| (5) Requests to modify a provider's enrollment status
during an open enrollment period must be received by HHSC by the last
day of the open enrollment period as per subsection (f) of this section.
If the last day of open enrollment is on a weekend day, state holiday,
or national holiday, the next business day will be considered the
last day requests will be accepted.
(6) For PHC, DAHS, RC, and CLASS--DSA providers from
which HHSC has not received an acceptable request to modify their
enrollment by the last day of the open enrollment period will continue
at the level of participation in effect during the open enrollment
period within available funds until the provider notifies HHSC in
accordance with subsection (y) of this section that it no longer wishes
to participate or until the provider's enrollment is limited in accordance
with subsection (v) of this section.
(7) To be acceptable, an enrollment contract amendment
must be completed according to instructions, signed by an authorized
representative as per HHSC's signature authority designation form
applicable to the provider's contract or ownership type, and legible.
(h) Enrollment of new contracts. For the purposes of
this section, for each rate year a new contract is defined as a contract
or component code whose effective date is on or after the first day
of the open enrollment period, as defined in subsection (f) of this
section, for that rate year. Contracts that underwent a contract assignment
or change of ownership and new contracts that are part of an existing
component code are not considered new contracts. For purposes of this
subsection, an acceptable contract amendment is defined as a legible
enrollment contract amendment that has been completed according to
instructions, signed by an authorized representative as per HHSC's
signature authority designation form applicable to the provider's
contract or ownership type, and received by HHSC within 30 days of
notification to the provider that such an enrollment contract amendment
must be submitted. If the 30th day is on a weekend day, state holiday,
or national holiday, the next business day will be considered the
last day requests will be accepted. New contracts will receive the
nonparticipant attendant compensation rate as specified in subsection
(m) of this section with no enhancements. For new contracts specifying
their desire to participate in the attendant compensation rate enhancement
on an acceptable enrollment contract amendment, the attendant compensation
rate is adjusted as specified in subsection (s) of this section, effective
on the first day of the month following receipt by HHSC of an acceptable
enrollment contract amendment. If the granting of newly requested
enhancements was limited by subsection (q)(2)(B) of this section during
the most recent enrollment, enrollment for new contracts will be subject
to that same limitation. If the most recent enrollment was canceled
by subsection (f) of this section, new contracts will not be permitted
to be enrolled.
(i) Attendant Compensation Report.
(1) Definition of Attendant Compensation Report. An
attendant compensation report is a report reflecting the provider's
activities while delivering contracted services from the first day
of the rate year through the last day of the rate year or provider's
cost report year while participating in the attendant compensation
rate enhancement program. This report is used as the basis for determining
compliance with the spending requirements as described in subsection
(t) of this section. Cost and accountability reports requested by
HHSC are considered attendant compensation reports, and preparers
must complete mandatory training requirements per §355.102(d)
of this subchapter (relating to General Principles of Allowable and
Unallowable Costs).
(2) Providers must file Attendant Compensation Reports
as follows. HHSC will require a subset of participating contracted
providers to submit an annual Attendant Compensation Report to HHSC
in a method specified by HHSC.
(A) Cost reports serving as Attendant Compensation
Reports. If HHSC requires a participating provider to file a cost
report for a rate year, HHSC will use that provider's cost report
as an Attendant Compensation Report as the basis for determining compliance
with the spending requirements as described in subsection (t) of this
section.
(B) Accountability reports serving as Attendant Compensation
Reports. HHSC will require a select number of participating providers
who are not required to submit a cost report for a rate year to submit
an accountability report, which will serve as an Attendant Compensation
Report as the basis for determining compliance with the spending requirements
as described in subsection (t) of this section. These providers will
be selected at random from the total number of participating contracts
that are not required to submit a cost report for a rate year. The
number selected must 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.
Cont'd... |
