| (a) Eligible programs. Providers contracted in the
following programs are eligible to participate in the attendant compensation
rate enhancement:
(1) Community Based Alternatives (CBA)--Assisted Living/Residential
Care (AL/RC);
(2) CBA--Home and Community Support Services (HCSS);
(3) Community Living Assistance and Support Services
(CLASS)--Direct Service Agency (DSA);
(4) Day Activity and Health Services (DAHS);
(5) Deaf-Blind with Multiple Disabilities Waiver (DBMD);
(6) Home and Community-based Services (HCS);
(7) Intermediate Care Facilities for Individuals with
Intellectual Disability or Related Conditions (ICF/IID) ("Related
Conditions" has the same meaning as in 40 TAC §9.203 (relating
to Definitions));
(8) Primary Home Care (PHC);
(9) RC; and
(10) Texas Home Living (TxHmL).
(b) Definition of attendant. For the attendant compensation
rate enhancement, under this section, an attendant is the unlicensed
caregiver providing direct assistance to individuals with Activities
of Daily Living (ADL) and Instrumental Activities of Daily Living
(IADL).
(1) For the ICF/IID, DAHS, RC, and CBA AL/RC programs
and the HCS supervised living (SL)/residential support services (RSS)
and HCS and TxHmL day habilitation (DH) settings, the attendant may
perform some nonattendant functions. In such cases, the attendant
must perform attendant functions at least 80% of his or her total
time worked. Staff in these settings not providing attendant services
at least 80% of their total time worked are not considered attendants.
Time studies must be performed in accordance with §355.105(b)(2)(B)(i)
of this subchapter (relating to General Reporting and Documentation
Requirements, Methods, and Procedures) for staff in the ICF/IID, DAHS,
RC, and CBA AL/RC programs and the HCS SL/RSS and HCS and TxHmL DH
settings that are not full-time attendants but perform attendant functions
to determine if a staff member meets this 80% requirement. Failure
to perform the time studies for these staff will result in the staff
not being considered attendants. Staff performing attendant functions
in both the HCS SL/RSS and HCS and TxHmL DH settings that combine
to equal at least 80% of their total hours worked would be included
in this designation.
(2) 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. In the case of HCS supported home living (SHL) and HCS Community
First Choice Personal Assistance Services/Habilitation (CFC PAS HAB),
TxHmL community support services (CSS), and TxHmL CSS/CFC PAS HAB,
PHC, CLASS, CBA--HCSS, and DBMD, 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.
(3) An attendant also includes the following:
(A) a driver who is transporting individuals in the
CBA AL/RC, DAHS, ICF/IID, and RC programs and the HCS SL/RSS and HCS
and TxHmL DH settings;
(B) a medication aide in the HCS SL/RSS setting and
the CBA AL/RC, 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.
(c) 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
(b) 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.
(d) Rate year. The rate year begins on the first day
of September and ends on the last day of August of the following year.
(e) 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. If open enrollment has been postponed or cancelled, 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.
(f) Enrollment contract amendment.
(1) For CBA--HCSS and AL/RC, 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.
(A) For the PHC program, the participating provider
must also specify whether the attendant compensation rate enhancement
should apply to the provider’s provision of priority, nonpriority,
or both priority and nonpriority services.
(B) For providers delivering both RC and CBA AL/RC
services in the same facility, participation includes both the RC
and CBA AL/RC programs.
(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 have 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-day habilitation services:
(I) SHL/CFC PAS HAB/CSS;
(II) respite;
(III) supported employment; and
(IV) employment assistance;
(ii) day habilitation 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 (u) 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 Rate Analysis
by the last day of the open enrollment period as per subsection (e)
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, CLASS--DSA, CBA--HCSS, DBMD,
and CBA--AL/RC, providers from which HHSC Rate Analysis 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 (x)
of this section that it no longer wishes to participate or until the
provider's enrollment is limited in accordance with subsection (u)
of this section.
(7) For ICF/IID, HCS, and TxHmL, all participating
and nonparticipating providers must request to modify their enrollment
status during the 2021 enrollment period.
(A) A nonparticipant can request to become a participant;
a participant can request to become a nonparticipant; and a participant
can request to change its participation level.
(B) This request to modify enrollment status will constitute
a revised enrollment. Providers who have not submitted to HHSC Rate
Analysis an acceptable revised enrollment by the last day of the open
enrollment period will become non-participating providers.
(C) Once the revised enrollment has been completed,
providers will continue to participate at the level of participation
in effect during the last open enrollment period within available
funds until the provider notifies HHSC in accordance with subsection
(x) of this section that it no longer wishes to participate or until
the provider's enrollment is limited in accordance with subsection
(u) of this section.
(8) 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.
(g) 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 (e) 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 Rate Analysis 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 (l) 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
(r) 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
(p)(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 Cont'd... |
