| (a) Prospective payment rates. The Texas Health and
Human Services Commission (HHSC) sets payment rates to be paid prospectively
to Home and Community-based Services (HCS) and Texas Home Living (TxHmL)
providers.
(b) Levels of need.
(1) Variable rates. Rates vary by level of need (LON)
for the following services:
(A) host home/companion care (HH/CC);
(B) individualized skills and socialization;
(C) residential support services (RSS); and
(D) supervised living (SL).
(2) Non-variable rates. Rates do not vary by LON for
the following services:
(A) audiology;
(B) behavioral support;
(C) cognitive rehabilitative therapy (CRT);
(D) community first choice personal assistance services/habilitation
(CFC PAS/HAB);
(E) community support services transportation (CSS);
(F) dietary;
(G) employment assistance (EA);
(H) in-home respite;
(I) licensed vocational nurse (LVN);
(J) occupational therapy (OT);
(K) out-of-home respite (OHR);
(L) physical therapy (PT);
(M) registered nurse (RN);
(N) social work;
(O) speech therapy;
(P) supported employment (SE); and
(Q) supported home living transportation (SHL).
(c) Recommended rates. The recommended payment rates
are determined for each HCS and TxHmL service listed in subsections
(b)(1) and (2) of this section by type and, for services listed in
subsection (b)(1) of this section, by LON to include the following
cost areas.
(1) Attendant compensation cost area. The determination
of the attendant compensation cost area is calculated as specified
in §355.112 of this chapter (relating to Attendant Compensation
Rate Enhancement). The attendant compensation cost area includes personal
attendant staffing costs (wages, benefits, modeled staffing ratios
for attendant staff, direct care trainers, and job coaches).
(2) Other direct care cost area. The other direct care
cost area includes other direct service staffing costs (wages and
benefits for direct care and attendant supervisors). The other direct
care cost area is determined by calculating a median from allowable
other direct care costs for each service, weighed by units of service
for the applicable service from the most recently examined HCS/TxHmL
cost report adjusted for inflation from the cost reporting period
to the prospective rate period as specified in §355.108 of this
chapter (relating to Determination of Inflation Indices).
(A) For the following services, multiply the other
direct care cost area as specified in this paragraph by 1.044:
(i) EA;
(ii) in-home respite;
(iii) OHR in a camp;
(iv) OHR in a respite facility;
(v) OHR in a setting where HH/CC is provided;
(vi) OHR in a setting that is not listed; and
(vii) SE.
(B) For the following services, multiply the other
direct care cost area as specified in this paragraph 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) OHR in a setting with SL or RSS is provided;
(v) RSS; and
(vi) SL.
(3) Administration and operations cost area. The administration
and operation cost area includes:
(A) administration and operation costs; and
(B) professional consultation and program support costs,
including:
(i) allowable costs for required case management and
service coordination activities; and
(ii) service-specific transportation costs.
(4) Projected costs. Projected costs are determined
by allowable administrative and operations costs 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
of this chapter. The steps to determine projected costs are as follows.
(A) Step 1. Determine total projected administration
and operation costs and projected units of service by service type
using cost reports submitted by HCS and TxHmL providers in accordance
with §355.722 of this subchapter (relating to Reporting Costs
by Home and Community-based Services (HCS) and Texas Home Living (TxHmL)
Providers).
(B) Step 2. Determine the HH/CC coordinator component
of the HH/CC rate as follows: This component is determined by summing
total reported HH/CC coordinator wages and allocated payroll taxes
and benefits from the most recently available audited HCS cost report,
inflating those costs to the rate period, and dividing the resulting
product by the total number of host home units of service reported
on that cost report.
(C) Step 3. Determine total HH/CC coordinator dollars
as follows. Multiply the HH/CC coordinator component of the HH/CC
rate from subparagraph (B) of this paragraph by the total number of
HH/CC units of service reported on the most recently available, reliable
audited HCS cost report database.
(D) Step 4. Determine total projected administration
and operation costs after offsetting total HH/CC coordinator dollars
as follows. Subtract the total HH/CC coordinator dollars from subparagraph
(C) of this paragraph from the total projected administration and
operation costs from subparagraph (A) of this paragraph.
(E) Step 5. Determine projected weighted units of service
for each HCS and TxHmL service type as follows.
(i) SL and RSS in HCS. Projected weighted units of
service for SL and RSS equal projected SL and RSS units of service
times a weight of 1.00.
(ii) Individualized skills and socialization in HCS
and TxHmL. Projected weighted units of service for individualized
skills and socialization equal projected individualized skills and
socialization units of service times a weight of 0.25.
(iii) HH/CC in HCS. Projected weighted units of service
for HH/CC equal projected HH/CC units of service times a weight of
0.50.
(iv) SHL in HCS, high medical needs support in HCS,
and CSS in TxHmL. For each service, projected weighted units of service
equal projected units of service times a weight of 0.30.
(v) Respite in HCS and TxHmL. Projected weighted units
of service for respite equal projected respite units of service times
a weight of 0.20.
(vi) SE in HCS and TxHmL. Projected weighted units
of service for SE equal projected units of service times a weight
of 0.25.
(vii) Behavioral support in HCS and TxHmL. Projected
weighted units of service for behavioral support equal projected behavioral
support units of service times a weight of 0.18.
(viii) Audiology, CRT, OT, PT, and speech therapy in
HCS and TxHmL. Projected weighted units of service for audiology,
CRT, OT, PT, and speech therapy equal projected audiology, CRT, OT,
PT, and speech therapy units of service times a weight of 0.18.
(ix) Social work in HCS. Projected weighted units of
service for social work equal projected social work units of service
times a weight of 0.18.
(x) Nursing in HCS and TxHmL and high medical needs
nursing in HCS. Projected weighted units of service for nursing and
high medical needs nursing equal projected nursing and high medical
needs nursing units of service times a weight of 0.25.
(xi) EA in HCS and TxHmL. Projected weighted units
of service for EA equal projected EA units of service times a weight
of 0.25.
(xii) Dietary in HCS and TxHmL. Projected weighted
units of service for dietary equal projected dietary units of service
times a weight of 0.18.
(F) Step 6. Calculate the total projected weighted
units of service by summing the projected weighted units of service
from subparagraph (E) of this paragraph.
(G) Step 7. Calculate the percent of total administration
and operation costs to be allocated to the service type by dividing
the projected weighted units for the service type from subparagraph
(E) of this paragraph by the total projected weighted units of service
from subparagraph (F) of this paragraph.
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