1 Tex. Admin. Code § 355.205 - Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID-19)
(a) Introduction.
The Texas Health and Human Services Commission (HHSC) uses the methodology
described in this section to establish emergency temporary reimbursement rate
increases while limiting use of the funds received by the provider through the
increases. This section also describes the circumstances in which recoupments
will be necessary for certain provider types or services during the COVID-19
federal public health emergency period. Provider types and services that are
eligible for increased reimbursement rates under this section include:
(1) all provider types and services for which
a reimbursement rate methodology is described in this chapter; and
(2) any other provider or service that is
established in response to COVID-19.
(b) Eligibility. To receive and retain
emergency temporary reimbursement rate increases from HHSC under this section:
(1) the provider must be enrolled as a
Medicaid provider with HHSC;
(2)
the provider must be actively providing and billing for services provided to
fee-for-service Medicaid clients;
(3) the provider must agree not to use the
reimbursement rate increases to increase hourly wages paid to direct care staff
on an ongoing basis, and to limit use of the funds to overtime payments, lump
sum bonuses, bonuses for hazard pay, or other types of compensation that will
not result in future reductions to hourly wages when the emergency temporary
reimbursement rate increase is discontinued; and
(4) HHSC must receive approval from Centers
for Medicare & Medicaid Services (CMS) for the provider type or specific
service to be reimbursed through this section.
(c) Attestation of agreement. The provider
must submit an electronic attestation of agreement to comply with subsection
(b)(3) of this section either within 90 days of the effective date of the
reimbursement rate increase, or by September 30, 2020, whichever date is later.
(d) Reconciliation process. HHSC
uses the methodology in this subsection to recoup the temporary emergency
payments made under this section if a provider fails to submit the attestation
of agreement under subsection (c) of this section.
(1) HHSC will reduce reimbursement rates for
any claim for services to the amount that would have been paid to the provider
absent the emergency temporary reimbursement rate increase.
(2) The provider's claims will be reprocessed
at the lower reimbursement rate under paragraph (1) of this subsection and an
accounts receivable will be established.
(3) The provider will be paid on a normal per
claim basis after the equivalent amount of the account receivable has been
collected by HHSC, or its designee.
(4) After 270 days from the date of the
establishment of the account receivable under paragraph (1) of this subsection,
HHSC will recoup any overpayments owed under paragraph (1) of this subsection
by demanding immediate repayment of any outstanding amount.
(e) Overpayment.
(1) If payments under this section result in
an overpayment to a provider, HHSC, or its designee, may recoup an amount
equivalent to the overpayment.
(2)
Payments made under this section may be subject to any adjustments for payments
made in error or due to fraud, including, without limitation, adjustments made
under the Texas Administrative Code, the Code of Federal Regulations, and state
and federal statutes. HHSC, or its designee, may recoup an amount equal to any
such adjustments from the providers in question. This section may not be
construed to limit the independent authority of another federal or state agency
or organization to recover from the provider for a payment made due to fraud.
(f) Disallowance of
federal funds. If payments under this section are disallowed by CMS, HHSC may
recoup the amount of the disallowance from providers that participated in the
program associated with the disallowance. If the recoupment from a provider for
such a disallowance results in a subsequent disallowance, HHSC will recoup the
amount of that subsequent disallowance from the same entity.
(g) Termination of emergency temporary rate
increases. HHSC will terminate the emergency temporary rate increases at the
earlier of either the termination of the federally declared public health
emergency, including any extensions, or at the time that HHSC determines rate
increases are no longer necessary pursuant to §
355.201(c)(3) of
this chapter (relating to Establishment and Adjustment of Reimbursement Rates
for Medicaid). However, HHSC will continue to enforce the reconciliation and
recoupment processes described in subsections (d), (e), and (f) of this section
after the termination of the temporary emergency rate increases.
Notes
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