1 TAC §§352.1 - 352.5
The Health and Human Services Commission (HHSC) adopts on
an emergency basis amendments to §352.1, concerning the purpose and duration
of chapter 352, §352.2, concerning definitions, §352.3, concerning
quality assurance fee, §352.4, concerning required reports, and §352.5,
concerning payment and collection of the quality assurance fee. In accordance
with SB 1862, 78th Legislature, Regular Session, the amendments implement
a statutorily required change that: makes the quality assurance fee applicable
to facilities owned by the Texas Department of Mental Health and Mental Retardation
(MHMR) beginning with the state fiscal year ending on August 31, 2003; requires
payment by MHMR of fees for those facilities by that date; expands the possible
uses of the funds; changes the definition of patient days; and, changes the
time for facilities to file required reports from the 10th to the 20th day
after the last day of a month. The amendments also increase the quality assurance
fee from 5.5 to 6 percent beginning September 1, 2003, in accordance with
projected revenues and related federal matching funds specified in the General
Appropriations Act for the 2004-2005 biennium.
HHSC finds that in order to comply with state law (SB 1862, 78th Legislature,
Regular Session, and also see HB 7, 78th Legislature, Regular Session), the
amendments making the quality assurance fee applicable to MHMR facilities
in the current state fiscal year, requiring MHMR to make payment by August
31, 2003, and changing the definition of patient days and the time for facilities
to file required reports must be adopted on an emergency basis. HHSC also
finds that failing to change the quality assurance fee from 5.5 to 6 percent
on September 1, 2003, will result in an imminent peril to the public health,
safety and welfare by jeopardizing the availability of care and services for
persons with mental retardation funded by these revenues, and therefore, that
the fee increase must be adopted on an emergency basis.
The amendments are simultaneously being proposed for permanent adoption
in accordance with §2001.034 (c). The proposed amendments are published
elsewhere in this issue of the
Texas Register
.
The emergency amendments are adopted pursuant to HHSC's authority
under §531.033, Government Code and under §252.205 Health and Safety
Code, and in accordance with §2001.034, Government Code.
The amendments affect Health & Safety Code §252.202 and House
Bill 7, 78th Leg. §11.
§352.1.Purpose and Duration of Chapter.
(a)
This chapter implements the determination, assessment,
collection, and enforcement of the quality assurance fee authorized under
chapter 252, Health and Safety Code, subchapter H.
(b)
The purpose of the quality assurance fee established under
this chapter is to improve the quality of care provided to persons with mental
retardation as follows:
(1)
The quality assurance fee is intended to support and/or
maintain an increase in reimbursement to licensed intermediate care facilities
for the mentally retarded and facilities operated according to the requirements
of chapter 252, Health and Safety Code and owned and/or operated by a community
mental health and mental retardation center as described in chapter 534, subchapter
A, Health and Safety Code,
and a facility owned by the Texas Department
of Mental Health and Mental Retardation
that participate in Medicaid
program, subject to legislative appropriation for this purpose; and
[
(2)
If funds generated from the
collection of quality assurance fees under this chapter are available following
fulfillment of the purpose described in subsection (b)(1) of this section,
such funds may be allocated to the Home and Community Based waiver program
and the Mental Retardation Local Authority waiver program established pursuant
to 42 U.S.C. §1396n(c).]
(2)
[
(3)
] The Commission or its designee
may also offset allowable expenses to administer the quality assurance fee
program against revenues generated by the collection of the quality assurance
fee.
(c)
This chapter will expire on September 1, 2005, unless chapter
252, subchapter H, Health and Safety Code, is extended by the 79th Texas Legislature.
§352.2.Definitions.
As used in this chapter, the following terms shall have the meanings
prescribed below, unless the context clearly indicates otherwise:
(1)
"Facility" means:
(A)
An intermediate care facility for the mentally retarded
or the corporate parent of an intermediate care facility for the mentally
retarded licensed under chapter 252, Health and Safety Code; or
(B)
A facility operated according to the requirements of chapter
252, Health and Safety Code, and owned and/or operated by a community mental
health and mental retardation center as described in chapter 534, subchapter
A, Health and Safety Code
; or
[
.
]
(C)
A facility owned by the Texas
Department of Mental Health and Mental Retardation.
(2)
"Gross receipts" means money paid to a facility as compensation
for services provided to patients, including client participation, but does
not include charitable contributions to a facility.
(3)
"Total patient days" means the sum, computed on a monthly
basis, of the following:
(A)
The total number of patients occupying a facility bed immediately
before midnight on each day of the month;
and
[
(B)
The total number of facility
beds that are on hold on each day of the month and that have been placed on
hold for a period not to exceed three consecutive calendar days during which
a patient is in a hospital during the month; and]
(B)
[
(C)
] The total number of beds that
are on hold on each day of the month and that have been placed on hold for
a period not to exceed three consecutive calendar days during which a patient
is on therapeutic [
home
] leave during the month.
