| (ii) the overall average occupancy rate for contracted
beds in facilities included in the rate base during the cost reporting
periods included in the base.
(4) Cost projections. HHSC projects certain expenses
in the reimbursement base to normalize or standardize the reporting
period and to account for cost inflation between reporting periods
and the period to which the prospective reimbursement applies as specified
in §355.108 of this chapter.
(5) In addition to the requirements of §355.102
of this chapter (relating to General Principles of Allowable and Unallowable
Costs) and §355.103 of this chapter (relating to Specifications
for Allowable and Unallowable costs), the following apply to costs
for nursing facilities.
(A) Medical costs. The costs for medical services and
items delineated in 26 TAC §554.2601 (relating to Vendor Payment
(Items and Services Included)) are allowable. These costs must also
comply with the general definition of allowable costs as stated in §355.102
of this chapter.
(B) Chaplaincy or pastoral services. Expenses for chaplaincy
or pastoral services are allowable costs.
(C) Voucherable costs. Any expenses directly reimbursable
to the provider through a voucher payment and any expenses in excess
of the limit for a voucher payment system are unallowable costs.
(D) Preferred items. Costs for preferred items that
are billed to the recipient, responsible party, or the recipient's
family are not allowable costs.
(E) Preadmission Screening and Annual Resident Review
(PASARR) expenses. Any expenses related to the direct delivery of
specialized services and treatment required by PASARR for residents
are unallowable costs.
(F) Advanced Clinical Practitioner (ACP) or Licensed
Professional Counselor (LPC) services. Expenses for services provided
by an ACP or LPC are unallowable costs.
(G) Limits on contracted management fees. To ensure
that the results of HHSC's cost analyses accurately reflect the costs
that an economical and efficient provider must incur, HHSC may place
upper limits on contracted management fees and expenses included in
the non-case mix rate component. HHSC sets upper limits at the 90th
percentile of all costs per unit of service as reported by all contracted
facilities using the cost report database immediately preceding the
database used to establish reimbursements in subsection (e) of this
section.
(h) Special Reimbursement Class. HHSC may define special
reimbursement classes, including experimental reimbursement classes
of service to be used in research and demonstration projects on new
reimbursement methods and reimbursement classes of service, to address
the cost differences of a select group of recipients. Special classes
may be implemented on a statewide basis, may be limited to a specific
region of the state, or may be limited to a selected group of providers.
Reimbursement for the Pediatric Care Facility Class is calculated
as specified in §355.316 of this chapter (relating to Reimbursement
Methodology for Pediatric Care Facilities).
(i) Nurse aide training and competency evaluation costs.
(1) HHSC reimburses nursing facilities for the actual
costs of training and testing nurse aides. Payments are based on cost
reimbursement vouchers that are to be submitted quarterly. Allowable
costs are limited to those costs incurred for training for:
(A) actual training course expenses up to a set amount
determined by HHSC per nurse aide;
(B) competency evaluation; or
(C) supplies and materials used in the nurse aide training
not already covered by the training course fee.
(2) Nurse aide salaries while in training are factored
into the vendor rate and are not to be included in the reimbursement
voucher.
(3) Training program costs that exceed the HHSC cost
ceiling must have prior approval from HHSC before costs can be reimbursed.
A written request to HHSC must include:
(A) name and vendor number of the facility;
(B) description of the training program for which the
facility is seeking reimbursement approval, including:
(i) name, telephone number, and address of the NATCEP;
(ii) whether the NATCEP is facility or non-facility-based;
and
(iii) name of the NATCEP director;
(C) an explanation of why the cost for the NATCEP exceeds
the reimbursement ceiling and the explanation must include:
(i) a completed nurse aide unit cost calculation form
for a facility-based NATCEP; or
(ii) a breakdown of the nurse aide unit cost by the
instructor fees and training materials for a non-facility-based NATCEP;
and
(D) an explanation of why the nursing facility cannot
use a training program at or below the reimbursement ceiling and what
steps the facility has taken to explore more cost-efficient training
courses and the explanation must include:
(i) the availability of NATCEPs, such as the location
or the frequency of training offered, in the geographic region of
the facility;
(ii) the name and address of each NATCEP that the facility
has explored as a provider of nurse aide training; and
(iii) the cost per nurse aide for each NATCEP identified
in subparagraph (C)(i) or (ii) of this paragraph.
(4) All prior approval requests, as outlined in paragraph
(3) of this subsection, must be submitted to HHSC and HHSC:
(A) may request additional information to evaluate
a reimbursement request; and
(B) will make the final decision on a reimbursement
request.
(5) All nurse aide training courses must be approved
by HHSC before costs associated with them can be reimbursed.
(6) Nursing facilities are responsible for tracking
and documenting nurse aide training costs for each nurse aide trained.
All documentation is subject to HHSC audits. If substantiating documentation
for amounts billed to HHSC cannot be verified, HHSC will immediately
recoup funds paid to the facility.
(7) Individuals who have completed a NATCEP may be
directly reimbursed for costs incurred in completing a NATCEP. The
individual must meet all of the conditions specified in subparagraphs
(A) - (E) of this paragraph.
(A) The individual must not have been employed at the
time of completing the NATCEP.
(B) The individual must have been employed by or received
an offer of employment from a nursing facility no later than 12 months
after successfully completing the NATCEP.
(C) The individual must have been employed by the facility
for no less than 6 months.
(D) The nursing facility must not have claimed reimbursement
for training expenses for the individual.
(E) The individual must be listed on the current Nurse
Aide Registry.
(8) Individuals must submit cost reimbursement vouchers
to HHSC with proof that the individual has been employed by a facility
for no less than 6 months.
(9) Individuals who leave nursing facility employment
before accruing the required 6 months of employment, as specified
in paragraph (7)(C) of this subsection, may receive 50 percent reimbursement
as long as the individual was employed for no less than 3 months.
(10) Reimbursement to individuals may not exceed the
HHSC reimbursement limit described in paragraph (1)(A) of this subsection.
(j) Adopted rates are limited to available levels of
appropriated state and federal funds.
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