|(a) In conducting reimbursement reviews for adjustments,
the Texas Health and Human Services Commission (HHSC) takes into consideration
changes in laws, rules, regulations, policies, guidelines, or economic
factors which will have a demonstrable material impact on most contracted
providers' costs of providing services meeting federal and state standards.
(1) HHSC may recommend adjustments to reimbursement
when federal or state laws, rules, regulations, policies, or guidelines
are adopted, promulgated, judicially interpreted, or otherwise changed
in ways that affect allowable costs. The law, rule, regulation, policy,
or guideline change must result in necessary changes in allowable
(A) affect most, if not all, contracted providers;
(B) require contracted providers to take definitive
action to incur additional allowable costs not included in the cost
database used to determine reimbursements and which would not otherwise
be covered in reimbursements.
(2) HHSC may recommend adjustments to reimbursement
when it can be clearly demonstrated that changes in economic factors
will result in changes in allowable costs. The changes in economic
factors must result in changes in allowable costs that:
(A) affect most, if not all, providers; and
(B) are allowable cost changes that the providers have
little or no control over and are allowable costs that are not included
in the cost database used to determine reimbursements and which would
not otherwise be covered in reimbursements.
(3) HHSC may recommend adjustments to reimbursement
when there is a change to any of the unemployment insurance tax components
detailed in subparagraphs (A) - (D) of this paragraph. If unemployment
insurance tax rates for the prospective reimbursement period are not
available at the time reimbursement is prepared for public comment,
the most recent known tax rates are assumed to remain in effect.
(A) The calendar year average Texas Unemployment Compensation
Tax Act (TUCA) rate, as calculated by the Texas Workforce Commission
(B) if HHSC has determined that a specific program
will have significantly higher or lower average unemployment tax costs
than the average industry in Texas, the calendar year average effective
TUCA rate for the North American Industry Classification System code
or codes pertinent to that specific program, as calculated by TWC;
(C) the rate of tax set by the Federal Unemployment
Tax Act; or
(D) the maximum credits against tax set by the Federal
Unemployment Tax Act.
(b) HHSC may recommend adjustments to reimbursement
for the reasons stated in subsection (a)(1) of this section at the
earliest feasible opportunity in order for the adjustment to become
effective on the effective date of the federal or state laws, rules,
regulations, policies, or guidelines. In the case of Medicaid state
plan program reimbursements, the adjustments will not be effective
until after the federal requirements for notice are met.
(c) HHSC may recommend adjustments to reimbursement
when federal or state funding is changed in ways that affect the available
funding for programs.
|Source Note: The provisions of this §355.109 adopted to be effective September 1, 1996, 21 TexReg 7866; duplicated effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective August 31, 2004, 29 TexReg 8093; amended to be effective February 27, 2022, 47 TexReg 768