be used as the basis for determining
any recoupment amounts as described in subsection (t) of this section.
These providers may still be required to submit a cost report covering
the entire cost reporting period. The cost report will be used for
determining any recoupment amounts.
(D) For new contracts as defined in subsection (h)
of this section, the cost reporting period will begin with the effective
date of participation in the enhancement.
(E) Existing providers who become participants in the
enhancement as a result of the open enrollment process described in
subsection (f) of this section on any day other than the first day
of their fiscal year may be required to submit an Attendant Compensation
Report with a reporting period that begins on their first day of participation
in the enhancement and ends on the last day of the provider's fiscal
year. If required, this report will be used as the basis for determining
any recoupment amounts as described in subsection (t) of this section.
These providers may still be required to submit a cost report covering
the entire cost reporting period. The cost report will be used for
determining any recoupment amounts.
(F) 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 attendant services to HHSC recipients
during the reporting period.
(4) Other reports. HHSC may require other reports from
all contracts as needed.
(5) Vendor hold. HHSC, or its designee, will place
on hold the vendor payments for any participating provider who does
not submit 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 contracts or, for the ICF/IID, HCS
and TxHmL programs, component codes may be required to submit an Attendant
and Compensation Report. Participating facilities required to submit
an Attendant and Compensation Report 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
subchapter 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 contractor
for services provided during the reporting period in question. These
contracts or component codes 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 subsection (t) 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 contracts or, for the ICF/IID, HCS,
and TxHmL programs, component codes that have terminated or undergone
a contract assignment or ownership-change from one legal entity to
a different legal entity may be required to submit an Attendant and
Compensation Report. Participating facilities required to submit an
Attendant and Compensation Report that do not submit an acceptable
report completed in accordance with all applicable rules and instructions
within 60 days of the contract assignment, ownership-change, or termination
effective date will become nonparticipants retroactive to the first
day of the reporting period in question. These contracts or component
codes 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 under subsection
(t) of this section. If an acceptable report is not received within
365 days of the contract assignment, ownership-change, or termination
effective 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.
(6) Provider-initiated amended Attendant Compensation
Reports and cost reports functioning as Attendant Compensation Reports.
Reports must be received before the date the provider is notified
of compliance with spending requirements for the report in question
in accordance with subsection (t) of this section.
(j) Report contents. Each Attendant Compensation Report
and cost report functioning as an Attendant Compensation Report will
include any information required by HHSC to implement this attendant
compensation rate enhancement.
(k) Completion of compensation reports. All Attendant
Compensation Reports and cost reports functioning as Attendant Compensation
Reports must be completed in accordance with the provisions of §§355.102
- 355.105 of this subchapter (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 subchapter (relating to Basic Objectives
and Criteria for Audit and Desk Review of Cost Reports). All Attendant
Compensation Reports and cost reports functioning as Attendant Compensation
Reports must be completed by preparers who have attended the required
cost report training for the applicable program under §355.102(d)
of this subchapter. For the ICF/IID program, cost reports functioning
as Attendant Compensation Reports must also be completed in accordance
with the provisions of §355.456 of this chapter (relating to
Reimbursement Methodology). For the HCS and TxHmL programs, cost reports
functioning as Attendant Compensation Reports must also be completed
in accordance with the provisions of §355.722 of this chapter
(relating to Reporting Costs by Home and Community-based Services
(HCS) and Texas Home Living (TxHmL) Providers).
(l) Enrollment. Providers choosing to participate in
the attendant compensation rate enhancement must submit to HHSC a
signed enrollment contract amendment as described in subsection (g)
of this section. Participation is determined separately for each program
specified in subsection (a) of this section, except that for providers
delivering both HCS and TxHmL services, participation includes both
the HCS and TxHmL programs. For PHC, participation is also determined
separately for priority and nonpriority services. For ICF/IID, participation
is also determined separately for residential services and day habilitation
services. For HCS and TxHmL, participation is also determined separately
for the non-individualized skills and socialization services, individualized
skills and socialization services, and residential services categories
as defined in subsection (g)(2)(B) of this section. Participation
will remain in effect, subject to availability of funds, until the
provider notifies HHSC, in accordance with subsection (y) of this
section, that it no longer wishes to participate or until HHSC excludes
the contract from participation for reasons outlined in subsection
(v) of this section. Contracts or component codes voluntarily withdrawing
from participation will have their participation end effective with
the date of withdrawal as determined by HHSC. Contracts or components
codes excluded from participation will have their participation end
effective on the date determined by HHSC.
(m) Determination of attendant compensation rate component
for nonparticipating contracts.
(1) For CLASS--DSA; DAHS; DBMD; PHC; RC; STAR+PLUS
AL; STAR+PLUS HCBS and Non-HCBS programs, HHSC will calculate an attendant
compensation rate component for nonparticipating contracts by calculating
a median of attendant compensation cost center data as defined in
subsection (d) of this section for each applicable attendant service,
weighted by the applicable attendant service's units of service from
the most recently examined cost report database for each program,
and adjusted for inflation from the cost reporting period to the prospective
rate period as specified in §355.108 (related to Determination
of Inflation Indices).
(A) The weighted median cost component is multiplied
by 1.044 for CLASS--DSA, DBMD, PHC, STAR+PLUS HCBS, and Non-HCBS;
and by 1.07 for DAHS, RC and STAR+PLUS AL. The result is the attendant
compensation rate component for nonparticipating contracts.
Cont'd... |
