Current through Reg. 49, No. 38; September 20, 2024
(a) Introduction. The Texas Health and Human
Services Commission (HHSC) establishes the Nursing Care Staff Rate Enhancement
Program for Nursing Facilities on or after September 1, 2025. The Nursing Care
Staff Rate Enhancement Program for Nursing Facilities established under this
section will be implemented pending implementation of the Patient Driven
Payment Model (PDPM) for Long-Term Care (LTC), as specified in §355.318 of
this subchapter (relating to Reimbursement Setting Methodology for Nursing
Facilities on or after September 1, 2025).
(b) Definitions. The following words and
terms, when used in this section, have the following meanings unless the
context clearly indicates otherwise.
(1)
Combined entity--Combined entities consist of one or more commonly owned
corporations and one or more limited partnerships, where the general partner is
controlled by the same person as the commonly owned corporation.
(2) Commonly owned corporations--Commonly
owned corporations are two or more corporations where five or fewer identical
persons who are individuals, estates, or trusts control greater than 50 percent
of the total voting power in each corporation.
(3) Control--The entity has greater than 50
percent ownership.
(4) Enrollment
contract amendment--An acceptable enrollment contract amendment is defined as a
legible document requesting a change in enrollment status that has been
completed according to instructions, signed by an authorized representative per
the HHSC signature authority designation form applicable to the provider's
contract or ownership type, and received by HHSC within 30 days of HHSC's
notification to the facility that an enrollment contract amendment must be
submitted.
(A) An initial enrollment contract
amendment is required from each facility choosing to participate in the Nursing
Care Staff Rate Enhancement Program.
(B) Participating and nonparticipating
facilities may request to modify their enrollment status (i.e., a
nonparticipant can request to become a participant, a participant can request
to become a nonparticipant, or a participant can request to change its
enhancement level) during any open enrollment period.
(C) Nonparticipants and participants
requesting to increase their enrollment levels will be limited to increases of
three or fewer enhancement levels during any single open enrollment period
unless HHSC waives such limits.
(D)
Requests to modify a facility's enrollment status during an open enrollment
period must be received by HHSC by the last day of the open enrollment period
as per paragraph (8) of this subsection.
(i)
If the last day of the open enrollment period falls on a weekend, national
holiday, or state holiday, then the first business day following the last day
of the open enrollment period is the final day the enrollment contract
amendment will be accepted.
(ii) An
enrollment contract amendment that is not received by the stated deadline will
not be accepted.
(iii) A facility
from which HHSC has not received an acceptable request to modify its enrollment
by the last day of the open enrollment period will continue at the level of
participation in effect during the open enrollment period, within available
funds. The facility will continue at that level of enrollment until the
facility notifies HHSC following subsection (n) of this section that it no
longer wishes to participate, or until the facility's enrollment is limited
according to subsection (g) of this section.
(E) If HHSC determines that funds are not
available to continue participation at the level in effect during the open
enrollment period, facilities will be notified as per subsection (v) of this
section.
(5) Entity--An
entity is a parent company, sole member, individual, limited partnership, or
group of limited partnerships controlled by the same general partner.
(6) Nursing care staff base rate--The nursing
care staff base rate is equal to the adopted nursing rate component as
specified in §355.318 of this subchapter.
(7) Nursing care staff cost center--The
nursing care staff cost center is equal to the PDPM LTC nursing rate component
as specified in §355.318 of this subchapter.
(8) Open enrollment--Open enrollment begins
on the first day of July and ends on the thirty-first day of July, preceding
the rate year for which payments are being determined. HHSC notifies providers
of open enrollment via email sent to an authorized representative per the
signature authority designation form applicable to the provider's contract or
ownership type. Requests to modify a provider's enrollment status during an
open enrollment period must be received by HHSC by the last day of the open
enrollment period through HHSC's enrollment portal or another method designated
by HHSC. If the last day of open enrollment is on a weekend day, state holiday,
or national holiday, the next business day will be considered the last day
requests will be accepted. If open enrollment has been postponed or canceled,
HHSC will notify providers by email before the first day of July. Should
conditions warrant, HHSC may conduct additional enrollment periods during a
rate year.
(9) Rate year--The
standard rate year begins on the first day of September and ends on the last
day of August of the following year.
(10) Responsible entity--The contracted
provider, owner, or legal entity that received the recouped revenue is
responsible for the repayment of any recoupment amount.
