Long-term Services & Supports

Announcement regarding LTSS payment rates effective September 1, 2019

Please note that new payment rates effective September 1, 2019 have been posted for the following LTSS programs: Community First Choice, Community Based Alternatives, Community Living Assistance & Support Services, Day Activity & Health Services, Deaf-Blind Multiple Disabilities, Home and Community-based Services, Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Condition, Medically Dependent Children Program, Primary Home Care, and Residential Care.

Please do not alter your billing practices; the billing system will automatically adjust payment rates for services delivered on or after September 1, 2019, for any services with approved payment rate increases.

Overview

The Rate Analysis Department (RAD) develops reimbursement methodology rules for determining payment rates or rate ceilings for recommendation to the Health and Human Services Commission (HHSC) for Medicaid payment rates and non-Medicaid payment rates for programs operated by the Department of Aging and Disability Services (DADS) and the Department of Family and Protective Services (DFPS). RAD develops payment rates or rate ceilings in accordance with these rules and agency policy guidelines.

Introduction to Cost Report Reform

Beginning with the 2018 cost reports, cost report reform began as a pilot for Home and Community-based Services and Texas Home Living (HCS/TxHmL) waiver programs and the Intermediate Care Facilities for Individuals with an Intellectual or Developmental Disability or Related Conditions (ICF/IID) program providers to submit cost reports biennially rather than annually. The Texas Health and Human Services Commission (HHSC) Executive Commissioner directed the Rate Analysis Department (RAD) to expand cost report reform to all Long-term Services and Supports (LTSS) programs. The intended frequency of cost report submission is on a biennial basis rather than annual basis.

The Attendant Compensation Rate Enhancement and Direct Care Staffing Compensation Participants

A provider who participates in the Attendant Compensation Rate Enhancement or the Direct Care Staff Compensation programs (rate enhancement) are required to submit accountability reports in the years that they are not required to submit full cost reports. Providers are notified of the requirement to submit this report in an HHSC Rate Analysis letter that specifically requests this report.

Providers who do not participate in the rate enhancement program are only required to submit cost reports every two years; no reports will be required in the interim years as long as they continue to be non-participants in the rate enhancement program.

Cost Report Training

The Long-term Services and Supports (LTSS) cost report reform initiative requires preparers of most LTSS cost reports and accountability reports to attend state-sponsored cost report training in the same year that a cost report is required to be submitted to HHSC. Preparers of LTSS cost reports and accountability reports are required to attend training on a schedule that is related to their cost reporting deadlines.

There are no substantive changes to the Department of Family Protective Services (DFPS) 24-hour Residential Child Care program, and the Deaf-Blind with Multiple Disabilities (DBMD) training requirements.

Please note that due to the schedule of the implementation of the change in submission requirements, preparers of the following programs will be required to take the 2018 Cost Report Training regardless of whether or not they attended the 2017 Cost Report Training:

  • Home and Community-based Services / Texas Home Living (HCS/TxHmL);
  • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID);
  • Nursing Facilities (NF); and
  • Residential Care (RC)

Cost Reporting Cycle

Primary Home Care (PHC), Day Activity and Health Services (DAHS), Community Living Assistance and Support Services (CLASS)-Direct Service Agency (DSA), and Community Living Assistance and Support Services (CLASS)-Case Management Agency (CMA) providers will be required to submit cost reports to HHSC Rate Analysis Department in odd-numbered years.

Nursing Facility (NF), Residential Care (RC), HCS/TxHmL, and ICF/IID providers will be required to submit cost reports in even years.

NF providers who are members of the Pediatric Care Facility class and The Department of Family and Protective Services’ (DFPS) 24-Hour Residential Child Care (24-HR RCC) providers will continue to submit their cost reports every year.

Below is the cost reporting cycle for all LTSS programs:

Cost Reporting Cycle

Report Type          

Reports Collected               

Even-Year Cost Reports

Beginning with 2018 cost reports, collected in 2019:

 

 

 

CR

24RCC

HCS/TxHmL

ICF/IID

NF

RC

 

AR

CPC

DAHS

DBMD

Odd-Year Cost Reports

Beginning with 2019 cost reports, collected in 2020: 

 

 

CR

24RCC

CPC

DAHS

 

 

AR

DBMD

HCS/TxHmL

ICF/IID

NF

RC