Texas Register, Volume 46, Number 38, Pages 5983-6306, September 17, 2021 Page: 6,005

                                
public dissemination and comment the most recent known rates are
assumed to remain in effee-}
f(2) Cests asseiated with workers' e s     e-g., tra-
ditional insiraneecoveragerisk peel paicipato, and diret claims
set lement ests vary widely among individual providers- Even for
those subsribing to traditional insuranee- there is no uniform "rate"
per payroll dollars nsequently, these cests are inflated at the same
rate as applicable employee wages-}
(3) Except where indicated other-wise for specific
pgrams, the unemloyment tax ilation index is based on unem-
ployment insurance payroll taxes in accordance with the Federal
Unemployment Tax Act (FU-TA) and the Texas Unemployment
Compensation Act (TUCA) rates obtained from the Texas Workforce
Commission    Because the T-UA component of the tax rate may
be contractor specific, HC obtains the average effetive rates for
the lowest available Standard ndstrial ssi4icatiori (SIC) code
pertinent to each program  -The unemployment tax ifation index
is the average tax rate during the prospeetie feimbhurseent period
divided by the average tax rate during each provider's reporting period-
If either the FUTA er TUCA rates for the prospective rate period are
not available at the time proposed reimbursements are prepared for
public dissemination and comment, the most reent known rates are
assumed to remain in efret When changes eeur in such factors as
payroll limits to which tax rates app  I4-SC may make appropriate
adjustments in projections to reect new limits and related factors
affecting the impact of new limits such as employee teumver rates}
1{4) inflation factors for key professional andlor parapr-
fessional staff wages and salaries, eg., nurses, nurse aides and atten-
dants, are based on wage surwy data pertaining to specific types of
profe-ssional ad pr-apofe-sional s-aff i T0Xmwh- --g-N  e-
termined that reliable data of this kind are available for specific or com-
parable programs. Projections from the cost reporting period to the re-
imursement period are based on discernible trends or experience as
evidenced by the most recent reliable data avaiable at the time pr-
posed reimlmrsement is prepared for public dissemination and corm-
ment, and take into consideration eeenomie renditions and regulatory
changes which may be reasonably anticipated for the reimbursement
period WhenH-SC has determined that reliable wage and salary data
pertaining to specific types of staff in Texas are unavailable for spe-
eifie er emparable programs infation factors for professional and/er
paraprofessional staff are based en the lowest feasible forecast of the
PCFT Professional ander paraprofessional wage and benefit inflation
rates for state employees are based on state employee wage and saary
increases determined by the Texas egis atuie4
{(5) For the Medicaid nursing facility program determina-
tion of adjustments to historical costs of fixed capital assets are consis-
tent with requirements of the federal Omnibus Budget Reconciliation
Act of 49M4 (OBRA 4984) and Consolidated Omnibus Budget Recon-
ciliation Act of 495 (COBRA 4-98 For each program one of two
options is use-}
(4)  Reimbursement is in the form ofa fixed capital as-
set use fee component of the overall reimbursement> based on facility
appraisals, as described in program-specific reimbursement methodol-
gy rules-}
(B) Reimbursement for fixed capital asset cests is cal-
culated based on historical costs included in the reimbur-sem-ntcompo-
ne-t de-sigae-d inprogr-a-spec-ificre-imbur-e-ent m-thdoleg  & l
The index used to inlate-lease expense and to adjust the allowable de-
preciation base of assets which have undergone ownership changes is
one-half the All-item Urban Consumer Price Index (CPIU)-

(d) Inflation adjustment calculations. When adjusting costs
for inflation, HHSC considers economic conditions and regulatory
changes that may be reasonably anticipated for the prospective reim-
bursement period as specified in  355.109 of this subchapter (relating
to Adjusting Reimbursement When New Legislation, Regulations, or
Economic Factors Affect Costs). For each inflation index specified in
subsection (c) of this section:
(1) the inflation index is forecasted using a nationally rec-
ognized source available to HHSC at the time proposed payment rates
are prepared for public dissemination and comment; and
(2) a rate of inflation over a specific period of time is cal-
culated and applied to the allowable costs appropriate to that index as
follows:
(A) costs reported in HHSC cost reports or other sur-
veys are multiplied by the result of the inflation rate at the midpoint of
the prospective reimbursement period divided by the inflation rate at
the midpoint of the provider's reporting period; or
(B) costs are multiplied by the result of the average in-
flation rate during the entire prospective reimbursement period divided
by the average inflation rate during the entire base period.
355.109. Adjusting Reimbursement When New Legislation, Regula-
tions, or Economic Factors Affect Costs.
(a) In conducting reimbursement reviews for adjustments, the
Texas Health and Human Services Commission (HHSC) takes into
consideration changes in laws, rules, regulations, policies, guidelines,
or economic factors which will have a demonstrable material impact
on most contracted providers' costs of providing services meeting fed-
eral and state standards.
(1) HHSC may recommend adjustments to reimbursement
when federal or state laws, rules, regulations, policies, or guidelines
are adopted, promulgated, judicially interpreted, or otherwise changed
in ways that affect allowable costs. The law, rule, regulation, policy, or
guideline change must result in necessary changes in allowable costs
that:
(A) affect most, if not all, contracted providers; and
(B) require contracted providers to take definitive ac-
tion to incur additional allowable costs not included in the cost database
[data base] used to determine reimbursements and which would not
otherwise be covered in reimbursements.
(2) HHSC may recommend adjustments to reimbursement
when it can be clearly demonstrated that changes in economic factors
will result in changes in allowable costs. The changes in economic
factors must result in changes in allowable costs that:
(A) affect most, if not all, providers; and
(B) are allowable cost changes that the providers have
little or no control over and are allowable costs that are not included
in the cost database [data base] used to determine reimbursements and
which would not otherwise be covered in reimbursements.
(3) HHSC may recommend adjustments to reimbursement
when there is a change to any of the unemployment insurance tax com-
ponents detailed in subparagraphs (A) - (D) of this paragraph. If unem-
ployment insurance tax rates for the prospective reimbursement period
are not available at the time reimbursement is prepared for public com-
ment, the most recent known tax rates are assumed to remain in effect.
(A) The calendar year average Texas Unemployment
Compensation Tax Act (TUCA) rate, as calculated by the Texas Work-
force Commission (TWC); or

PROPOSED RULES      September 17, 2021  46 TexReg 6005