(11) Staffing and compensation report--A
staffing and compensation report is a report reflecting the provider's
activities while delivering contracted services from the first day through the
last day of the rate year or provider's cost report year while participating in
the Nursing Care Staff Rate Enhancement Program. Staffing and compensation
reports and cost reports functioning as staffing and compensation reports will
include any information required by HHSC to implement the Nursing Care Staff
Rate Enhancement Program. Staffing and compensation reports must be submitted
annually or as specified in subsection (d) of this section. Cost and
accountability reports requested by HHSC are considered staffing and
compensation reports, and preparers must complete mandatory training
requirements per §
355.102(d) of this
subchapter (relating to General Principles of Allowable and Unallowable Costs).
Staffing and compensation reports will be used as the basis for determining
compliance with the spending requirements and recoupment amounts as described
in subsection (k) of this section. Participating facilities failing to submit
an acceptable annual staffing and compensation report within 60 days of
notification of the due date for the report as determined by HHSC will be
placed on vendor hold until an acceptable report is received and processed by
HHSC.
(c) Enrollment for
new facilities. For purposes of this section, for each rate year, a new
facility is defined as a facility delivering its first day of service to a
Medicaid recipient after the first day of the open enrollment period, as
defined in subsection (b)(8) of this section. Facilities that underwent an
ownership change are not considered new facilities. New facilities will receive
the nursing rate component as determined in §355.318 of this subchapter
with no enhancements. For new facilities specifying their desire to participate
in an acceptable enrollment contract amendment, the nursing rate component is
adjusted as specified in subsection (j) of this section, effective on the first
day of the month following receipt by HHSC of the acceptable enrollment
contract amendment. If the granting of newly requested enhancements was limited
as per subsection (g) of this section during the most recent enrollment,
enrollment for new facilities will be subject to that same
limitation.
(d) Reporting
requirements.
(1) All participating facilities
will provide HHSC, in a method specified by HHSC, an annual staffing and
compensation report reflecting the activities of the facility while delivering
contracted services from the first day through the last day of the rate
year.
(2) When a participating
facility changes ownership, the prior owner must submit a staffing and
compensation report covering the period from the beginning of the rate year to
the date recognized by HHSC or its designee as the ownership-change effective
date. This report will be used as the basis for determining any recoupment
amounts as described in subsection (k) of this section. The new owner will be
required to submit a staffing and compensation report covering the period from
the day after the date recognized by HHSC or its designee as the ownership
change effective date to the end of the rate year.
(3) Participating facilities whose contracts
are terminated either voluntarily or involuntarily must submit a staffing and
compensation report covering the period from the beginning of the rate year to
the date recognized by HHSC or its designee as the contract termination date.
This report will be used as the basis for determining any recoupment amounts as
described in subsection (k) of this section.
(4) Participating facilities who voluntarily
withdraw from participation as per subsection (n) of this section must submit a
staffing and compensation report within 60 days of the due date of the report
as determined by HHSC, covering the period from the beginning of the rate year
to the date of withdrawal as determined by HHSC. This report will be used as
the basis for determining any recoupment amounts as described in subsection (k)
of this section.
(5) For new
facilities, as defined in subsection (c) of this section, the reporting period
will begin with the effective date of participation in enhancement.
(6) Existing facilities that become
participants in the enhancement as a result of the open enrollment process
described in subsection (b)(8) of this section on any day other than the first
day of their fiscal year are required to submit a staffing and compensation
report with a reporting period that begins on their first day of participation
in the enhancement and ends on the last day of the facility's fiscal year. This
report will be used as the basis for determining any recoupment amounts as
described in subsection (k) of this section.
(7) A participating provider that is required
to submit a staffing and compensation report under this paragraph will be
excused from the requirement to submit a report if the provider did not provide
any billable services to Medicaid recipients during the reporting
period.
(8) Reports must be
received before the date the provider is notified of compliance with spending
requirements for the report in question as per subsection (k) of this
section.
(9) HHSC may require other
staffing and compensation reports from all facilities as needed.
(e) Vendor hold. HHSC or its
designee will place on hold the vendor payments for any participating facility
that does not submit a timely report as described in subsection (d) of this
section. This vendor hold will remain in effect until HHSC receives an
acceptable report.
