(a) Introduction. The Texas Health and Human Services
Commission (HHSC) uses the methodology described in this section to
establish emergency temporary reimbursement rate increases while limiting
use of the funds received by the provider through the increases. This
section also describes the circumstances in which recoupments will
be necessary for certain provider types or services during the COVID-19
federal public health emergency period. Provider types and services
that are eligible for increased reimbursement rates under this section
include:
(1) all provider types and services for which a reimbursement
rate methodology is described in this chapter; and
(2) any other provider or service that is established
in response to COVID-19.
(b) Eligibility. To receive and retain emergency temporary
reimbursement rate increases from HHSC under this section:
(1) the provider must be enrolled as a Medicaid provider
with HHSC;
(2) the provider must be actively providing and billing
for services provided to fee-for-service Medicaid clients;
(3) the provider must agree not to use the reimbursement
rate increases to increase hourly wages paid to direct care staff
on an ongoing basis, and to limit use of the funds to overtime payments,
lump sum bonuses, bonuses for hazard pay, or other types of compensation
that will not result in future reductions to hourly wages when the
emergency temporary reimbursement rate increase is discontinued; and
(4) HHSC must receive approval from Centers for Medicare &
Medicaid Services (CMS) for the provider type or specific service
to be reimbursed through this section.
(c) Attestation of agreement. The provider must submit
an electronic attestation of agreement to comply with subsection (b)(3)
of this section either within 90 days of the effective date of the
reimbursement rate increase, or by September 30, 2020, whichever date
is later.
(d) Reconciliation process. HHSC uses the methodology
in this subsection to recoup the temporary emergency payments made
under this section if a provider fails to submit the attestation of
agreement under subsection (c) of this section.
(1) HHSC will reduce reimbursement rates for any claim
for services to the amount that would have been paid to the provider
absent the emergency temporary reimbursement rate increase.
(2) The provider's claims will be reprocessed at the
lower reimbursement rate under paragraph (1) of this subsection and
an accounts receivable will be established.
(3) The provider will be paid on a normal per claim
basis after the equivalent amount of the account receivable has been
collected by HHSC, or its designee.
(4) After 270 days from the date of the establishment
of the account receivable under paragraph (1) of this subsection,
HHSC will recoup any overpayments owed under paragraph (1) of this
subsection by demanding immediate repayment of any outstanding amount.
(e) Overpayment.
(1) If payments under this section result in an overpayment
to a provider, HHSC, or its designee, may recoup an amount equivalent
to the overpayment.
(2) Payments made under this section may be subject
to any adjustments for payments made in error or due to fraud, including,
without limitation, adjustments made under the Texas Administrative
Code, the Code of Federal Regulations, and state and federal statutes.
HHSC, or its designee, may recoup an amount equal to any such adjustments
from the providers in question. This section may not be construed
to limit the independent authority of another federal or state agency
or organization to recover from the provider for a payment made due
to fraud.
(f) Disallowance of federal funds. If payments under
this section are disallowed by CMS, HHSC may recoup the amount of
the disallowance from providers that participated in the program associated
with the disallowance. If the recoupment from a provider for such
a disallowance results in a subsequent disallowance, HHSC will recoup
the amount of that subsequent disallowance from the same entity.
(g) Termination of emergency temporary rate increases.
HHSC will terminate the emergency temporary rate increases at the
earlier of either the termination of the federally declared public
health emergency, including any extensions, or at the time that HHSC
determines rate increases are no longer necessary pursuant to §355.201(c)(3)
of this chapter (relating to Establishment and Adjustment of Reimbursement
Rates for Medicaid). However, HHSC will continue to enforce the reconciliation
and recoupment processes described in subsections (d), (e), and (f)
of this section after the termination of the temporary emergency rate
increases.
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