Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter E - COMMUNITY CARE FOR AGED AND DISABLED › Section 355.505 - Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program

Current through Reg. 49, No. 28; July 12, 2024
(a) General
				  requirements. The Texas Health and Human Services Commission (HHSC) applies the
				  general principles of cost determination as specified in §
										RSA 355.101 of this
				  title (relating to Introduction). Providers are reimbursed for waiver services
				  provided to Medicaid-enrolled persons with related conditions. Additionally,
				  providers will be reimbursed a one-time administrative expense fee for a
				  pre-enrollment assessment of potential waiver participants. The pre-enrollment
				  assessment covers care planning for the participant.
(b) Reporting of cost.
(1) Providers must follow the cost reporting
				  guidelines as specified in §
											RSA
				  355.105 of this title (relating to General
				  Reporting and Documentation Requirements, Methods, and Procedures).
(2) Number of cost reports to be submitted.
				  All legal entities must submit a cost report unless the number of days between
				  the date the legal entity's first Texas Department of Aging and Disability
				  Services (DADS) client received services and the legal entity's fiscal year end
				  is 30 days or fewer.
(A) Contracted providers
				  participating in the attendant compensation rate enhancement.
(i) At the same level of enhancement. If all
				  the contracts under the legal entity participate in the enhancement at the same
				  level of enhancement, the contracted provider must submit one cost report 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 attendant compensation rate
				  enhancement. If all the contracts under the legal 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 attendant 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:
(I) one cost report for the contracts that do
				  not participate; and
(II) one cost
				  report for the contracts that do participate.
(ii) At different levels 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 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
				  enhancement.
(3) 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 §
											RSA
				  355.105(b)(4)(D) of this
				  title.