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TITLE 1. ADMINISTRATION be an estimated additional cost to state government as a result of enforcing and administering the rule as proposed. PART 15. TEXAS HEALTH AND The effect on state government for each year of the first HUMAN SERVICES COMMISSION five years the proposed rule is in effect is an estimated cost of $5,983,315 in General Revenue (GR) ($16,149,299 in CHAPTER 355. REIMBURSEMENT RATES All Funds (AF)) in state fiscal year (SFY) 2022, $6,330,525 in GR ($16,149,299 in AF) in SFY 2023, $6,330,525 in SUBCHAPTER F. REIMBURSEMENT GR ($16,149,299 in AF) in SFY 2024, $6,330,525 in GR METHODOLOGY FOR PROGRAMS SERVING ($16,149,299 in AF) in SFY 2025, and $6,330,525 in GR PERSONS WITH MENTAL ILLNESS OR ($16,149,299 in AF) in SFY 2026. Enforcing or administering the rule does not have foreseeable INTELLECTUAL OR DEVELOPMENTAL implications relating to costs or revenues of local government. DISABILITY GOVERNMENT GROWTH IMPACT STATEMENT 1 TAC §355.727 HHSC has determined that during the first five years that the rule The Executive Commissioner of the Texas Health and Human will be in effect: Services Commission (HHSC) proposes an amendment to (1) the proposed rule will not create or eliminate a government §355.727, concerning Add-on Payment Methodology for Home program; and Community-Based Services Supervised Living and Resi- dential Support Services. (2) implementation of the proposed rule will not affect the number of HHSC employee positions; BACKGROUND AND PURPOSE (3) implementation of the proposed rule will result in no assumed The purpose of the proposal is to extend the period in which change in future legislative appropriations; add-on payments for Home and Community-based Services Waiver (HCS) Supervised Living and Residential Support Ser- (4) the proposed rule will not affect fees paid to HHSC; vices (SL/RSS) are effective. (5) the proposed rule will not create a new rule; The proposal is necessary to comply with 2022-23 General Ap- (6) the proposed rule will not expand, limit, or repeal existing propriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular rules; Session, 2021 (Article II, HHSC, Rider 30), which requires HHSC to maintain rate increases authorized by the 2020-21 General (7) the proposed rule will not change the number of individuals Appropriations Act, House Bill 1, 86th Legislature, Regular Ses- subject to the rule; and sion, 2019 (Article II, HHSC, Rider 44). (8) HHSC has insufficient information to determine the proposed SECTION-BY-SECTION SUMMARY rule's effect on the state's economy. The proposed amendment to §355.727(b) revises the last date SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COM- in which HHSC will pay an add-on to the direct care portion of MUNITY IMPACT ANALYSIS the SL/RSS rates from August 31, 2021, to August 31, 2023. Trey Wood has also determined that there will be no adverse The proposed amendment to §355.727(c)(1) revises the period economic effect on small businesses, micro-businesses, or rural in which providers may be required to submit cost reports in ad- communities. The rules do not impose any additional costs on dition to other reporting requirements. This proposed amend- small businesses, micro-businesses, or rural communities that ment corresponds with the date revision in the proposed change are required to comply with the rules. to subsection (b). The proposed amendment to §355.727(c)(1) LOCAL EMPLOYMENT IMPACT also revises the name of HHSC Rate Analysis to reflect the new name of the department, which is the HHSC Provider Finance The proposed rule will not affect a local economy. Department. COSTS TO REGULATED PERSONS FISCAL NOTE Texas Government Code §2001.0045 does not apply to this rule Trey Wood, Chief Financial Officer, has determined that for each because the rule does not impose a cost on regulated persons year of the first five years that the rule will be in effect, there will and is necessary to implement legislation that does not specifi- cally state that §2001.0045 applies to the rule. PROPOSED RULES August 13, 2021 46 TexReg 4927 PUBLIC BENEFIT AND COSTS (1) The add-on for each level of need (LON) is as follows: Victoria Grady, Director of Provider Finance, has determined that (A) $4.06 per unit for LON 1; for each year of the first five years the rule is in effect, the public (B) $4.53 per unit for LON 5; benefit will be additional funds for HCS providers of SL/RSS, which will enable HCS providers to maintain access to care in (C) $5.22 per unit for LON 8; group home settings. (D) $6.04 per unit for LON 6; and Trey Wood has also determined that for the first five years the (E) $8.45 per unit for LON 9. rule is in effect, there are no