Current through Reg. 49, No. 38; September 20, 2024
(a) In conducting
reimbursement reviews for adjustments, the Texas Health and Human Services
Commission (HHSC) takes into consideration changes in laws, rules, regulations,
policies, guidelines, or economic factors which will have a demonstrable
material impact on most contracted providers' costs of providing services
meeting federal and state standards.
(1) HHSC
may recommend adjustments to reimbursement when federal or state laws, rules,
regulations, policies, or guidelines are adopted, promulgated, judicially
interpreted, or otherwise changed in ways that affect allowable costs. The law,
rule, regulation, policy, or guideline change must result in necessary changes
in allowable costs that:
(A) affect most, if
not all, contracted providers; and
(B) require contracted providers to take
definitive action to incur additional allowable costs not included in the cost
database used to determine reimbursements and which would not otherwise be
covered in reimbursements.
(2) HHSC may recommend adjustments to
reimbursement when it can be clearly demonstrated that changes in economic
factors will result in changes in allowable costs. The changes in economic
factors must result in changes in allowable costs that:
(A) affect most, if not all, providers;
and
(B) are allowable cost changes
that the providers have little or no control over and are allowable costs that
are not included in the cost database used to determine reimbursements and
which would not otherwise be covered in reimbursements.
(3) HHSC may recommend adjustments to
reimbursement when there is a change to any of the unemployment insurance tax
components detailed in subparagraphs (A) - (D) of this paragraph. If
unemployment insurance tax rates for the prospective reimbursement period are
not available at the time reimbursement is prepared for public comment, the
most recent known tax rates are assumed to remain in effect.
(A) The calendar year average Texas
Unemployment Compensation Tax Act (TUCA) rate, as calculated by the Texas
Workforce Commission (TWC); or
(B)
if HHSC has determined that a specific program will have significantly higher
or lower average unemployment tax costs than the average industry in Texas, the
calendar year average effective TUCA rate for the North American Industry
Classification System code or codes pertinent to that specific program, as
calculated by TWC; or
(C) the rate
of tax set by the Federal Unemployment Tax Act; or
(D) the maximum credits against tax set by
the Federal Unemployment Tax Act.
(b) HHSC may recommend adjustments to
reimbursement for the reasons stated in subsection (a)(1) of this section at
the earliest feasible opportunity in order for the adjustment to become
effective on the effective date of the federal or state laws, rules,
regulations, policies, or guidelines. In the case of Medicaid state plan
program reimbursements, the adjustments will not be effective until after the
federal requirements for notice are met.
(c) HHSC may recommend adjustments to
reimbursement when federal or state funding is changed in ways that affect the
available funding for programs.