(1) Participating
facilities that do not submit an acceptable report completed in compliance with
all applicable rules and instructions within 60 days of the due dates described
in this subsection or, for cost reports, the due dates described in §
355.105(b) of this
chapter (relating to General Reporting and Documentation Requirements, Methods,
and Procedures), will become nonparticipants retroactive to the first day of
the reporting period in question and will be subject to immediate recoupment of
funds related to participation paid to the facility for services provided
during the reporting period in question. These facilities will remain
nonparticipants, and recouped funds will not be restored until they submit an
acceptable report and repay to HHSC or its designee funds identified for
recoupment from subsection (k) of this section. If an acceptable report is not
received within 365 days of the due date, the recoupment will become permanent,
and if all funds associated with participation during the reporting period in
question have been recouped by HHSC or its designee, the vendor hold associated
with the report will be released.
(2) Participating facilities with an
ownership change or contract termination that do not submit an acceptable
report completed in accordance with all applicable rules and instructions
within 60 days of notification of the due date for the report as determined by
HHSC will become nonparticipants retroactive to the first day of the reporting
period in question. These facilities will be subject to an immediate recoupment
of funds related to participation paid to the facility for services provided
during the reporting period in question. These facilities will remain
nonparticipants, and recouped funds will not be restored until they submit an
acceptable report and repay to HHSC or its designee funds identified for
recoupment from subsection (k) of this section. If an acceptable report is not
received within 365 days of the change of ownership or contract termination
date, the recoupment will become permanent, and if all funds associated with
participation during the reporting period in question have been recouped by
HHSC or its designee, the vendor hold associated with the report will be
released.
(f) Completion
of Reports. All staffing and compensation reports must be completed in
compliance with the provisions of §§
355.102-
355.105 of this chapter (relating
to General Principles of Allowable and Unallowable Costs; Specifications for
Allowable and Unallowable Costs; Revenues; and General Reporting and
Documentation Requirements, Methods, and Procedures, respectively) and may be
reviewed or audited in accordance with §
355.106 of this chapter (relating
to Basic Objectives and Criteria for Audit and Desk Review of Cost Reports).
All staffing and compensation reports must be completed by preparers who have
attended the required nursing facility cost report training as per §
355.102(d) of this
chapter.
(g) Enrollment
limitations. A facility will not be enrolled in the Nursing Care Staff Rate
Enhancement Program at a level higher than the level it achieved on its most
recently available audited staffing and compensation report. HHSC will notify a
facility of its enrollment limitations (if any) before the first day of the
open enrollment period.
(1) Notification of
enrollment limitations. The enrollment limitation level is indicated in the
State of Texas Automated Information Reporting System (STAIRS), the online
application for submitting cost and accountability reports. STAIRS will
generate an email to the entity contact, indicating that the facility's
enrollment limitation level is available for review. The entity contact is the
provider's authorized representative per the signature authority designation
form applicable to the provider's contract or ownership type.
(2) Enrollment after a limitation. At no time
will a facility be allowed to enroll in the enhancement program at a level
higher than its current level of enrollment plus three additional levels unless
otherwise instructed by HHSC.
(3)
New owners after a change of ownership. Enhancement levels for a new owner
after a change of ownership will be determined according to subsection (s) of
this section. A new owner will not be subject to enrollment limitations based
on the prior owner's performance. This exemption from enrollment limitations
does not apply in cases where HHSC or its designee has approved a
successor-liability-agreement that transfers responsibility from the former
owner to the new owner.
(4) New
facilities. A new facility's enrollment will be determined according to
subsection (c) of this section.
(h) Determination of nursing care staff
component enhancements. HHSC will determine a per diem add-on payment for each
nursing rate component enhancement level using data from sources such as cost
reports, surveys, or other relevant sources and considering the quality of
care, labor market conditions, economic factors, and budget constraints. The
nursing rate component enhancement add-ons will be determined on a
per-unit-of-service basis. Add-on payments may vary by enhancement
level.
(i) Granting of nursing
staff rate enhancements. HHSC divides all requested enhancements, after
applying any enrollment limitations from subsection (g) of this section, into
two groups: pre-existing enhancements that facilities request to carry over
from the prior year and newly requested enhancements. Newly requested
enhancements may be enhancements requested by facilities that were
nonparticipants in the prior year or by facilities that were participants in
the prior year, desiring to be granted additional enhancements. Using the
process described herein, HHSC first determines the distribution of carry-over
enhancements. If HHSC determines that funds are not available to carry over
some or all pre-existing enhancements, facilities will be notified as per
subsection (v) of this section. If funds are available after the distribution
of carry-over enhancements, HHSC then determines the distribution of newly
requested enhancements. HHSC may not distribute newly requested enhancements to
facilities owing funds identified for recoupment from subsection (k) of this
section.
