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 355.507 - Reimbursement Methodology for the Medically Dependent Children Program

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
				  Commission (HHSC) determines payment rates for qualified contracted providers
				  for the provision of services in the Medically Dependent Children Program
				  (MDCP). HHSC applies the general principles of cost determination as specified
				  in §
										RSA 355.101 of this
				  title (relating to Introduction).
(b) The rates for nursing services provided
				  by a registered nurse (RN) or licensed vocational nurse (LVN) will be
				  determined in accordance with §
										RSA
				  355.502 of this title (Relating to
				  Reimbursement Methodology for Common Services in Home and Community-Based
				  Services Waivers).
(c) The rates
				  for personal assistance services (PAS) without delegation of the service by an
				  RN will be based upon the Community-Based Alternatives (CBA) approved rates for
				  PAS in accordance with §
										RSA
				  355.503 of this title (relating to
				  Reimbursement Methodology for the Community-Based Alternatives Waiver Program
				  and the Integrated Care Management-Home and Community Support Services and
				  Assisted Living/Residential Care Programs) and §
										RSA
				  355.112(l) of this title
				  (relating to Attendant Compensation Rate Enhancement). The rates for PAS with
				  delegation of the service by an RN will be based upon the Community-Based
				  Alternatives (CBA) approved rates for PAS in accordance with §
										RSA
				  355.503 of this title and the add-on payment
				  for the highest level of attendant compensation rate enhancement in accordance
				  with §
										RSA
				  355.112(n) of this
				  title.
(d) The rate ceiling for
				  camp services will be equivalent to the Community Living Assistance and Support
				  Services direct service agency (CLASS DSA) out-of-home respite rate. Actual
				  payments for this service will be the lesser of the rate ceiling or the actual
				  cost of the camp.
(e)
				  Facility-based respite care rates are determined on a 24-hour basis. The rates
				  for facility-based respite care are calculated at 77 percent of the daily
				  nursing facility base rates by level of care. The base rates used in this
				  calculation do not include nursing facility rate add-ons.
(f) The rates for supported employment and
				  employment assistance will be based upon the CBA approved rates for supported
				  employment and employment assistance in accordance with §
										RSA
				  355.503 of this title.
(g) The following sections of this title will
				  apply to cost reports or surveys required to obtain the necessary information
				  to determine new payment rates: §
										RSA
				  355.102 of this title (relating to General
				  Principles of Allowable and Unallowable Costs), §
										RSA
				  355.103 of this title (relating to
				  Specifications for Allowable and Unallowable Costs), §
										RSA 355.104 of this
				  title (relating to Revenues), §
										RSA
				  355.105 of this title (relating to General
				  Reporting and Documentation Requirements, Methods, and Procedures), §
										RSA
				  355.106 of this title (relating to Basic
				  Objectives and Criteria for Audit and Desk Review of Cost Reports), §
										RSA
				  355.107 of this title (relating to
				  Notification of Exclusions and Adjustments), §
										RSA
				  355.108 of this title (relating to
				  Determination of Inflation Indices), §
										RSA
				  355.109 of this title (relating to Adjusting
				  Reimbursement When New Legislation, Regulations, or Economic Factors Affect
				  Costs), §
										RSA
				  355.110 of this title (relating to Informal
				  Reviews and Formal Appeals), and §
										RSA
				  355.111 of this title (relating to
				  Administrative Contract Violations).