| (4) Participating facilities who voluntarily withdraw
from participation as per subsection (n) of this section must submit
a staffing and compensation report within 60 days of the due date
of the report as determined by HHSC, covering the period from the
beginning of the rate year to the date of withdrawal as determined
by HHSC. This report will be used as the basis for determining any
recoupment amounts as described in subsection (k) of this section.
(5) For new facilities, as defined in subsection (c)
of this section, the reporting period will begin with the effective
date of participation in enhancement.
(6) Existing facilities that become participants in
the enhancement as a result of the open enrollment process described
in subsection (b)(8) of this section on any day other than the first
day of their fiscal year are required to submit a staffing and compensation
report with a reporting period that begins on their first day of participation
in the enhancement and ends on the last day of the facility's fiscal
year. This report will be used as the basis for determining any recoupment
amounts as described in subsection (k) of this section.
(7) A participating provider that is required to submit
a staffing and compensation report under this paragraph will be excused
from the requirement to submit a report if the provider did not provide
any billable services to Medicaid recipients during the reporting
period.
(8) Reports must be received before the date the provider
is notified of compliance with spending requirements for the report
in question as per subsection (k) of this section.
(9) HHSC may require other staffing and compensation
reports from all facilities as needed.
(e) Vendor hold. HHSC or its designee will place on
hold the vendor payments for any participating facility that does
not submit a timely report as described in subsection (d) of this
section. This vendor hold will remain in effect until HHSC receives
an acceptable report.
(1) Participating facilities that do not submit an
acceptable report completed in compliance with all applicable rules
and instructions within 60 days of the due dates described in this
subsection or, for cost reports, the due dates described in §355.105(b)
of this chapter (relating to General Reporting and Documentation Requirements,
Methods, and Procedures), will become nonparticipants retroactive
to the first day of the reporting period in question and will be subject
to immediate recoupment of funds related to participation paid to
the facility for services provided during the reporting period in
question. These facilities will remain nonparticipants, and recouped
funds will not be restored until they submit an acceptable report
and repay to HHSC or its designee funds identified for recoupment
from subsection (k) of this section. If an acceptable report is not
received within 365 days of the due date, the recoupment will become
permanent, and if all funds associated with participation during the
reporting period in question have been recouped by HHSC or its designee,
the vendor hold associated with the report will be released.
(2) Participating facilities with an ownership change
or contract termination that do not submit an acceptable report completed
in accordance with all applicable rules and instructions within 60
days of notification of the due date for the report as determined
by HHSC will become nonparticipants retroactive to the first day of
the reporting period in question. These facilities will be subject
to an immediate recoupment of funds related to participation paid
to the facility for services provided during the reporting period
in question. These facilities will remain nonparticipants, and recouped
funds will not be restored until they submit an acceptable report
and repay to HHSC or its designee funds identified for recoupment
from subsection (k) of this section. If an acceptable report is not
received within 365 days of the change of ownership or contract termination
date, the recoupment will become permanent, and if all funds associated
with participation during the reporting period in question have been
recouped by HHSC or its designee, the vendor hold associated with
the report will be released.
(f) Completion of Reports. All staffing and compensation
reports must be completed in compliance with the provisions of §§355.102
- 355.105 of this chapter (relating to General Principles of Allowable
and Unallowable Costs; Specifications for Allowable and Unallowable
Costs; Revenues; and General Reporting and Documentation Requirements,
Methods, and Procedures, respectively) and may be reviewed or audited
in accordance with §355.106 of this chapter (relating to Basic
Objectives and Criteria for Audit and Desk Review of Cost Reports).
All staffing and compensation reports must be completed by preparers
who have attended the required nursing facility cost report training
as per §355.102(d) of this chapter.
(g) Enrollment limitations. A facility will not be
enrolled in the Nursing Care Staff Rate Enhancement Program at a level
higher than the level it achieved on its most recently available audited
staffing and compensation report. HHSC will notify a facility of its
enrollment limitations (if any) before the first day of the open enrollment
period.
(1) Notification of enrollment limitations. The enrollment
limitation level is indicated in the State of Texas Automated Information
Reporting System (STAIRS), the online application for submitting cost
and accountability reports. STAIRS will generate an email to the entity
contact, indicating that the facility's enrollment limitation level
is available for review. The entity contact is the provider's authorized
representative per the signature authority designation form applicable
to the provider's contract or ownership type.
(2) Enrollment after a limitation. At no time will
a facility be allowed to enroll in the enhancement program at a level
higher than its current level of enrollment plus three additional
levels unless otherwise instructed by HHSC.
(3) New owners after a change of ownership. Enhancement
levels for a new owner after a change of ownership will be determined
according to subsection (s) of this section. A new owner will not
be subject to enrollment limitations based on the prior owner's performance.
This exemption from enrollment limitations does not apply in cases
where HHSC or its designee has approved a successor-liability-agreement
that transfers responsibility from the former owner to the new owner.
(4) New facilities. A new facility's enrollment will
be determined according to subsection (c) of this section.
(h) Determination of nursing care staff component enhancements.
HHSC will determine a per diem add-on payment for each nursing rate
component enhancement level using data from sources such as cost reports,
surveys, or other relevant sources and considering the quality of
care, labor market conditions, economic factors, and budget constraints.
The nursing rate component enhancement add-ons will be determined
on a per-unit-of-service basis. Add-on payments may vary by enhancement
level.
(i) Granting of nursing staff rate enhancements. HHSC
divides all requested enhancements, after applying any enrollment
limitations from subsection (g) of this section, into two groups:
pre-existing enhancements that facilities request to carry over from
the prior year and newly requested enhancements. Newly requested enhancements
may be enhancements requested by facilities that were nonparticipants
in the prior year or by facilities that were participants in the prior
year, desiring to be granted additional enhancements. Using the process
described herein, HHSC first determines the distribution of carry-over
enhancements. If HHSC determines that funds are not available to carry
over some or all pre-existing enhancements, facilities will be notified
as per subsection (v) of this section. If funds are available after
the distribution of carry-over enhancements, HHSC then determines
the distribution of newly requested enhancements. HHSC may not distribute
newly requested enhancements to facilities owing funds identified
for recoupment from subsection (k) of this section.
(1) HHSC determines projected Medicaid units of service
for facilities requesting each enhancement option and multiplies this
number by the rate add-on associated with that enhancement option
as determined in subsection (h) of this section.
(2) HHSC compares the sum of the products from paragraph
(1) of this subsection to available funds:
(A) if the product is less than or equal to available
funds, all requested enhancements are granted; or
(B) if the product 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 on an examination
of existing staffing levels and staffing needs, HHSC may grant certain
enhancement options priority for distribution.
(3) Notification of granting of enhancements. Participating
facilities are notified of the status of their request for rate enhancements
in a manner determined by HHSC.
Cont'd... |