(1) HHSC determines projected
Medicaid units of service for facilities requesting each enhancement option and
multiplies this number by the rate add-on associated with that enhancement
option as determined in subsection (h) of this section.
(2) HHSC compares the sum of the products
from paragraph (1) of this subsection to available funds:
(A) if the product is less than or equal to
available funds, all requested enhancements are granted; or
(B) if the product is greater than available
funds, enhancements are granted beginning with the lowest level of enhancement
and granting each successive level of enhancement until requested enhancements
are granted within available funds. Based on an examination of existing
staffing levels and staffing needs, HHSC may grant certain enhancement options
priority for distribution.
(3) Notification of granting of enhancements.
Participating facilities are notified of the status of their request for rate
enhancements in a manner determined by HHSC.
(4) In cases where more than one enhanced
rate level is in effect during the reporting period, the spending requirement
will be based on the weighted average enhanced rate level in effect during the
reporting period calculated as follows.
(A)
Multiply the first enhanced rate level in effect during the reporting period by
the most recently available reliable Medicaid days of service utilization data
for the time period the first enhanced rate level was in effect.
(B) Multiply the second enhanced rate level
in effect during the reporting period by the most recently available reliable
Medicaid days of service utilization data for the time period the second
enhanced rate level was in effect.
(C) Sum the products from subparagraphs (A)
and (B) of this paragraph.
(D)
Divide the sum from subparagraph (C) of this paragraph by the sum of the most
recently available reliable Medicaid days of service utilization data for the
entire reporting period used in subparagraphs (A) and (B) of this
paragraph.
(j)
Determine each participating facility's total nursing rate component. Each
participating facility's total nursing rate component will be equal to the
nursing care staff base rate as defined in subsection (b)(6) of this section,
plus any add-on payments associated with staffing enhancements selected by and
awarded to the facility during open enrollment. HHSC will determine a per diem
add-on payment for each enhanced staffing level informed by analysis of the
most recently available reliable data relating to staff compensation levels and
available appropriations for the program as specified in subsection (h) of this
section.
(k) Spending requirements
for participants. Participating facilities are subject to a nursing care staff
spending requirement with recoupment calculated as follows.
(1) Effective September 1, 2023, HHSC will
complete calculations associated with nursing care rate increases and spending
requirements in compliance with §
355.304 of this subchapter
(relating to Direct Care Staff Spending Requirement on or after September 1,
2023).
(2) At the end of the rate
year, a spending floor will be calculated by multiplying accrued Medicaid
fee-for-service and managed care nursing care staff revenues by 0.70.
(3) Accrued allowable Medicaid nursing care
staff fee-for-service expenses for the rate year will be compared to the
spending floor from paragraph (2) of this subsection. HHSC or its designee will
recoup the difference between the spending floor and accrued allowable Medicaid
nursing care staff fee-for-service expenses from facilities whose Medicaid
nursing care staff spending is less than their spending floor.
(4) At no time will a participating
facility's nursing care rates after spending recoupment be less than the
nursing care staff base rates.
(l) Dietary and Fixed Capital Mitigation.
Recoupment of funds described in subsection (k) of this section may be
mitigated by high dietary and fixed capital expenses as follows.
(1) Calculate dietary cost deficit. At the
end of the facility's rate year, accrued Medicaid dietary per diem revenues
will be compared to accrued, allowable Medicaid dietary per diem costs. If
costs are greater than revenues, the dietary per diem cost deficit will be
equal to the difference between accrued, allowable Medicaid dietary per diem
costs and accrued Medicaid dietary per diem revenues. If costs are less than
revenues, the dietary cost deficit will be equal to zero.
(2) Calculate dietary revenue surplus. At the
end of the facility's rate, accrued Medicaid dietary per diem revenues will be
compared to accrued, allowable Medicaid dietary per diem costs. If revenues are
greater than costs, the dietary per diem revenue surplus will be equal to the
difference between accrued Medicaid dietary per diem revenues and accrued,
allowable Medicaid dietary per diem costs. If revenues are less than costs, the
dietary revenue surplus will be equal to zero.
