Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter C - REIMBURSEMENT METHODOLOGY FOR NURSING FACILITIES › Section 355.307 - Reimbursement Setting Methodology

Current through Reg. 49, No. 28; July 12, 2024
(a) Case
				  mix classes. The Texas Health and Human Services Commission (HHSC)
				  reimbursement rates for nursing facilities (NFs) vary according to the assessed
				  characteristics of the recipient. Rates are determined for 34 case mix classes
				  of service, plus a 35th, temporary classification assigned by default when
				  assessment data are incomplete or in error and a 36th classification assigned
				  by default when an assessment is missing.
(b) Reimbursement determination. HHSC applies
				  the general principles of cost determination as specified in §
										RSA 355.101 of this
				  title (relating to Introduction).
(1) Rate
				  Components. Under the case mix methodology, reimbursements are comprised of
				  five cost-related components: the direct care staff component; the other
				  recipient care component; the dietary component; the general/administration
				  component; and the fixed capital asset component. The direct care staff
				  component is calculated as specified in §
											RSA
				  355.308 of this title (relating to Direct
				  Care Staff Rate Component).
(A) The dietary
				  rate component is constant across all case mix classes and is calculated at the
				  median cost (weighted by Medicaid days of service in the rate base) in the
				  array of projected allowable per diem costs for all contracted nursing
				  facilities included in the rate base, multiplied by 1.07.
(B) The general/administration rate component
				  is constant across all case mix classes and is calculated at the median cost
				  (weighted by Medicaid days of service in the rate base) in the array of
				  projected allowable per diem costs for all contracted nursing facilities
				  included in the rate base, multiplied by 1.07.
(C) The fixed capital asset component is
				  constant across all case mix classes and is calculated as follows:
(i) Determine the 80th percentile in the
				  array of allowable appraised property values per licensed bed, including land
				  and improvements. Appraised values for this purpose are determined as follows:
(I) For proprietary facilities, tax exempt
				  facilities provided an appraisal from their local property taxing authority,
				  and tax exempt facilities not provided an appraisal from their local property
				  taxing authority because of an "exempt" status whose independent appraisal is
				  in the first year of its five-year interval as described in §
														RSA
				  355.306(g)(2)(B)(ii) of this
				  title (relating to Cost Finding Methodology), allowable appraised values are
				  determined as described in §
														RSA
				  355.306(g) of this title
				  (relating to Cost Finding Methodology).
(II) For tax exempt facilities not provided
				  an appraisal from their local property taxing authority because of an "exempt"
				  status whose independent appraisal is not in the first year of its five-year
				  interval as described in §
														RSA
				  355.306(g)(2)(B)(ii) of this
				  title (relating to Cost Finding Methodology), allowable appraised values are
				  determined by indexing the facility's allowable appraised value as determined
				  in §
														RSA
				  355.306(g) of this title
				  (relating to Cost Finding Methodology) to the median increase in appraised
				  values among contracted facilities in the state as a whole from the reporting
				  period coinciding with the first year of the facility's five-year interval to
				  the reporting period upon which reimbursements are to be based.
(III) Those facilities that do not report an
				  allowable appraised value as described in §
														RSA
				  355.306(g) of this title
				  (relating to Cost Finding Methodology) are not included in the array for
				  purposes of calculating the use fee.
(ii) Project the 80th percentile of appraised
				  property values per bed by one-half the forecasted increase in the personal
				  consumption expenditures (PCE) chain-type price index from the cost reporting
				  year to the rate year.
(iii)
				  Calculate an annual use fee per bed as the projected 80th percentile of
				  appraised property values per bed times an annual use rate of 14%.
(iv) Calculate a per diem use fee per bed by
				  dividing the annual use fee per bed by annual days of service per bed at the
				  higher of 85% occupancy, or the statewide average occupancy rate during the
				  cost reporting period.
(v) The use
				  fee is limited to the lesser of the fee as calculated in clauses (i) - (iv) of
				  this subparagraph, or the fee as calculated by inflating the fee from the
				  previous rate period by the forecasted rate of change in the PCE chain-type
				  price index.