SECTION 355.727. Add-on Payment Methodology for Home and Community-Based Services Supervised Living and Residential Support Services  


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  • (a) Purpose of methodology. Direct care staffing add-on payments for Supervised Living and Residential Support Services add funds to the direct care portion of the rates specifically for attendant compensation. The recommended rates for Supervised Living and Residential Support Services are determined in accordance with §355.723 of this subchapter (relating to Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs).

    (b) Direct Care Staffing Add-on Payment Methodology. Effective January 1, 2020, through August 31, 2021, HHSC will pay an add-on to the direct care portion of the Supervised Living and Residential Support Services rates.

    (1) The add-on for each level of need (LON) is as follows:

    (A) $4.06 per unit for LON 1;

    (B) $4.53 per unit for LON 5;

    (C) $5.22 per unit for LON 8;

    (D) $6.04 per unit for LON 6; and

    (E) $8.45 per unit for LON 9.

    (2) The add-on is to be used only for attendant compensation as defined in §355.103(b)(1) of this chapter (relating to Specifications for Allowable and Unallowable Costs).

    (c) Reporting requirements.

    (1) All Home and Community-based Services (HCS) providers who deliver Supervised Living or Residential Support Services during the time period the add-on is in effect must comply with reporting requirements as described in §355.105(b) of this chapter (relating to General Reporting and Documentation Requirements, Methods, and Procedures) for each reporting period during the time period the add-on is in effect. Providers may be required to submit cost reports in addition to other reporting requirements to include those days in calendar years 2020 and 2021 not otherwise included in another report in which accountability has been determined. This report must be submitted for each component code if the provider requested participation individually or if the provider requested participation as a group. This report will be used as the basis for determining any recoupment amounts as described in subsection (f) of this section for the direct care staffing add-on reporting period. Participating providers failing to submit an acceptable Direct Care Staffing Compensation Report within 60 days of the date of the HHSC request for the report will be placed on vendor hold until such time as an acceptable report is received and processed by HHSC Rate Analysis.

    (2) Providers who do not participate in attendant compensation rate enhancement and deliver no Supervised Living or Residential Support Services during the time period the add-on is in effect may be excused from submitting an accountability report for the years in which an HCS cost report is not required.

    (d) Applicability of the Direct Care Staffing Add-on Spending Requirement.

    (1) The spending requirement is applicable to all HCS providers who deliver Supervised Living or Residential Support Services during the time period the add-on is in effect regardless of their participation status in the attendant compensation rate enhancement described in §355.112 of this chapter (relating to Attendant Compensation Rate Enhancement).

    (2) HCS providers who do not deliver Supervised Living or Residential Support Services during the time period the add-on is in effect are not subject to the spending requirement unless they participate in the attendant compensation rate enhancement described in §355.112 of this chapter.

    (e) Calculation of the Direct Care Staffing Add-on Spending Requirement.

    (1) HCS providers who deliver Supervised Living or Residential Support Services during the time period the direct care staffing add-on is in effect are required to spend at least 90 percent of the accrued direct care compensation revenue as defined in §355.103(b)(1) of this chapter and §355.722 of this subchapter (relating to Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers).

    (2) The direct care staffing revenues are the following.

    (A) For providers who do not participate in the attendant compensation rate enhancement described in §355.112 of this chapter, the base rate revenues as determined in §355.723 of this subchapter plus the direct care staffing add-on revenues; or

    (B) For providers who participate in the attendant compensation rate enhancement described in §355.112 of this chapter:

    (i) the base rate revenues as determined in §355.723 of this subchapter, plus;

    (ii) the attendant compensation rate enhancement revenues based on the provider's enrolled level as described in §355.112 of this chapter, plus;

    (iii) the direct care staffing add-on revenues.

    (3) HHSC will determine the direct care staffing add-on spending requirement per unit of service delivered using attendant compensation spending from the following sources:

    (A) the applicable cost report as specified in §355.105(b)-(c) of this chapter, or;

    (B) other appropriate data sources prescribed by HHSC.

    (f) Recoupment. The provider's compliance with the direct care staffing add-on spending requirement is determined based on the total attendant compensation spending for each component code and is calculated as follows.

    (1) The accrued direct care staffing revenue per unit of service is multiplied by 0.90 to determine the spending requirement per unit of service.

    (2) The accrued direct care staffing revenue per unit of service will be subtracted from the direct care staffing spending requirement per unit of service to determine the amount to be recouped.

    (A) If the accrued attendant compensation spending per unit of service is greater than or equal to the direct care staffing spending requirement per unit of service, there is no recoupment.

    (B) If the accrued attendant compensation spending per unit of service is less than the direct care staffing spending requirement per unit of service, the direct care staffing add-on spending revenues per unit of service that exceed the direct care staffing actual attendant compensation spending are recouped. The amount paid per unit of service after adjustments for recoupment must not be less than the base rate revenues as determined in §355.723 of this subchapter.

    (C) Notwithstanding §355.112(s), for providers who participate in the attendant compensation rate enhancement described in §355.112 of this chapter, any remaining recoupment will be subtracted from the attendant compensation rate enhancement. The amount paid per unit of service after adjustments for recoupment must not be less than the base rate revenues as determined in §355.723 of this subchapter.

    (3) Compliance with the spending requirement is determined separately for each component code.

    (g) Determination of compliance with spending requirements in the aggregate.

    (1) Definitions. The following words and terms have the following meanings when used in this subsection.

    (A) Combined entity--One or more commonly owned corporations and one or more limited partnerships where the general partner is controlled by the same identical persons as the commonly owned corporation or corporations.

    (B) Commonly owned corporations--Two or more corporations where five or fewer identical persons who are individuals, estates, or trusts own greater than 50 percent of the total voting power in each corporation.

    (C) Control--Greater than 50 percent ownership by the entity.

    (D) Entity--A parent company, sole member, individual, limited partnership, or group of limited partnerships controlled by the same general partner.

    (2) Aggregation. For an entity, for two or more commonly owned corporations, or for a combined entity that controls more than one participating contract or component code in the HCS program, compliance with the spending requirements detailed in subsection (f) of this section can be determined in the aggregate for all participating contracts or component codes in the HCS program controlled by the entity, commonly owned corporations, or combined entity at the end of the rate year, the effective date of the change of ownership of its last participating contract or component code in the program, or the effective date of the termination of its last participating contract or component code in the program rather than requiring each contract or component code to meet its spending requirement individually. Corporations that do not meet the definitions under paragraphs (1)(A) - (C) of this subsection are not eligible for aggregation to meet spending requirements.

    (A) Aggregation Request. To exercise aggregation, the entity, combined entity, or commonly owned corporations must submit an aggregation request, in a manner prescribed by HHSC, at the time each Direct Care Staffing Add-on Compensation Report or cost report is submitted. In limited partnerships in which the same single general partner controls all the limited partnerships, the single general partner must make this request. Other such aggregation requests will be reviewed on a case-by-case basis.

    (B) Frequency of Aggregation Requests. The entity, combined entity, or commonly owned corporations must submit a separate request for aggregation for each reporting period.

Source Note: The provisions of this §355.727 adopted to be effective January 1, 2020, 44 TexReg 8225