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 355.308 - Direct Care Staff Rate Component

Current through Reg. 49, No. 28; July 12, 2024
(a) Direct care
				  staff cost center. This cost center will include compensation for employee and
				  contract labor Registered Nurses (RNs), including Directors of Nursing (DONs)
				  and Assistant Directors of Nursing (ADONs); Licensed Vocational Nurses (LVNs),
				  including DONs and ADONs; medication aides; and nurse aides performing
				  nursing-related duties for Medicaid contracted beds.
(1) Compensation to be included for these
				  employee staff types is the allowable compensation defined in §
											355.103(b)(1) of
				  this title (relating to Specifications for Allowable and Unallowable Costs)
				  that is reported as either salaries and/or wages (including payroll taxes and
				  workers' compensation) or employee benefits. Benefits required by §
											355.103(b)(1)(A)(iii)
				  of this title to be reported as costs applicable to specific cost report line
				  items are not to be included in this cost center.
(2) Direct care staff who also have
				  administrative duties not related to nursing must properly direct charge their
				  compensation to each type of function performed based upon daily time sheets
				  maintained throughout the entire reporting period.
(3) Nurse aides must meet the qualifications
				  enumerated under 26 TAC §
											556.3(relating to Nurse Aide
				  Training and Competency Evaluation Program (NATCEP) Requirements) to be
				  included in this cost center. Nurse aides include certified nurse aides and
				  nurse aides in training.
(4)
				  Contract labor refers to personnel for whom the contracted provider is not
				  responsible for the payment of payroll taxes (such as FICA, Medicare, and
				  federal and state unemployment insurance) and who perform tasks routinely
				  performed by employees. Allowable contract labor costs are defined in §
											355.103(b)(3) of
				  this title.
(5) For facilities
				  receiving supplemental reimbursement for children with tracheostomies requiring
				  daily care as described in §
											355.307(b)(3)(F)
				  of this title (relating to Reimbursement Setting Methodology), staff required
				  by 26 TAC §
											554.901(15)(C)(iii)
				  (relating to Quality of Care) performing nursing-related duties for Medicaid
				  contracted beds are included in the direct care staff cost center.
(6) For facilities receiving supplemental
				  reimbursement for qualifying ventilator-dependent residents as described in
				  §
											355.307(b)(3)(E)
				  of this title, Registered Respiratory Therapists and Certified Respiratory
				  Therapy Technicians are included in the direct care staff cost
				  center.
(7) Nursing facility
				  administrators and assistant administrators are not included in the direct care
				  staff cost center.
(8) Staff
				  members performing more than one function in a facility without a differential
				  in pay between functions are categorized at the highest level of licensure or
				  certification they possess. If this highest level of licensure or certification
				  is not that of an RN, LVN, medication aide, or certified nurse aide, the staff
				  member is not to be included in the direct care staff cost center but rather in
				  the cost center where staff members with that licensure or certification status
				  are typically reported.
(9) Paid
				  feeding assistants are not included in the direct care staff cost center and
				  are not to be counted toward the staffing requirements described in subsection
				  (j) of this section. Paid feeding assistants are intended to supplement
				  certified nurse aides, not to be a substitute for certified or licensed nursing
				  staff.