(3) Calculate fixed capital cost deficit. At
the end of the facility's rate year, accrued Medicaid fixed capital asset per
diem revenues will be compared to accrued, allowable Medicaid fixed capital
asset per diem costs. Allowable fixed capital asset costs are defined in
§355.318(d)(4)(C) of this subchapter. If costs are greater than revenues,
the fixed capital cost per diem deficit will be equal to the difference between
accrued, allowable Medicaid fixed capital per diem costs and accrued Medicaid
fixed capital per diem revenues. If costs are less than revenues, the fixed
capital cost deficit will be equal to zero. For purposes of this paragraph,
fixed capital per diem costs of facilities with occupancy rates below 85
percent are adjusted to the cost per diem the facility would have accrued had
it maintained an 85 percent occupancy rate throughout the rate year.
(4) Calculate fixed capital revenue surplus.
At the end of the facility's rate year, accrued Medicaid fixed capital asset
per diem revenues will be compared to accrued, allowable Medicaid fixed capital
asset per diem costs. Allowable fixed capital asset costs are defined in
§355.318(d)(4)(C) of this subchapter. If revenues are greater than costs,
the fixed capital revenue per diem surplus will be equal to the difference
between accrued Medicaid fixed capital per diem revenues and accrued, allowable
Medicaid fixed capital per diem costs. If revenues are less than costs, the
fixed capital revenue surplus will be equal to zero. For purposes of this
paragraph, fixed capital per diem costs of facilities with occupancy rates
below 85 percent are adjusted to the cost per diem the facility would have
accrued had it maintained an 85 percent occupancy rate throughout the rate
year.
(5) Mitigation of a dietary
per diem cost deficit. Facilities with a dietary per diem cost deficit will
have their dietary per diem cost deficit reduced by their fixed capital per
diem revenue surplus, if any. Any remaining dietary per diem cost deficit will
be capped at $2.00 per diem.
(6)
Mitigation of a fixed capital cost per diem deficit. Facilities with a fixed
capital cost per diem deficit will have their fixed capital cost per diem
deficit reduced by their dietary revenue per diem surplus, if any. Any
remaining fixed capital per diem cost deficit will be capped at $2.00 per
diem.
(7) Recoupment calculation.
Each facility's recoupment, as calculated in subsection (k) of this section,
will be reduced by the sum of that facility's dietary per diem cost deficit, as
calculated in paragraph (5) of this subsection, and its fixed capital per diem
cost deficit as calculated in paragraph (6) of this subsection.
(m) Adjusting spending
requirements. Facilities that determine that they will not be able to meet
their spending requirements from subsection (k) of this section may request a
reduction in their spending requirements and associated rate add-on. These
requests will be effective on the first day of the month following approval of
the request.
(n) Voluntary
withdrawal. Facilities wishing to withdraw from participation must notify HHSC
in writing by certified mail, and the request must be signed by an authorized
representative as designated per the HHSC signature authority designation form
applicable to the provider's contract or ownership type. Facilities voluntarily
withdrawing must remain nonparticipants for the remainder of the rate year. The
participation end date for facilities voluntarily withdrawing from the program
will be effective on the date of the withdrawal, as determined by
HHSC.
(o) Notification of
recoupment based on annual staffing and compensation report or cost report. The
estimated amount to be recouped is indicated in STAIRS. STAIRS will generate an
email to the entity contact, indicating that the facility's estimated
recoupment is available for review. If HHSC's subsequent review of the staffing
and compensation report results in report adjustments that change the amount to
be repaid to HHSC or its designee, the facility's entity contact will be
notified by email that the adjustments and the adjusted amount to be repaid are
available in STAIRS for review. HHSC or its designee will recoup any amount
owed from a facility's vendor payments following the date of the initial or
subsequent notification.
(p) Change
of ownership and contract terminations.
(1)
Facilities required to submit a staffing and compensation report due to a
change of ownership or contract termination as described in subsection (d) of
this section will have funds held as per 26 TAC §
554.210(relating to Change of
Ownership and Notice of Changes) until HHSC receives an acceptable staffing and
compensation report and funds identified for recoupment from subsection (k) of
this section are repaid to HHSC or its designee. Informal reviews and formal
appeals relating to these reports are governed by §
355.110 of this chapter(relating to
Informal Reviews and Formal Appeals). HHSC or its designee will recoup any
amount owed from the facility's vendor payments that are being held. In cases
where funds identified for recoupment cannot be repaid from the held vendor
payments, the responsible entity, as defined in subsection (b)(10) of this
section, will be jointly and severally liable for any additional payment due to
HHSC or its designee. Failure to repay the amount due or submit an acceptable
payment plan within 60 days of notification will result in the recoupment of
the owed funds from other Medicaid contracts controlled by the responsible
entity, placement of a vendor hold on all Medicaid contracts controlled by the
responsible entity and will bar the responsible entity from receiving any new
contracts with HHSC or its designees until repayment is made in full. The
responsible entity for these contracts will be notified as described in
subsection (o) of this section before the recoupment of owed funds, placement
of vendor hold, and barring of new contracts.
