The Texas Health and Human Services Commission (HHSC) adopts amendments to §355.105, concerning General Reporting and Documentation Requirements, Methods, and Procedures; §355.112, concerning Attendant Compensation Rate Enhancement; §355.306, concerning Cost Finding Methodology; §355.308, concerning Direct Care Staff Rate Component; §355.503, concerning Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs; §355.505, concerning Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program; §355.509, concerning Reimbursement Methodology for Residential Care; §355.510, concerning Reimbursement Methodology for Emergency Response Services (ERS); §355.511, concerning Reimbursement Methodology for Home-Delivered Meals; §355.513, concerning Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver Program; §355.5902, concerning Reimbursement Methodology for Primary Home Care; and §355.6907, concerning Reimbursement Methodology for Day Activity and Health Services. The amendments to §355.306 and §355.503 are adopted with changes to the proposed text as published in the August 17, 2012, issue of the Texas Register (37 TexReg 6193). The text of the rules will be republished. The amendments to §§355.105, 355.112, 355.308, 355.505, 355.509 - 355.511, 355.513, 355.5902, and 355.6907 are adopted without changes to the proposed text as published in the August 17, 2012, issue of the Texas Register (37 TexReg 6193) and will not be republished.

Background and Justification

HHSC, under its authority and responsibility to administer and implement rates, is adopting the amendments to: (1) standardize how some providers may be automatically excused from submitting a cost report; (2) delete obsolete language to reflect current agency practice; and (3) update references to legacy health and human services (HHS) agencies.

Under certain circumstances, HHSC may excuse a provider not participating in the Attendant Compensation Rate Enhancement from submitting a cost report. These exceptions have varied by program and been inconsistent in application. HHSC removed these exceptions from the program reimbursement methodology rules and grouped them in §355.105(b)(4)(D). HHSC also inserted a cross-reference to §355.105(b)(4)(D) in each program reimbursement methodology rule to inform providers where to find the exceptions.

HHSC also defined circumstances whereby a provider who is participating in the Attendant Compensation Rate Enhancement or the Nursing Facility Direct Care Staff Rate Enhancement may be automatically excused from submitting a cost report, an Attendant Compensation Report, or a Nursing Facility Staffing and Compensation Report.

Finally, HHSC deleted obsolete language to reflect current agency practice and updated references to legacy HHS agencies.

Comments

The 30-day comment period ended September 16, 2012. During this period, HHSC received one comment from the Texas Health Care Association regarding the proposed amendments to these rules. A summary of the comment and HHSC's response follow.

Comment: Concerning §355.306(e), the commenter suggested that HHSC replace the term "final cost report" with the term "accountability report." The commenter understands the need for a final settlement/recoupment process for providers participating in the enhancement program, but believes that this can be accomplished just as well with the more abbreviated accountability report as with a full cost report. The commenter believes that this change would benefit both the agency and providers and would remain consistent with the agency's desire to simplify the system when possible.

Response: HHSC agrees that, in the situation described by the commenter, the provider should have to submit only an accountability report. This situation is addressed in §355.308(f)(2)(B), which states "When a participating facility changes ownership, the prior owner must submit a Staffing and Compensation Report covering the period from the beginning of the facility's cost reporting period to the date recognized by HHSC or its designee as the ownership-change effective date." In order to make this requirement clear in §355.306, HHSC has changed §355.306(e) to read "(e) Final cost reports for change of ownership. When a facility changes ownership, for a provider who participates in the rate enhancement program, the prior owner must submit a final Staffing and Compensation Report as described in §355.308 of this title. When a facility changes ownership, for a provider not participating in the rate enhancement program, the prior owner is excused from submitting a final cost report and, if its prior year's cost report is pending audit completion, the audit will be suspended and the cost report excluded from the final cost report database."

After the proposed rules were published in the Texas Register, the Centers for Medicare and Medicaid Services (CMS) approved a request from HHSC to not pursue a Section 1915(i) amendment. As a result of this approval, DADS has discontinued plans to add Day Activity and Health Services (DAHS) to the Community-Based Alternatives (CBA) and Medically Dependent Children Program (MDCP) waiver programs. Therefore, it is no longer necessary to add a reimbursement methodology for DAHS to the CBA and MDCP waivers. As a result, HHSC has withdrawn the proposed amendment to §355.507 and is adopting the amendment to §355.503 with changes to remove the language (proposed as subsection (c)(3)(7)) concerning the reimbursement methodology for DAHS.

Statutory Authority

The amendments are adopted under Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules necessary to carry out the commission's duties; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §531.021(a), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under the Texas Human Resources Code Chapter 32.