| (a) General requirements. The Texas Health and Human
Services Commission (HHSC) applies the general principles of cost
determination as specified in §355.101 of this title (relating
to Introduction). Common services are those services that are available
in multiple home and community-based services (HCBS) waivers.
(b) Professional services. Professional services include
nursing services provided by a registered nurse (RN) or a licensed
vocational nurse (LVN) (including Adjunct Support and Respite in the
Medically Dependent Children Program), physical therapy, occupational
therapy, speech/language therapy, cognitive rehabilitative therapy,
nutrition/dietary services, audiology services, and behavioral support
services.
(c) Employment services. Employment services include
employment assistance and supported employment.
(d) Rates for professional services, employment services,
and in-home respite. The rates for these services are calculated in
the following manner:
(1) If there is sufficient reliable cost report data
from which to determine reimbursements, rates are calculated in the
following manner.
(A) An allowable cost per unit of service for each
cost report is calculated in accordance with the specific methodology
for each HCBS waiver.
(B) The allowable cost per unit of service for each
cost report for all HCBS waivers is combined into an array.
(C) The array of allowable costs per unit of service
for all HCBS waivers is weighted by the number of units of service,
and the median cost per unit of service is calculated.
(2) If there is not sufficient, reliable cost report
data from which to determine reimbursements, reimbursements will be
developed by using pro forma costing. This approach involves using
historical costs of delivering similar services, where appropriate
data are available, and estimating the basic types and costs of products
and services necessary to deliver services meeting federal and state
requirements.
(3) Specialized nursing rates will be determined for
both RN and LVN services by multiplying the RN and LVN rates by 1.15.
The specialized nursing rate is paid when a client requires, as determined
by a physician, daily skilled nursing to cleanse, dress, and suction
a tracheostomy or daily skilled nursing assistance with ventilator
or respirator care. The client must be unable to do self-care and
require the assistance of a nurse for the ventilator, respirator,
or tracheostomy care.
(e) Transition assistance services. The reimbursement
for transition assistance services will be determined as a one-time
rate per client based on modeled costs of compensation and other support
costs using data from surveys, cost reports, consultation with other
professionals in delivering contracted services, or other sources
determined appropriate by HHSC.
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| Source Note: The provisions of this §355.502 adopted to be effective September 1, 2009, 34 TexReg 5654; amended to be effective June 20, 2011, 36 TexReg 3707; amended to be effective April 1, 2014, 39 TexReg 2062 |