(2) Participation in the Nursing Care Staff
Rate Enhancement Program transfers to the new owner as defined in 26 TAC §
554.210 when there is a change of
ownership. The new owner is responsible for the reporting requirements in
subsection (d) of this section for any reporting period days occurring after
the change. If the change of ownership occurs during an open enrollment period
as defined in subsection (b)(8) of this section, then the owner recognized by
HHSC or its designee on the last day of the enrollment period may request to
modify the enrollment status of the facility.
(q) Failure to document staff spending.
Undocumented nursing care staff and contract labor compensation costs will be
disallowed and will not be used in the determination of nursing care staff
costs per unit of service.
(r)
Appeals. The subject matter of informal reviews and formal appeals is limited
as per §
355.110(a)(3) of
this chapter.
(s) Contract
cancellations. If a facility's Medicaid contract is canceled before the first
day of an open enrollment period as defined in subsection (b)(8) of this
section, and the facility is not granted a new contract until after the last
day of the open enrollment period, participation in the Nursing Care Staff Rate
Enhancement Program as it existed before the cancellation date of the
facility's contract will be reinstated when the facility is granted a new
contract. The contract must be under the same ownership, and reinstatement is
subject to the availability of funding. Any enrollment limitations from
subsection (g) of this section that would have applied to the canceled contract
will apply to the new contract.
(t)
Determination of compliance with spending requirements in the aggregate.
(1) Aggregation. For an entity, commonly
owned corporation, or combined entity that controls more than one participating
nursing facility contract, compliance with the spending requirements detailed
in subsection (k) of this section can be determined in the aggregate for all
participating nursing facility contracts controlled by the entity, commonly
owned corporations, or combined entity at the end of the rate year, the
effective date of the change of ownership of its last participating contract,
or the effective date of the termination of its last participating contract
rather than requiring each contract to meet its spending requirement
individually. Corporations that do not meet the definitions under subsection
(b) of this section are not eligible for aggregation to meet spending
requirements.
(2) Aggregation
Request. To exercise aggregation, the entity, combined entity, or commonly
owned corporations must submit an aggregation request in a manner prescribed by
HHSC when each staffing and compensation report is submitted. In limited
partnerships in which the same single general partner controls all the limited
partnerships, the single general partner must make this request. Other such
aggregation requests will be reviewed on a case-by-case basis.
(3) Frequency of Aggregation Requests. The
entity, combined entity, or commonly owned corporation must submit a separate
request for aggregation for each reporting period.
(4) Ownership changes or terminations.
Nursing facility contracts that change ownership or terminate, effective after
the end of the applicable reporting period but before the determination of
compliance with spending requirements as per subsection (k) of this section,
are excluded from all aggregate spending calculations. These contracts'
compliance with spending requirements will be determined on an individual
basis, and the costs and revenues will not be included in the aggregate
spending calculation.
(u)
Medicaid Swing Bed Program for Rural Hospitals. When a rural hospital
participating in the Medicaid swing bed program furnishes nursing care to a
Medicaid recipient under 26 TAC §
554.2326(relating to Medicaid
Swing Bed Program for Rural Hospitals), HHSC or its designee pays the hospital
using the same procedures, the same case-mix methodology, and the same PDPM LTC
rates that HHSC authorizes for reimbursing nursing facilities receiving the
nursing rate component with no enhancement levels. These hospitals are not
subject to the staffing and spending requirements detailed in this
section.
(v) Notification of lack
of available funds. If HHSC determines that funds are not available to continue
participation for facilities from which it has not received an acceptable
request to modify their enrollment by the last day of an enrollment period as
per subsection (b)(8) of this section or to fund carry-over enhancements as per
subsection (i) of this section, HHSC will notify providers in a manner
determined by HHSC that such funds are not available.
