Long-term Services & Supports
Federal CARES ACT Provider Relief Fund
Updated August 3rd 2020: DEADLINE TO APPLY for Federal CARES Act Provider Relief Fund is Friday, August 28, 2020 Interested providers are encouraged to apply.
Medicaid and CHIP Allocation
HHS expects to distribute $15 billion to eligible providers that participate in state Medicaid/CHIP programs or Medicaid managed care plans and have not yet received a payment from the Provider Relief Fund General Distribution allocation.
Per the published guidance, To be considered for the Medicaid and CHIP Distribution, providers must submit their gross revenues from patient care for CY 2017, 2018, or 2019 by August 28, 2020. Applications submitted after this deadline will not be considered for funding.
More information and application portal is available here: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html
COVID-19 Temporary Rate Increases:
Temporary COVID-19 rate increases for Nursing Facilities (NF) and the Home and Community-Based Services (HCS) Waiver Program effective April 1, 2020.
The payment rate add-ons for the HCS waiver only apply to providers delivering in-home day habilitation services to persons with intellectual disabilities or related conditions residing in three or four-bed group homes and receiving Supervised Living or Residential Support Services. These rate increases will apply to the current day habilitation rates so that providers delivering services in group homes can maintain hourly direct care staff wages due to reduced client to staff ratios.
NF providers may utilize the additional funding for COVID-related expenses; including direct care staff salary and wages, personal protective equipment (PPE), and dietary needs/supplies. As it relates to direct care staff salary and wages, NF providers may only use the additional funding to increase staff compensation through reimbursement of overtime or lump sum bonuses, including bonuses for hazard pay, or other methodologies that will not result in future reductions in hourly wages when the temporary rate increases are discontinued.
Per 355.205 - Emergency Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID-19), HCS and NF providers receiving increased funding associated with add-on payments for COVID-19 must submit an attestation affirming that the rate increases will be used only in the manner prescribed above. HCS and NF providers who receive add-ons but fail to complete the required attestation will be subject to recoupment of the associated payment add-ons. The attestation form can be here. Please utilize Chrome (Preferred Browser), Firefox or Safari.
- View the temporary COVID-19 rate increases for HCS and NF (.pdf)
- View the NF Informational Letter (IL) 2020-34
- View the HCS Informational Letter (IL) 2020-32
Random Moment Time Study
Random Moment Time Study for Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) program
In August 2020, the RMTS was reinitiated after being put on hold in March 2020.
The Health and Human Services Commission (HHSC) – Rate Analysis Department has contracted with a third-party vendor, Public Consulting Group (PCG), to administer a Random Moment Time Study (RMTS) related to Home- and Community-Based Services (HCS) and Texas Home Living (TxHmL) programs.
- Click here for more information regarding the RMTS (updated 08/06/2020)
What is the purpose of the RMTS?
- The RMTS will evaluate administrative weights in the HCS and TxHmL Rate Methodology by assisting HHSC in determining how many hours administrative staff work to support each service in HCS and TxHmL.
Will this RMTS be ongoing?
- No. This is a time limited RMTS designed to run for 30 days. The expected time study dates are October 15 – November 15, 2020.
As a HCS or TxHML provider, who and when will PCG contact me?
- If you are a provider of HCS or TxHmL services, your entity contact and/or financial contact designated in the STAIRS system should have received an email from PCG requesting a staff roster for this RMTS on August 17, 2020.
What should a HCS or TxHmL provider do, if they do not receive a notification from PCG?
- If you are a provider of HCS or TxHmL services and you have not received an email from PCG, please have your entity contact and/or financial contact, as designated in the STAIRS system, check their email SPAM folder or contact PCG at TXHHSCRMTS@pcgus.com or 1-888-314-2454.
I received an email from PCG regarding a staff roster. What is the purpose of the staff roster?
- All current providers of HCS and TxHmL services who contract with HHSC should complete a staff roster with applicable employed administrative staff (further details below) and return to TXHHSCRMTS@pcgus.com by September 15, 2020.
- Each RMTS participant will be identified by PCG from the submitted staff rosters.
What if my agency already sent in our roster earlier this year?
- Please review what you previously submitted. If there are changes, submit a new roster. If there are no changes, please notify PCG the roster is correct as is.
- PCG will follow up with you if you do not send an email about the roster.
Who should be included on the RMTS roster?
- Employed staff who provide administrative functions (including those staff who periodically provide direct care) including:
- assistant administrators
- electronic voice verification staff
- administrative staff, including program administrative staff and any other professional and nonprofessional administrative personnel such as Financial, Clerical, Human Resources, Information Technology staff
- facility and operations, including maintenance staff
- central office staff
Who should NOT be included in the roster?
- Contracted staff
- Direct care providers
- Includes direct service professionals or attendants who solely provide the following services- Supervised Living, Residential Support Services, Supported Home Living Transportation, Community First Choice PAS/HAB, Day Habilitation, Supported Employment, Employment Assistance, Host Home Companion Care
- Staff who solely provide non-attendant functions
- Includes Direct Care Supervisors, Host Home Companion Care Coordinators, Registered Nurses, Licensed Vocational Nurses, Behavioral Support, Dietary, Social Work, Physical Therapy, Occupational Therapy, Speech Therapy, Audiology, and Cognitive Rehabilitation Therapy
Are emails needed for each individual listed on the roster?
- Yes! The time study randomly emails participants throughout the length of the study, so each participant must have an email address to receive surveys. Emails will contain a link to a survey website, where participants will select an activity from a list. If any staff do not have an email address, please include them on the roster so PCG may track all staff who are unable to participate.
What if there is only one staff member who meets inclusion criteria?
- That is fine! Please provide PCG with the staff’s information.
What should I do if staff hours are flexible?
- We understand that staff may flex their time. Please complete the roster the best that you can with hours for each weekday reflective of a typical schedule. A schedule must be entered.
What should happen if an employee who provides administrative functions ceases to work for or is hired to work for the provider during the study?
- For those RMTS participants that cease to work for the provider prior to the start of the time study – If feasible, the supervisor or provider should notify PCG by October 12, 2020. PCG can stop notifications provided to that employee.
- For those RMTS participants that cease to work for the provider during the time study – If feasible, the supervisor or provider should notify PCG. PCG can stop notifications provided to that employee and/or note to disregard the non-responses.
- For staff who are hired after the staff roster is submitted and through the duration of the study – Due to the duration of the RMTS and the training needs, these individuals will not participate in the RMTS.
Will participants receive information and training before the time study begins?
- Yes! Each participant listed on an agency roster will receive notifications about the time study and invitations to training opportunities in advance. There will be multiple training opportunities for the RMTS participants prior to the start of the RMTS. We appreciate the timely submission of rosters so we can ensure all participants are able to receive this information before the time study begins.
What if you have additional questions?
- If you have any questions about how to complete the roster or at any point during the time study, please contact PCG at TXHHSCRMTS@pcgus.com or call 1-888-314-2454. Please note that dialing this number will play hold music; if PCG’s call staff are unavailable you will be directed to voicemail after a brief period of time. Please leave a voicemail with your name and number and PCG will call you back as soon as possible.
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
Even-Year Cost Reports
Beginning with 2018 cost reports, collected in 2019:
Odd-Year Cost Reports
Beginning with 2019 cost reports, collected in 2020: