Texas Register, Volume 20, Number 1, Pages 1-46, January 3, 1995 Page: 13
46 p. ; 28 cm.View a full description of this periodical.
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Texas Health and Human Services Commis-
sion with the authority to administer federal
medical assistance funds.
The repeal implements Texas Human Re-
sources Code, 22.002, 32. 001-32.040,
and Texas Civil Statutes, Article 4413(502),
16.
409.118. Reimbursement Methodology f,",
Home and and Community-based Services
(HCS).
This agency hereby certifies that the proposal
has been reviewed by legal counsel and
found to be within the agency's authority to
adopt.
Issued in Austin, Texas, on December 23,
1994.
TRD-9452815 Ann Utley
Chair, Texas MHMR Board
Texas Department of
Mental Health Mental
Retardation
Earliest possible date of adoption: February
3, 1995
For further information, please call: (512)
206-4516
The Texas Department of Mental Health and
Mental Retardation (TDMHMR) proposes
new 409.118 of Chapter 409, Subchapter D,
concerning home and community-based ser-
vices (HCS). Existing 409.118 of the
subchapter is proposed for repeal contempo-
raneously in this issue of the Texas Register.
The purpose of new 409.118 is to establish
cost determination rules that are consistent
with rules of the Texas Department of Human
Services (TDHS), provide explicit guidelines
for auditors, provide specific instructions con-
cerning cost reporting, and provide guidelnes
in areas such as documentation and alloca-
tion methods. Similar provisions have been
proposed contemporaneously in this issue of
the Texas Register by the TDHS for those
Medicaid programs for which that agency is
the state operating agency.
Leilani Rose, director, Financial Services De-
partment, has determined that for each year
of the first five-year period the new section is
in effect there will be no fiscal implications as
a result of implementing the provisions as
proposed. There is no anticipated local eco-
nomic impact
Ernest McKenney, director, Medicaid Admin-
istration, has determined that for each year of
the first five years the amendments are in
effect the public benefit anticipated as a result
of enforcing the sections will be the increased
use of federal funds as opposed to state
funds and the expansion of the current ser-
vice array, as well as having a single set of
guidelines for all Medicaid programs, whether
administered by TDMHMR or the Texas De-
partment of Human Services, to facilitate fi-
nancial accountability relating to service
delivery. There is no anticipated economic
cost to persons who are required to comply
with the proposed sections. There will be no
effect on small businesses.Written comments on the proposal may be
sent to Linda Logan, Director, Policy Devel-
opmert, Texas Department of Mental Health
and Mental Retardation, P.O. Box 12668,
Austin, Texas 78711-2668, within 30 days of
publication.
The new section proposed under the Health
and Safety Code, 532.015(a), which provide
the Texas Mental Health and Mental Retarda-
tion Board with broad rulemaking powers;
and under the provisions of Texas Civil Stat-
utes, Article 4413(502) 16, which provide
the Texas Health and Human Services Com-
mission with the authority to administer fede-
ral medical assistance funds.
The new section implements Texas Human
Resources Code, 22.002, 32 00-
1-32.040, and Texas Civil Statutes, Article
4413(502), 16.
409.118. Reimbursement Methodology for
Home and Community-based Services
(HCS).
(a) General information.
(1) TDMHMR reimburses quali-
fied providers for HCB services provided to
eligible persons.
(2) TDMHMR determines reim-
bursement in accordance with 409.1-409.2,
and 409.8-409.11 of Chapter 409,
Subchapter D of this title (relating to Gen-
eral Reimbursement Methodology for Medi-
cal Assistance Programs). These rates are
uniform, determined prospectively, cost re-
lated, and determined annually.
(3) Providers must follow the
cost reporting guidelines as specified in
409.12 of this title (relating to General
Reporting and Documentation Require-
ments, Methods and Procedures).
(A) All contracted providers
rust submit a cost report if the provider
delivered services for at least thirty consec-
utive days during the provider's fiscal year.
If the provider is a new provider, the thirty
consecutive days of service begin with the
first TDMHMR client served.
(B) The provider may be ex-
cused from submitting a cost report if cir-
cumstances beyond the control of the
provider make cost report completion im-
possible, such as the loss of records due to
natural disasters or removal of records from
the provider's custody by any governmental
entity. Requests to be excused from submit-
ting a cost report must be received by the
Rate Analysis Department of TDHS before
the due date of the cost report.
(b) Reimbursement determination.
Providers must follow the cost reporting
guidelines as specified in 409.12 of this
title (relating to General Reporting and
Documentation Requirements, Methods and
Procedures).(1) Providers are responsible for
reporting only allowable costs on the cost
report, except where cost report instructions
indicate that other costs are to be reported
in specific lines or sections. Only allowable
cost information is used to determine rec-
ommended reimbursements. DHS excludes
from reimbursement determination any un-
allowable expenses included in the cost re-
port and makes the appropriate adjustments
to expenses and other information reported
by providers. The purpose is to ensure that
the data base reflects costs and other infor-
mation which are necessary for the provi-
sion of services and are consistent with
federal and state regulations. Individual cost
reports may not be included in the data base
used for reimbursement determination when
there is reasonable doubt as to the accuracy
or allowability of a significant part of the
information reported; when there is reason-
able doubt that a provider entity reflected
economic and efficient operation and long
term viability, due to low utilization or op-
eration for less than a full fiscal year; or
when an auditor determines that reported
costs are not verifiable.
(2) Reimbursement Determina-
tion Process.
(A) Total allowable costs for
each provider will be determined by analyz-
ing the allowable historical costs reported
on the cost report and other pertinent cost
survey information.
(B) Allowable costs are
grouped into cost centers which reflect the
operations and service delivery for this pro-
gram. Specific cost centers can be provided
upon request.
(C) Each provider's total al-
lowable costs, excluding depreciation and
mortgage interest, are projected from the
historical cost reporting period to the pro-
spective rate period as described in 409.15
of this title (relating to Determination of
Inflation Indices).
(D) Payroll taxes and em-
ployee benefits are allocated to each salary
line item on the cost report on a pro rata
basis based on the portion of that salary line
item to the amount of total salary expense
for the appropriate group of staff. Employee
benefits will be charged to a specific salary
line item if the benefits are reported sepa-
rately. The allocated payroll taxes are Fede-
ral Insurance Contributions Act (FICA) or
Social Security, Medicare Contributions,
Workers' Compensation Insurance (WCI)
and the Federal and State Unemployment (-
FUTA/SUTA).
(E) An allowable cost per
client day of service is calculated for each
cost center. The allowable costs per client. PROPOSED RULES January 3, 1995 29 TexReg 13
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Texas. Secretary of State. Texas Register, Volume 20, Number 1, Pages 1-46, January 3, 1995, periodical, January 3, 1995; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth176733/m1/13/: accessed April 24, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.