| (e) Other sources of cost information. If HHSC has
determined that there is not sufficient reliable cost report data
from which to set reimbursements and reimbursement ceilings for waiver
services, reimbursements and reimbursement ceilings will be developed
by using rates for similar services from other Medicaid programs,
data from surveys, cost report data from other similar programs, consultation
with other service providers or professionals experienced in delivering
contracted services, and similar sources. If HHSC has insufficient
cost data, the recommended payment rate for each service is developed
based on payment 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 analysis in accordance with §355.105(h) of this chapter.
(f) Refinement and adjustment. Refinement and adjustment
of the rate components and model assumptions will be considered, as
appropriate, by HHSC. All adopted rates are limited to available levels
of appropriated state and federal funds as defined in §355.201
of this chapter (relating to Establishment and Adjustment of Reimbursement
Rates for Medicaid).
|
| Source Note: The provisions of this §355.723 adopted to be effective March 25, 1997, 22 TexReg 2772; transferred effective September 1, 1997, as published in the Texas Register December 26, 1997, 22 TexReg 12748; amended to be effective April 5, 1998, 23 TexReg 3255; amended to be effective March 1, 2000, 25 TexReg 1592; amended to be effective March 1, 2001, 26 TexReg 1696; amended to be effective September 1, 2007, 32 TexReg 5341; amended to be effective September 20, 2009, 34 TexReg 6317;amended to be effective September 1, 2010, 35 TexReg 5030; amended to be effective June 20, 2011, 36 TexReg 3709; amended to be effective September 1, 2011, 36 TexReg 5331; amended to be effective April 1, 2014, 39 TexReg 2062; amended to be effective September 1, 2015, 40 TexReg 5297; amended to be effective August 1, 2017, 42 TexReg 3359; amended to be effective March 1, 2018, 43 TexReg 339; amended to be effective September 2, 2019, 44 TexReg 4691; amended to be effective January 10, 2021, 46 TexReg 299; amended to be effective September 1, 2023, 48 TexReg 4632 |
