| (H) Step 8. Calculate the total administration and
operation cost to be allocated to the service type by multiplying
the percent of total administration and operation costs allocated
to the service type from subparagraph (G) of this paragraph by the
total administration and operation costs after offsetting total HH/CC
coordinator dollars from subparagraph (D) of this paragraph.
(I) Step 9. Calculate the administration and operation
cost component per unit of service for each HCS and TxHmL service
type by dividing the total administration and operation cost to be
allocated to that service type from subparagraph (H) of this paragraph
by the projected units of service for that service type from subparagraph
(A) of this paragraph.
(J) Step 10. The final recommended administration and
operation cost area per unit of service for each HCS and TxHmL service
type is calculated as follows.
(i) For the following services, multiply the administration
and operation cost area from this subparagraph by 1.044:
(I) CFC PAS/HAB;
(II) CSS;
(III) EA;
(IV) in-home individualized skills and socialization;
(V) in-home respite;
(VI) OHR in a camp;
(VII) OHR in a respite facility;
(VIII) OHR in a setting where HH/CC is provided;
(IX) OHR in a setting that is not listed;
(X) SE; and
(XI) SHL.
(ii) For the following services, multiply the administration
and operation cost area from this subparagraph by 1.07:
(I) individualized skills and socialization;
(II) in-home and out-of-home individualized skills
and socialization;
(III) OHR in an individualized skills and socialization
facility;
(IV) RSS; and
(V) SL.
(5) The facility cost area. The facility cost area
includes the following:
(A) room and board costs, including rent, mortgage
interest, depreciation expenses, property taxes, property insurance,
and food costs as defined in §355.103 of this chapter (relating
to Specifications for Allowable and Unallowable Costs), unless excluded
if unallowable under Federal Medicaid rules; and
(B) non-room and board costs not already reimbursed
through the monthly amount collected from the individual receiving
services as defined in 26 TAC §565.27(a).
(6) The facility cost area is determined by calculating
a median cost for each service using allowable facility costs, weighted
by units of service for the applicable service from the most recently
audited cost report, adjusted for inflation from the cost reporting
period to the prospective rate period as specified in §355.108.
(A) For the following services, multiply the facility
cost component by 1.044:
(i) HH/CC;
(ii) OHR in a camp;
(iii) OHR in a respite facility; and
(iv) OHR in a setting where HH/CC is provided.
(B) For the following services, multiply the facility
cost component by 1.07:
(i) individualized skills and socialization;
(ii) in-home and out-of-home DH;
(iii) OHR in a DH or individualized skills and socialization
facility;
(iv) OHR in a setting where SL or RSS are provided;
(v) RSS; and
(vi) SL.
(d) Recommended payment rates are determined for each
service by the following.
(1) CFC PAS/HAB. The recommended payment rate is calculated
by summing the attendant compensation cost area and the administration
and operations cost area as defined in subsection (c) of this section.
The recommended rate for CFC PAS/HAB does not include a cost component
for other direct care staffing costs.
(2) CRT. The recommended payment rate 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
(relating to General Reporting and Documentation Requirements, Methods,
and Procedures).
(3) HH/CC. The recommended payment rate is determined
by summing the direct care worker component, HH/CC coordinator cost
area, administration and operations component, and facility cost area.
The direct care worker component is calculated using the median of
allowable direct care worker costs, weighted by HH/CC units of service
from the most recently examined cost report database. The result is
adjusted for each LON. The HH/CC coordinator cost area and administration
and operations components are calculated as determined in subsection
(c) of this section. The facility cost area is calculated as determined
in subsection (c) of this section but does not include room and board
costs as defined in subsection (c)(5)(A) of this section. If HHSC
lacks reliable cost report data, the rate 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.
(4) In-home respite. The recommended payment rate is
calculated by summing the attendant compensation cost area and the
administration and operations component as defined in subsection (c)
of this section.
(5) Individualized skills and socialization. The recommended
payment cost areas are adjusted using modeled staffing ratios to establish
recommended rates for on-site and off-site rates by LON. The recommended
rates are calculated by summing the attendant compensation cost area,
other direct care cost area, the administration and operations component,
and the facility cost component as defined in subsection (c) of this
section. Transportation costs are calculated as a standalone component
separate from the administration and operations component for off-site
services. The enhanced staffing level one rate is equal to the LON
8 individualized skills and socialization off-site recommended rate.
The enhanced staffing level two rate is modeled and assumes a one-staff-to-one-individual
staffing ratio.
(6) Nursing services provided by an RN, nursing services
provided by an LVN, physical therapy, occupational therapy, speech/language
therapy, behavioral support services, audiology services, dietary
services, EA, SE, and transition assistance services are determined
based on §355.725 of this subchapter (relating to Reimbursement
Methodology for Common Waiver Services in Home and Community-based
Services (HCS) and Texas Home Living (TxHmL)).
(7) OHR. The recommended payment cost areas may be
adjusted using modeled direct care worker hour-per-unit ratios for
similar services to calculate OHR rates that vary by setting where
the service is provided. The recommended payment rates are calculated
by summing the attendant compensation cost area, other direct care
cost area, the administration and operations component, and the facility
cost component as defined in subsection (c) of this section.
(8) SHL and CSS. The recommended payment rates for
SHL and CSS are calculated by summing the attendant compensation cost
area and the administration and operations cost area as defined in
subsection (c) of this section.
(9) SL and RSS. The recommended payment cost areas
are adjusted using modeled direct care worker hour-per-unit ratios
updated by actual hours reported on the most recently audited cost
report to calculate variable rates by LON. The recommended rates are
calculated by summing the attendant compensation cost area, other
direct care cost area, and the administration and operations component
as defined in subsection (c) of this section. The facility cost area
is calculated as determined in subsection (c) of this section but
does not include room and board costs defined in subsection (c)(5)(A)
of this section.
(10) Social work. The recommended payment rate is calculated
using the weighted median social worker hourly cost from the most
recently audited cost report, and the administration and operations
cost component as determined in subsection (c) of this section. If
HHSC lacks reliable cost report data, the rate 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.
Cont'd... |
