| (a) Eligible programs. Providers contracted in the
following programs are eligible to participate in the attendant compensation
rate enhancement:
(1) Community Living Assistance and Support Services
(CLASS)--Direct Service Agency (DSA);
(2) Day Activity and Health Services (DAHS);
(3) Deaf-Blind with Multiple Disabilities Waiver (DBMD);
(4) Home and Community-based Services (HCS);
(5) Intermediate Care Facilities for Individuals with
Intellectual Disability or Related Conditions (ICF/IID) ("Related
Conditions" has the same meaning as in 26 TAC §261.203 (relating
to Definitions));
(6) Primary Home Care (PHC);
(7) Residential Care (RC); and
(8) Texas Home Living (TxHmL).
(b) Managed Care Providers. A provider contracted with
a managed care organization (MCO) to provide attendant care services
may participate in any Attendant Compensation Rate Enhancement Program
through the MCO with whom it is contracted, as provided by the MCO's
managed care contract with HHSC. Each MCO is responsible for managing
any Attendant Compensation Rate Enhancement Program for its contracted
providers, including provider enrollment and compliance with the program's
spending requirements or any spending requirements imposed under state
or federal law.
(c) Definition of attendant. For the purposes of the
Attendant Compensation Rate Enhancement Program under this section,
an attendant is an unlicensed caregiver providing direct assistance
to individuals with Activities of Daily Living (ADL) and Instrumental
Activities of Daily Living (IADL).
(1) Attendants do not include the director, administrator,
assistant director, assistant administrator, clerical and secretarial
staff, professional staff, other administrative staff, licensed staff,
attendant supervisors, cooks and kitchen staff, maintenance and groundskeeping
staff, activity director, DBMD Interveners I, II or III, Qualified
Intellectual Disability Professionals (QIDPs) or assistant QIDPs,
direct care worker supervisors, direct care trainer supervisors, job
coach supervisors, foster care providers, and laundry and housekeeping
staff. Staff other than attendants may deliver attendant services
and be considered an attendant if they must perform attendant services
that cannot be delivered by another attendant to prevent a break in
service.
(2) An attendant also includes the following:
(A) a driver who is transporting individuals in the
DAHS, ICF/IID, and RC programs and the HCS SL/RSS and HCS and TxHmL
individualized skills and socialization settings;
(B) a medication aide in the HCS SL/RSS setting, ICF/IID,
and RC programs; and
(C) direct care workers, direct care trainers, job
coaches, employment assistance direct care workers, and supported
employment direct care workers.
(d) Attendant compensation cost center. This cost center
will include employee compensation, contract labor costs, and personal
vehicle mileage reimbursement for attendants as defined in subsection
(c) of this section.
(1) Attendant compensation is the allowable compensation
for attendants defined in §355.103(b)(1) of this title (relating
to Specifications for Allowable and Unallowable Costs) and required
to be reported as either salaries and/or wages, including payroll
taxes and workers' compensation, or employee benefits. Benefits required
by §355.103(b)(1)(A)(iii) of this title to be reported as costs
applicable to specific cost report line items, except as noted in
paragraph (3) of this subsection, are not to be included in this cost
center. For ICF/IID, attendant compensation is also subject to the
requirements detailed in §355.457 of this title (relating to
Cost Finding Methodology). For HCS and TxHmL, attendant compensation
is also subject to the requirements detailed in §355.722 of this
title (relating to Reporting Costs by Home and Community-based Services
(HCS) and Texas Home Living (TxHmL) Providers).
(2) Contract labor refers to personnel for whom the
contracted provider is not responsible for the payment of payroll
taxes, such as FICA, Medicare, and federal and state unemployment
insurance, and who perform tasks routinely performed by employees
where allowed by program rules.
(3) Mileage reimbursement paid to the attendant for
the use of his or her personal vehicle and which is not subject to
payroll taxes is considered compensation for this cost center.
(e) Rate year. The rate year begins on the first day
of September and ends on the last day of August of the following year.
(f) Open enrollment. Open enrollment begins on the
first day of July and ends on the last day of that same July preceding
the rate year for which payments are being determined. The Texas Health
and Human Services Commission (HHSC) notifies providers of open enrollment
via email sent to an authorized representative per the signature authority
designation form applicable to the provider's contract or ownership
type. 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 through HHSC's enrollment portal or another
method designated by HHSC. 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. If
open enrollment has been postponed or canceled, HHSC will notify providers
by email before the first day of July. Should conditions warrant,
HHSC may conduct additional enrollment periods during a rate year.
(g) Enrollment contract amendment.
(1) For CLASS--DSA, DBMD, DAHS, RC and PHC, an initial
enrollment contract amendment is required from each provider choosing
to participate in the attendant compensation rate enhancement. On
the initial enrollment contract amendment, the provider must specify
for each contract a desire to participate or not to participate and
a preferred participation level.
(2) For ICF/IID, HCS and TxHmL, an initial enrollment
contract amendment is required from each provider choosing to participate
in the attendant compensation rate enhancement. On the initial enrollment
contract amendment, the provider must specify for each component code
a desire to participate or not to participate and a preferred participation
level. All contracts of a component code within a specific program
must either participate at the same level or not participate.
(A) For the ICF/IID program, the participating provider
must also specify the services the provider wishes to participate
in the attendant compensation rate enhancement. Eligible services
are residential services and day habilitation services. The participating
provider must specify whether the provider wishes to participate for
residential services only, day habilitation services only or both
residential services and day habilitation services.
(B) For the HCS and TxHmL programs, eligible services
are divided into three categories. The three categories of services
eligible for rate enhancement are the following:
(i) non-individualized skills and socialization services:
(I) SHL/CFC PAS HAB/CSS;
(II) in-home respite (IHR) and out-of-home respite
(OHR);
(III) supported employment (SE); and
(IV) employment assistance (EA);
(ii) individualized skills and socialization services;
and
(iii) residential services:
(I) SL; and
(II) RSS.
(C) The participating provider must specify which combination
of the three categories of services the attendant compensation rate
enhancement will apply to. For providers delivering services in both
the HCS and TxHmL programs, the selected categories must be the same
for their HCS and TxHmL programs, except for residential services
which are only available in the HCS program.
(3) After initial enrollment, participating and nonparticipating
providers may request to modify their enrollment status during any
open enrollment period as follows:
(A) a nonparticipant can request to become a participant;
(B) a participant can request to become a nonparticipant;
or
(C) a participant can request to change its participation
level.
(4) Providers whose prior year enrollment was limited
by subsection (v) of this section who request to increase their enrollment
levels will be limited to increases of three or fewer enhancement
levels during the first open enrollment period after the limitation.
Providers that were subject to an enrollment limitation may request
to participate at any level during open enrollment beginning two years
after limitation.
(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 Cont'd... |