anticipated economic costs to per- sons who are required to comply with the proposed rule as it im- (2) The add-on is to be used only for attendant compensa- plements an extension to add-on payments for HCS providers of tion as defined in §355.103(b)(1) of this chapter (relating to Specifica- SL/RSS and, therefore, all costs to implement the proposal will tions for Allowable and Unallowable Costs). be absorbed by HHSC. (c) Reporting requirements. TAKINGS IMPACT ASSESSMENT (1) All Home and Community-based Services (HCS) HHSC has determined that the proposal does not restrict or limit providers who deliver Supervised Living or Residential Support Ser- an owner's right to their property that would otherwise exist in vices during the time period the add-on is in effect must comply with the absence of government action and, therefore, does not con- reporting requirements as described in §355.105(b) of this chapter stitute a taking under Texas Government Code §2007.043. (relating to General Reporting and Documentation Requirements, Methods, and Procedures) for each reporting period during the time PUBLIC COMMENT period the add-on is in effect. Providers may be required to submit Written comments on the proposal may be submitted to cost reports in addition to other reporting requirements to include HHSC Provider Finance Department, Mail Code H-400, those days in which the add-on was in effect and [calendar years 2020 P.O. Box 149030, Austin, Texas 78714-9030, or by email to and 2021] not otherwise included in another report in which account- [email protected]. ability has been determined. This report must be submitted for each component code if the provider requested participation individually To be considered, comments must be submitted no later than or if the provider requested participation as a group. This report will 21 days after the date of this issue of the Texas Register. Com- be used as the basis for determining any recoupment amounts as ments must be (1) postmarked or shipped before the last day described in subsection (f) of this section for the direct care staffing of the comment period; (2) hand-delivered before 5:00 p.m. on add-on reporting period. Participating providers failing to submit an the last working day of the comment period; or (3) emailed be- acceptable Direct Care Staffing Compensation Report within 60 days fore midnight on the last day of the comment period. If last day of the date of the HHSC request for the report will be placed on vendor to submit comments falls on a holiday, comments must be post- hold until such time as an acceptable report is received and processed marked, shipped, or emailed before midnight on the following by the HHSC Provider Finance Department [Rate Analysis]. business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rules 21R147" in the subject (2) Providers who do not participate in attendant compen- line. sation rate enhancement and deliver no Supervised Living or Residen- tial Support Services during the time period the add-on is in effect may STATUTORY AUTHORITY be excused from submitting an accountability report for the years in The amendment is authorized by Texas Government Code which an HCS cost report is not required. §531.0055, which provides that the Executive Commissioner (d) - (g) (No change.) of HHSC shall adopt rules for the operation and provision of services by the health and human services system; Texas The agency certifies that legal counsel has reviewed the pro- Government Code §531.033, which provides the Executive posal and found it to be within the state agency's legal authority Commissioner of HHSC with broad rulemaking authority; Texas to adopt. Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to adminis- Filed with the Office of the Secretary of State on July 30, 2021. ter the federal medical assistance (Medicaid) program in Texas; TRD-202102968 and Texas Government Code §531.021(b-1), which establishes Karen Ray HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for Chief Counsel medical assistance (Medicaid) payments under Texas Human Texas Health and Human Services Commission Resources Code Chapter 32. Earliest possible date of adoption: September 12, 2021 For further information, please call: (512) 424-6637 The amendment affects Texas Government Code §531.0055, Texas Government Code Chapter 531, and Texas Human Re- ♦ ♦ ♦ sources Code Chapter 32. SUBCHAPTER I. REPORTING §355.727. Add-on Payment Methodology for Home and Community- Based Services Supervised Living and Residential Support Services. 1 TAC §355.7201 (a) (No change.) The Executive Commissioner of the Texas Health and Human (b) Direct Care Staffing Add-on Payment Methodology.

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