Texas Register, Volume 38, Number 26, Pages 4053-4242, June 28, 2013 Page: 4,100
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costs and other statistics from the most recently audited cost reports
from providers delivering similar care.
(ii) Non-direct care costs. The rate component for
the non-direct care cost center will be equal to the non-attendant portion
of the non-apartment assisted living rate per day for non-participants in
the Attendant Compensation Rate Enhancement. Providers receiving
the Personal Care 3 rate are not eligible to participate in the Attendant
Compensation Rate Enhancement and receive direct care add-on's to
the Personal Care 3 rates.
(3) Emergency Response Services. The reimbursement for
Emergency Response Services will be determined as monthly reim-
bursement ceiling, based on the ceiling amount determined in accor-
dance with 355.510 of this title (relating to Reimbursement Method-
ology for Emergency Response Services (ERS)).
(4) Requisition fees. Requisition fees are reimbursements
paid to the CBA home and community support services contracted
providers for their efforts in acquiring adaptive aids, medical supplies,
dental services, and minor home modifications for CBA participants.
Reimbursement for requisition fees for adaptive aids, medical supplies,
dental services, and minor home modifications will vary based on the
actual cost of the adaptive aids, medical supplies, dental services, and
minor home modifications. Reimbursements are determined using a
method based on modeled projected expenses, which are developed by
using data from surveys; cost report data from similar programs; con-
sultation with other service providers and/or professionals experienced
in delivering contracted services; and/or other sources.
(5) Pre-enrollment expense fee. Reimbursement for pre-
enrollment assessment is determined using a method based on mod-
eled projected expenses that are developed by using data from surveys;
cost report data from other similar programs; consultation with other
service providers and/or professionals experienced in delivering con-
tracted services; and other sources.
(6) Home-Delivered Meals. The reimbursement for
Home-Delivered Meals will be determined on a per meal basis, based
on the ceiling amount determined in accordance with 355.511 of this
title (relating to Reimbursement Methodology for Home-Delivered
Meals).
(7) Exceptions to the reimbursement determination
methodology. HHSC may adjust reimbursement if new legislation,
regulations, or economic factors affect costs, according to 355.109 of
this title (relating to Adjusting Reimbursement When New Legislation,
Regulations, or Economic Factors Affect Costs).
(d) Authority to determine reimbursement. The authority to
determine reimbursement is specified in 355.101 of this title [(relating
to ntroduction).
(e) Reporting of cost.
(1) Cost reporting guidelines. If HHSC requires a cost re-
port for any waiver service in this program, providers must follow the
cost-reporting guidelines as specified in 355.105 of this title (relating
to General Reporting and Documentation Requirements, Methods, and
Procedures).
(2) Excused from submission of cost reports. If required
by HHSC, a contracted provider must submit a cost report unless the
provider meets one or more of the conditions in 355.105(b)(4)(D) of
this title.
(3) Number of cost reports to be submitted.
(A) Contracted providers participating in the attendant
compensation rate enhancement.(i) At the same level of enhancement. If all the con-
tracts under the legal entity participate in the enhancement at the same
level of enhancement, the contracted provider must submit one cost re-
port for the legal entity.
(ii) At different levels of enhancement. If all the
contracts under the legal entity participate in the enhancement but they
participate at more than one enhancement level, the contracted provider
must submit one cost report for each level of enhancement.
(B) Contracted providers not participating in the atten-
dant compensation rate enhancement. If all the contracts under the le-
gal entity do not participate in the enhancement, the contracted provider
must submit one cost report for the legal entity.
(C) Contractors participating and not participating in at-
tendant compensation rate enhancement.
(i) At the same level of enhancement. If some of the
contracts under the legal entity do not participate in the enhancement
and the rest of the contracts under the legal entity participate at the same
level of enhancement, the contracted provider must submit:participate; and
ticipate.(I) one cost report for the contracts that do not
(II) one cost report for the contracts that do par-(ii) At different levels of enhancement. If some of
the contracts under the legal entity do not participate in the enhance-
ment and the rest of the contracts under the legal entity participate in
the enhancement but they participate at more than one enhancement
level, the contracted provider must submit:
(I) one cost report for the contracts that do not
participate; and
(II) one cost report for each level of enhance-
ment.
(4) Reporting and verification of allowable cost.
(A) Providers are responsible for reporting only allow-
able costs on the cost report, except where cost report instructions in-
dicate that other costs are to be reported in specific lines or sections.
Only allowable cost information is used to determine recommended
reimbursements. HHSC excludes from reimbursement determination
any unallowable expenses included in the cost report and makes the
appropriate adjustments to expenses and other information reported by
providers; the purpose is to ensure that the database reflects costs and
other information which are necessary for the provision of services,
and are consistent with federal and state regulations.
(B) Individual cost reports may not be included in the
database used for reimbursement determination if:
(i) there is reasonable doubt as to the accuracy or
allowability of a significant part of the information reported; or
(ii) an auditor determines that reported costs are not
verifiable.
(5) Allowable and unallowable costs. Providers must fol-
low the guidelines in determining whether a cost is allowable or unal-
lowable as specified in 355.102 and 355.103 of this title (relating to
General Principles of Allowable and Unallowable Costs, and Specifi-
cations for Allowable and Unallowable Costs), in addition to the fol-
lowing.
(A) Client room and board expenses are not allowable,
except for those related to respite care.38 TexReg 4100 June 28, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 26, Pages 4053-4242, June 28, 2013, periodical, June 28, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth313178/m1/48/: accessed April 25, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.