| (B) If HHSC has insufficient cost data, the attendant
compensation rate component will be established through a pro forma
costing approach as defined in §355.105(h) of this subchapter.
(2) For ICF/IID DH, ICF/IID residential services, HHSC
will calculate an attendant compensation rate component for nonparticipating
contracts for each service by calculating a median of attendant compensation
cost center data as defined in subsection (d) of this section for
each DH and Residential services, weighted by ICF/IID units of service
from the most recently examined ICF/IID cost report database, 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 attendant cost component is
adjusted by modeled direct care hours to unit ratios to determine
attendant compensation rate components for each level of need (LON).
(B) The weighted median cost component is multiplied
by 1.07 for both ICF/IID DH and residential services.
(C) If HHSC has insufficient cost data, the attendant
compensation rate component will be established through a pro forma
costing analysis as defined in §355.105(h) of this subchapter.
(3) For HCS and TxHmL programs, HHSC will calculate
an attendant compensation rate component for nonparticipating contracts
for each service 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 HCS/TxHmL
cost report database, 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 the following services:
(i) EA;
(ii) IHR;
(iii) OHR in a camp;
(iv) OHR in a respite facility;
(v) OHR in a setting where host home / companion care
(HH/CC) is provided;
(vi) OHR in a setting that is not listed; and
(vii) SE;
(B) The weighted median cost component is multiplied
by 1.07 for the following services:
(i) individualized skills and socialization services;
(ii) OHR in an individualized skills and socialization
facility;
(iii) OHR in a setting with SL or RSS is provided;
(vi) RSS; and
(v) SL.
(C) For services with rates that are variable by LON
as specified in §355.723(b) of this chapter (relating to Reimbursement
Methodology for Home and Community-based Services and Texas Home Living
Programs), the weighted median attendant cost component is adjusted
by modeled direct care hours to unit or direct care staff to individual
ratios to determine attendant compensation rate components for each
LON.
(D) If HHSC has insufficient cost data, the attendant
compensation rate component will be established through a pro forma
costing analysis as defined in §355.105(h) of this subchapter.
(4) The adopted attendant compensation rate component
for nonparticipating contracts will be limited to available levels
of appropriated state and federal funds as specified in §355.201
of this chapter (relating to Establishment and Adjustment of Reimbursement
Rates for Medicaid).
(n) Determination of attendant compensation base rate
for participating contracts. For each of the programs identified in
subsection (a) of this section, the attendant compensation base rate
is equal to the attendant compensation rate component for nonparticipating
contracts from subsection (m) of this section.
(o) 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.
(p) 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 (o) 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-individualized
skills and socialization services and/or individualized skills and
socialization services and/or residential services they have selected
for participation.
(q) 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; and DBMD 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 (v) 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 (t) of this
section.
(1) For all programs and levels, 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 (o) of this section.
(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.
(r) 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.
(s) 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
(n) of this section plus any add-on payments associated with enhanced
attendant compensation levels selected by and awarded to the provider
during open enrollment.
(t) 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 (i) 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 services in both
the HCS and TxHmL Cont'd... |
