ICF/MR & HCS Reimbursement
The 77th Texas Legislature authorized two funding mechanisms to provide needed rate adjustments for community-based ICF/MR and HCS/MRLA providers. These are:
Appropriations Bill: TDMHMR was appropriated $2.5 million in General Revenue (GR) to provide rate adjustments for HCS/MRLA providers. This equates to a rate adjustment of approximately 1.2% for the entire biennium.
SB 1839: This bill establishes a quality assurance fee applicable to both public and private ICF/MR providers. The fee, to be paid monthly by providers, will be combined with federal matching funds to support or maintain an increase in reimbursement rates for community-based ICF/MR providers. The bill specifies that once rates have been adjusted for ICF/MR providers, excess revenues can be used to augment rates for HCS and MRLA providers. The effective date of the bill is September 1, 2001. Unless reauthorized by the Legislature, the bill expires September 1, 2005.
Key provisions of the Quality Assurance Fee as specified in SB 1839, Article 9 are as follows…
Section
252.202:
Imposition of a quality assurance fee on each ICF/MR facility either
licensed under Section 252.034 or owned by a community MHMR center.
The fee is:
an
amount established under Subsection (b) multiplied by the number of patient
days as determined in accordance with Section 252.203;
payable
monthly; and
is
in addition to other fees imposed under this chapter.
HHSC
or the department (TDHS) shall set the fee for each day in the amount necessary
to produce annual revenues equal to an amount that is not more than six
percent of the facility’s total annual gross receipts.
The fee:
is
subject to a prospective adjustment as necessary,
the
amount must be determined using patient days and gross receipts reported to
the department and covering a period of at least 6 months,
is
an allowable cost for reimbursement under Medicaid.
Section
252.204:
HHSC or TDHS shall collect the fee in accordance with criteria regarding
timeframes for collecting as specified in the bill.
Section
252.205: HHSC
is directed to adopt rules governing the administration and imposition of the
fee and may not adopt rules granting any exceptions from the fee.
An administrative penalty assessed under this subchapter may not exceed
one-half of the amount of the outstanding quality assurance fee or $20,000.00,
whichever is greater.
Section
252.206:
Money deposited in the quality assurance fund remains the property of the
fund and may not be used for any other purpose other than what is specified in
this chapter.
The
fee combined with federal matching funds will support or maintain an increase
in Medicaid reimbursement for facilities. After
reimbursement rates have been established for the biennium and money is
allocated from the fund for that purpose, HHSC may allocate any money remaining
in the fund to HCS/MRLA.
Section
252.207:
HHSC shall use the money in the fund, together with any federal match to:
offset
allowable expenses to administer the fee; or
to
increase rates paid under the Medicaid program to facilities subject to
Section 252.206 (d).
HHSC
shall by rule adopt the formula by which amounts received under this section
increase the reimbursement rates paid to facilities and HCS/MRLA programs and
ensure that the formula devised provides incentives to increase direct care
staffing and direct care wages and benefits.
The
rate paid to a facility under this Section may not be based solely on the amount
of the fee paid by that facility unless authorized by 42 C.F.R. Section 433.68
or other federal law.
Section
252.209:
The provisions of this section of the bill expire September 1, 2005
unless renewed by the 79th Texas Legislature.
Note: The quality assurance
fee imposed under this Subchapter of Chapter 252 of the Health and Safety Code
that is effective for the first month following the effective date of this
Act is equal to $5.25 multiplied by the number of patient days as determined
under that subchapter.
SPECIAL
NOTE:
Section 10.80. Contingency
Appropriation for Senate Bill 1839, Related to Long Term Care Facilities of SB
1, Other Appropriations and Adjustments states that…
Contingent
upon enactment of Senate Bill 1839, or similar legislation of the 77th
Legislature relating to a Quality assurance Fee on state-licensed ICFs/MR,
TDMHMR is hereby appropriated $17,854,395.00 in GR and $26.972,106.00 in Federal
Funds for FY 2002 and $19,173,011.00 in GR and $28,843,546.00 in Federal Funds
for FY 2003 contingent upon the collection and deposit of $44,826,501.00 in
revenues generated under the provisions of the bill for the biennium.
All of these GR and Federal Funds are to be utilized to provide rate
increases to non-state operated public ICF/MR providers and to private ICF/MR
providers.
The full text of SB 1839 can be obtained by calling the PPAT office or on the Texas Senate’s website at www.senate.state.tx.us or www.capitol.state.tx.us.