| (a) Introduction. The Texas Health and Human Services
Commission (HHSC) establishes the Nursing Care Staff Rate Enhancement
Program for Nursing Facilities on or after September 1, 2025. The
Nursing Care Staff Rate Enhancement Program for Nursing Facilities
established under this section will be implemented pending implementation
of the Patient Driven Payment Model (PDPM) for Long-Term Care (LTC),
as specified in §355.318 of this subchapter (relating to Reimbursement
Setting Methodology for Nursing Facilities on or after September 1,
2025).
(b) Definitions. The following words and terms, when
used in this section, have the following meanings unless the context
clearly indicates otherwise.
(1) Combined entity--Combined entities consist of one
or more commonly owned corporations and one or more limited partnerships,
where the general partner is controlled by the same person as the
commonly owned corporation.
(2) Commonly owned corporations--Commonly owned corporations
are two or more corporations where five or fewer identical persons
who are individuals, estates, or trusts control greater than 50 percent
of the total voting power in each corporation.
(3) Control--The entity has greater than 50 percent
ownership.
(4) Enrollment contract amendment--An acceptable enrollment
contract amendment is defined as a legible document requesting a change
in enrollment status that has been completed according to instructions,
signed by an authorized representative per the HHSC signature authority
designation form applicable to the provider's contract or ownership
type, and received by HHSC within 30 days of HHSC's notification to
the facility that an enrollment contract amendment must be submitted.
(A) An initial enrollment contract amendment is required
from each facility choosing to participate in the Nursing Care Staff
Rate Enhancement Program.
(B) Participating and nonparticipating facilities may
request to modify their enrollment status (i.e., a nonparticipant
can request to become a participant, a participant can request to
become a nonparticipant, or a participant can request to change its
enhancement level) during any open enrollment period.
(C) Nonparticipants and participants requesting to
increase their enrollment levels will be limited to increases of three
or fewer enhancement levels during any single open enrollment period
unless HHSC waives such limits.
(D) Requests to modify a facility's enrollment status
during an open enrollment period must be received by HHSC by the last
day of the open enrollment period as per paragraph (8) of this subsection.
(i) If the last day of the open enrollment period falls
on a weekend, national holiday, or state holiday, then the first business
day following the last day of the open enrollment period is the final
day the enrollment contract amendment will be accepted.
(ii) An enrollment contract amendment that is not received
by the stated deadline will not be accepted.
(iii) A facility from which HHSC has not received an
acceptable request to modify its 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.
The facility will continue at that level of enrollment until the facility
notifies HHSC following subsection (n) of this section that it no
longer wishes to participate, or until the facility's enrollment is
limited according to subsection (g) of this section.
(E) If HHSC determines that funds are not available
to continue participation at the level in effect during the open enrollment
period, facilities will be notified as per subsection (v) of this
section.
(5) Entity--An entity is a parent company, sole member,
individual, limited partnership, or group of limited partnerships
controlled by the same general partner.
(6) Nursing care staff base rate--The nursing care
staff base rate is equal to the adopted nursing rate component as
specified in §355.318 of this subchapter.
(7) Nursing care staff cost center--The nursing care
staff cost center is equal to the PDPM LTC nursing rate component
as specified in §355.318 of this subchapter.
(8) Open enrollment--Open enrollment begins on the
first day of July and ends on the thirty-first day of July, preceding
the rate year for which payments are being determined. 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.
(9) Rate year--The standard rate year begins on the
first day of September and ends on the last day of August of the following
year.
(10) Responsible entity--The contracted provider, owner,
or legal entity that received the recouped revenue is responsible
for the repayment of any recoupment amount.
(11) Staffing and compensation report--A staffing and
compensation report is a report reflecting the provider's activities
while delivering contracted services from the first day through the
last day of the rate year or provider's cost report year while participating
in the Nursing Care Staff Rate Enhancement Program. Staffing and compensation
reports and cost reports functioning as staffing and compensation
reports will include any information required by HHSC to implement
the Nursing Care Staff Rate Enhancement Program. Staffing and compensation
reports must be submitted annually or as specified in subsection (d)
of this section. Cost and accountability reports requested by HHSC
are considered staffing and 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). Staffing and compensation reports will be used as the basis
for determining compliance with the spending requirements and recoupment
amounts as described in subsection (k) of this section. Participating
facilities failing to submit an acceptable annual staffing and compensation
report within 60 days of notification of the due date for the report
as determined by HHSC will be placed on vendor hold until an acceptable
report is received and processed by HHSC.
(c) Enrollment for new facilities. For purposes of
this section, for each rate year, a new facility is defined as a facility
delivering its first day of service to a Medicaid recipient after
the first day of the open enrollment period, as defined in subsection
(b)(8) of this section. Facilities that underwent an ownership change
are not considered new facilities. New facilities will receive the
nursing rate component as determined in §355.318 of this subchapter
with no enhancements. For new facilities specifying their desire to
participate in an acceptable enrollment contract amendment, the nursing
rate component is adjusted as specified in subsection (j) of this
section, effective on the first day of the month following receipt
by HHSC of the acceptable enrollment contract amendment. If the granting
of newly requested enhancements was limited as per subsection (g)
of this section during the most recent enrollment, enrollment for
new facilities will be subject to that same limitation.
(d) Reporting requirements.
(1) All participating facilities will provide HHSC,
in a method specified by HHSC, an annual staffing and compensation
report reflecting the activities of the facility while delivering
contracted services from the first day through the last day of the
rate year.
(2) When a participating facility changes ownership,
the prior owner must submit a staffing and compensation report covering
the period from the beginning of the rate year to the date recognized
by HHSC or its designee as the ownership-change effective date. This
report will be used as the basis for determining any recoupment amounts
as described in subsection (k) of this section. The new owner will
be required to submit a staffing and compensation report covering
the period from the day after the date recognized by HHSC or its designee
as the ownership change effective date to the end of the rate year.
(3) Participating facilities whose contracts are terminated
either voluntarily or involuntarily must submit a staffing and compensation
report covering the period from the beginning of the rate year to
the date recognized by HHSC or its designee as the contract termination
date. This report will be used as the basis for determining any recoupment
amounts as described in subsection (k) of this section.
Cont'd... |