(C)
[
(D)
] The total number of days a
patient is discharged from a facility are not counted in the calculation of
the total patient days under this chapter.
§352.3.Quality Assurance Fee Determination Methodology.
(a)
Quality
[
Interim quality
] assurance
fee
on State facilities
. As provided in section
1(b)
[
9.02
] of the Act of
June 20, 2003, 78th Leg.
[
May 28,
2001, 77th Leg.
] R.S., (Senate Bill
1862
[
1839
]),
not later than August 31, 2003, the Texas Department of Mental Health and
Mental Retardation shall pay for each facility owned by the department the
quality assurance fee for patient days occurring between September 1, 2002,
and July 31, 2003.
[
the quality assurance fee for the month September
2001, and for each month thereafter until implementation of a final quality
assurance fee under subsection (b) of this section is the total number of
patient days reported by a facility under §352.4 of this chapter multiplied
by $5.25.
]
(b)
Quality assurance fee. Beginning
September 1, 2003,
[
November 1, 2001
] the quality assurance fee for a facility
is in the amount of
six
[
5.5
] percent of each reimbursement
or payment rate received, including those received from the resident, for
each resident in the facility during a calendar month, provided the amount
of all such quality assurance fees assessed for the facility during the 12-month
period following assessment of the quality assurance fee do not exceed six
percent of the facility's total annual gross receipts in Texas.
(c)
Not later than July 31, 2002, and every six months thereafter,
the commission or its designee will review each individual facility's quality
assurance fee calculation. A facility's liability for the quality assurance
fee may be adjusted following this review to ensure that the quality assurance
fee does not exceed six percent of annual revenue.
§352.4.Required reports.
(a)
The following reports must be filed by a facility in accordance
with the instructions of the Commission or its designee:
(1)
The monthly patient day report required under subsection
(c) of this section; and
(2)
The semi-annual report of gross receipts required under
subsection (d) of this section.
(b)
Amended reports.
(1)
A facility may amend a report required under subsections
(c) or (d) of this section;
(2)
An amended monthly patient day report must be filed no
later than 10 calendar days following the filing of the report required under
subsection (c) of this section.
(3)
An amended report of gross receipts must be filed no later
than 10 calendar days following the filing of the report required under subsection
(d) of this section.
(c)
Monthly patient day report.
(1)
A facility must report, not later than the
20th
[
10th
] calendar day after the last day of a month, the total number of
patient days for the facility during the preceding month.
(2)
A facility must file the report required by this subsection
on forms or in the format and according to the instructions prescribed by
the commission or its designee.
[
(3)
The first report required
under this subsection is not due until the 10th day after the end of the month
this chapter takes effect. This report will cover the months September 1,
2001 through the end of the month this chapter takes effect.]
(d)
Reporting of gross receipts.
(1)
A facility must report, not later than the 10th calendar
day following the last day of the sixth month following the effective date
of this chapter, the total gross receipts the facility received during the
preceding 6-month period.
(2)
A facility must file the report required by this subsection
on forms or in the format and according to the instructions prescribed by
the commission or its designee.
§352.5.Payment and Collection of Quality Assurance Fee.
A facility must:
(1)
Pay the amount of the quality assurance fee in accordance
with the instructions of the commission or its designee not later than the
30th day
after the last day
of the month
for which the fee
is assessed
; or
(2)
Pay the amount of the quality assurance fee in accordance
with the instructions of the commission or its designee and request an informal
review of the calculation of the quality assurance fee in accordance with §352.8
of this chapter.
(3)
Not later than August 31, 2003,
the Texas Department of Mental Health and Mental Retardation shall pay for
each facility owned by the department the quality assurance fee imposed under §352.3(a)
of this title for patient days occurring between September 1, 2002, and July
31, 2003.
[
(3)
The first payment required
under this section is not due until the 30th day after the end of the month
this chapter takes effect. That payment will cover all the months beginning
September 1, 2001 through the end of the month this chapter takes effect.]
(4)
The commission or its designee may review the calculation
of the quality assurance fee to ensure its accuracy and instruct the facility
to correct its calculation and payment.
This agency hereby certifies that the emergency adoption
has been reviewed by legal counsel and found to be within the agency's legal
authority to adopt.
Filed with the Office of
the Secretary of State on August 13, 2003.
TRD-200305180
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Effective Date: August 13, 2003
Expiration Date: December 11, 2003
For further information, please call: (512) 424-6576