1 Tex. Admin. Code § 355.9090 - Reimbursement Methodology for Community First Choice
(a) General information. The Texas Health and
Human Services Commission (HHSC) applies the general principles of cost
determination as specified in §
355.101 of this title (relating to
Introduction).
(b) Reimbursement
Methodology. Community First Choice (CFC) rates are established using
pre-existing rates as follows.
(1) CFC State
Plan Rate--Attendant and Habilitation: Rates will be equal to a weighted
average of rates established for Community Living Assistance and Support
Services (CLASS) habilitation services according to the reimbursement
methodology for the CLASS program under §
355.505 of this title (relating to
Reimbursement Methodology for the Community Living Assistance and Support
Services Waiver Program) and proxy rates for attendant services used in the
calculation of the STAR+PLUS managed care capitation rates for the Home and
Community-based Services (HCBS) risk group. The weighted average will include
applicable attendant compensation rate enhancements.
(A) Proxy rates are equal to rates
established for attendant services under the Community Based Alternatives (CBA)
waiver prior to its termination, updated for changes in allowable reported
expenses and units of service.
(B)
Weighting factors assume that 30 percent of personal attendant services
historically provided to existing recipients in the STAR+PLUS HCBS risk group
and 100 percent of personal attendant services provided to newly eligible
recipients under CFC will be for habilitation.
(2) CLASS--Attendant and Habilitation CFC:
Rates will be equal to rates established for CLASS habilitation services,
including applicable attendant compensation rate enhancements, under §
355.505 of this title.
(3) Deaf-Blind with Multiple Disabilities
(DBMD)--Attendant and Habilitation CFC: Rates will be equal to rates
established for DBMD Residential Habilitation, including applicable attendant
compensation rate enhancements, under §
355.513 of this title (relating to
Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver
Program).
(4) Home and
Community-Based Services (HCS)--Supported Home Living (SHL) CFC: Rates will be
equal to rates established for HCS SHL, including applicable attendant
compensation rate enhancements, under §
355.723 of this title (relating to
Reimbursement Methodology for Home and Community-Based Services and Texas Home
Living Programs).
(5) Texas Home
Living (TxHmL)--Community Support Services (CSS) CFC: Rates will be equal to
rates established for TxHmL CSS, including applicable attendant compensation
rate enhancements, under §
355.723 of this title.
(6) Personal Care Services
(PCS)--Habilitation CFC: Rates will be equal to rates established for PCS
attendant services for recipients with a behavioral health condition under
§
355.8441 of this title (relating to
Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) Services).
(7)
Personal Care Services (PCS)--Attendant CFC: Rates will be equal to the rates
established for PCS attendant services for recipients without a behavioral
health condition under §
355.8441 of this title.
(8) Consumer Directed Services (CDS)--CFC:
Rates will be equal to rates established for CDS for the equivalent non-CFC
service under §
355.114 of this title (relating to
Consumer Directed Services Payment Option).
(9) Support Consultation Services--CFC: Rates
will be equal to rates established for Support Consultation Services under
§
355.114 of this title.
(10) CFC State Plan rate for Financial
Management Services Agencies (FMSA) (only authorized for individuals receiving
all of their CDS services under CFC): Rates will be equal to rates established
for FMSAs for an equivalent non-CFC service under §
355.114 of this title.
(11) Emergency Response Services (ERS)--CFC:
Rates will be equal to rates established for ERS under §
355.510 of this title (relating to
Reimbursement Methodology for Emergency Response Services (ERS)).
Notes
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