| (a) Introduction. The Texas Health and Human Services
Commission (HHSC) uses the methodology described in this section to
establish retention payments for Home and Community-Based Services
(HCBS) under HHSC's spending plan pursuant to section 9817 of the
American Rescue Plan Act.
(b) Definitions. The following words and terms, when
used in this section, have the following meanings, unless the context
clearly indicates otherwise:
(1) Direct Care staff--
(A) A provider, or an employer in the consumer directed
services (CDS) option, who provides the following services, as described
in Title 40 Texas Administrative Code (TAC) §49.101 (relating
to Application):
(i) Community Attendant Services program services;
(ii) Primary Home Care program services;
(iii) day activity and health services;
(iv) in the Community Living Assistance and Support
Services Program:
(I) community first choice personal assistance services/habilitation
(CFC PAS/HAB);
(II) habilitation (transportation);
(III) supported employment;
(IV) in-home respite;
(V) nursing services; or
(VI) specialized nursing services;
(v) in the Deaf-Blind Multiple Disabilities Program:
(I) CFC PAS/HAB;
(II) residential habilitation (transportation);
(III) in-home respite;
(IV) licensed assisted living;
(V) licensed home health assisted living;
(VI) supported employment;
(VII) day habilitation;
(VIII) nursing services; or
(IX) specialized nursing services;
(vi) in the Home and Community-Based Services Program:
(I) CFC PAS/ HAB;
(II) supported home living (transportation);
(III) supervised living;
(IV) residential support services;
(V) day habilitation;
(VI) supported employment;
(VII) in-home respite;
(VIII) nursing services; or
(IX) specialized nursing services; and
(vii) in the Texas Home Living Program:
(I) CFC PAS/HAB;
(II) community support services (transportation);
(III) day habilitation;
(IV) supported employment;
(V) in-home respite;
(VI) nursing services; or
(VII) specialized nursing services.
(B) A provider or employee or subcontractor of a provider
who provides the following services in the Home and Community-Based
Services--Adult Mental Health (HCBS-AMH) Program, as described in
26 TAC §307.51(relating to Purpose and Application):
(i) supervised living;
(ii) supported home living; or
(iii) nursing services.
(C) An employee or subcontractor of a provider, or
an employee of an employer in the CDS option who provides:
(i) personal care services, as described in Chapter
363, Subchapter F of this title (relating to Personal Care Services);
or
(ii) CFC habilitation (CFC HAB) or CFC personal assistance
services (CFC PAS), as described in Chapter 354, Subchapter A, Division
27 of this title (relating to Community First Choice).
(D) A provider or an employer in the CDS option who
provides:
(i) in the STAR+PLUS program and STAR+PLUS HCBS program:
(I) assisted living;
(II) CFC PAS;
(III) CFC HAB;
(IV) day activity and health services;
(V) in-home respite care;
(VI) personal assistance services;
(VII) supported employment;
(VIII) protective supervision;
(IX) nursing services; or
(X) specialized nursing services;
(ii) in the STAR Health program and Medically Dependent
Children Program (MDCP):
(I) day activity and health services;
(II) CFC PAS;
(III) CFC HAB;
(IV) flexible family support;
(V) in-home respite;
(VI) personal care services;
(VII) nursing services; or
(VIII) specialized nursing services; and
(iii) in the STAR Kids program and MDCP:
(I) CFC PAS;
(II) CFC HAB;
(III) personal care services;
(IV) day activity and health services;
(V) flexible family support services;
(VI) in-home respite;
(VII) nursing services; or
(VIII) specialized nursing services.
(2) Managed care organization (MCO)--Has the meaning
assigned in §353.2 of this title (relating to Definitions).
(3) Provider--Refers to an HHSC contractor as defined
in §355.7051(a)(1) of this title (relating to Base Wage for a
Personal Attendant) and provider as defined in §353.2 of this
title.
(c) Eligibility. To receive and maintain retention
payments from HHSC under this section:
(1) A provider must be actively billing Medicaid services.
(2) A provider must agree to use at least 90 percent
of payments made under this section for recruitment and retention
efforts for direct care staff delivering HCBS services as defined
in subsection (b) of this section. Payments made under this section
can include financial compensation directed toward direct care staff,
including lump-sum bonuses, retention bonuses, and paid time off to
receive a COVID-19 vaccination or to isolate after receiving a positive
COVID-19 test. Funds under this section can be used to pay payroll
and unemployment taxes and workers' compensation necessary to implement
the financial compensation for HCBS direct care staff.
(3) A provider must agree not to use the payments made
under this section to increase hourly wages paid to direct care staff
on an ongoing basis and to limit use of the funds to types of compensation
that will not result in future reductions to hourly wages when the
payments are discontinued.
(4) A provider must submit two required reports regarding
use of funds made under this section in a manner prescribed by HHSC.
Required reporting includes furnishing data to document vacancy rates
in direct care staff positions and direct care staff retention percentage
and other indicators related to a provider's use of the funds made
under this section as defined by HHSC.
(5) HHSC must receive approval from Centers for Medicare &
Medicaid Services (CMS) for the provider type or specific service
to be paid under this section.
(d) Attestation of Agreement. A provider must submit
an electronic attestation of agreement to comply with subsection (c)(2)
- (c)(3) of this section as specified by HHSC. HHSC will provide notice
at least thirty calendar days prior to the attestation deadline.
(e) Required reporting. A provider must submit required
reporting to comply with subsection (c)(4) of this section. The required
reports will be due on dates specified by HHSC. HHSC will provide
at least thirty calendar day notice prior to the required deadline
for each report.
(f) Reconciliation process. HHSC uses the methodology
in this subsection to recoup the payments made under this section
if a provider fails to submit the attestation of agreement under subsection
(d) or required reporting under subsection (e) of this section.
(1) HHSC will reduce reimbursement rates for any claim
for services to the amount that would have been paid to the provider
absent the HCBS retention payment rate increase.
(2) The provider's claims will be reprocessed at the
lower reimbursement rate under paragraph (1) of this subsection and
an accounts receivable will be established.
(3) The provider will be paid on a normal per claim
basis after the equivalent amount of the account receivable has been
collected by HHSC, or its designee.
(4) After 270 days from the date of the establishment
of the account receivable under paragraph (2) of this subsection,
HHSC will recoup any overpayments owed under paragraph (1) of this
subsection by demanding immediate repayment of any outstanding amount.
(g) Overpayment.
(1) If payments under this section result in an overpayment
to a provider, HHSC, or its designee, may recoup an amount equivalent
to the overpayment.
Cont'd... |
