June 07, 2005

Texas Adopts Amendment to Reimbursement Methodology for ICF/MR

Clarification (note: some of the categories are similar and confusing, pay close attention to the repayment periods):
The Texas Health and Human Services Commission (HHSC) adopted an amendment to the reimbursement methodology applied to Intermediate Care Facilities for individuals with mental retardation (ICF/MR).

The amendment includes several changes in references from MHMR to DADS to reflect the changes in structure of the Health and Human Service Agencies. For example, 1 TAC § 355.457 (c)(2)(B) and (C) both change the agency that facilities are required to pay from MHMR to DADS.

For Fiscal Accountability Repayments Made Between April 5, 1998 and January 1, 1999.
The amendment also reinstates language that was inadvertently omitted from a previous amended version of the adopted text. The relevant clarifications include repayment requirements for providers spending between 85 and 90% of direct service revenues will pay DADS 50% of the difference between direct service costs and 90% of direct service revenues. § 355.457 (c)(2)(D)

For Fiscal Accountability Repayments Made After January 1, 1999.
The language of § 355.457 (c)(3) now provides, that for all fiscal accountability repayments for a providers fiscal year that begins on or after January 1, 1999:
- That the total direct service revenue is equal to the direct service portion of the rates multiplied by the number of allowable units paid for services provided during the reporting period:
- Providers whose direct service costs are 90% or more are not subject to repayment under this section § 355.457 (c)(3)(A);
- Providers whose direct service costs are less than 85% of direct service revenues will be required to pay DADS the difference between direct service costs and 95% of direct service revenues § 355.457 (c)(3)(B); and
- Providers whose direct service costs are between 85 and 90% of direct service revenues are required to pay DADS 75% of the difference between the direct service costs and 90% of the direct service revenues § 355.457 (c)(3)(C).

For a line by line reading of the text click here.