Medicaid Spending Requirement for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Home and Community-based (HCS) and Texas Home Living (TxHmL)

General Information

The 2016-2017 General Appropriations Act (Article II, House Bill 1, 84th Legislature, Regular Session, 2015) appropriated funds for rate increases in the Home and Community-based Services (HCS) program and Texas home Living (TxHmL) program (Rider 39) and non-state Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) program (Rider 40).

As a part of the appropriations, Rider 39 and Rider 40 require HHSC to establish a system of spending accountability that ensures each HCS, TxHmL and ICF/IID provider expends at least 90 percent of all funds received through the Medicaid payment rates on for Medicaid services as captured by the provider's Medicaid cost report.

If, after examining their historical revenues and expenditures, a provider believes they will not meet the spending accountability requirements for a particular rate period, HHSC will allow the provider to choose not to receive the rate increases for the (“opt out”).  A provider who opts out of receiving the rate increases will not be subject to the spending accountability requirements.

If a provider chooses to receive the rate increases, they will be subject to the spending accountability requirements referenced in the HCS / TxHmL reimbursement methodology at Title 1 of the Texas Administrative Code (TAC), §355.723 and the ICF/IID reimbursement methodology at 1 TAC, §355.456, and may be subject to recoupment of the rate increase if at least 90 percent of all funds received through the Medicaid payment rates are not expended on Medicaid services as captured by the provider’s Medicaid Cost Report.  HHSC will limit possible recoupments under the new spending accountability provisions to the rate increases from funds appropriated under Rider 39 and Rider 40.

If a provider chooses to receive the rate increases there is no action they must take.  If a provider chooses to opt out of the rate increases they must notify the HHSC Rate Analysis Department they are opting out of receiving the rate increases for the period of September 1, 2015, through August 31, 2017.  Providers must use the online form at the link below to provide notification they are opting out no later than 5:00 pm on August 28, 2015:

http://registration.hhsc.state.tx.us/Ltssoptoutvendorsearch.aspx

HHSC will host free webinars to answer any questions providers may have about the new spending accountability requirements. The training presented via Webinar does require registration. Webinar is an interactive online training. Once you have registered, you will receive a website link to access the presentation and a conference call number to call in and participate in the training sessions.

Register for Webinar Trainings

The training presented via Webinar does require registration. Webinar is an interactive online training. Once registered, you will receive a website link to access the presentation and a conference call number to call in and participate in the training session.

Class: Medicaid Spending Requirement, Opt Out Information Session
Date: Thursday, August 20, 2015
Time: 9:00 AM - 10:00 AM CST (recommended log in time 8:45 AM)
Sign up at: https://attendee.gotowebinar.com/register/1666381708744772866

Class: Medicaid Spending Requirement, Opt Out Information Session
Date: Thursday, August 20, 2015
Time: 10:15 AM - 11:15 AM CST (recommended log in time 10:00 AM)
Sign up at: https://attendee.gotowebinar.com/register/1891942121136551938

Class: Medicaid Spending Requirement, Opt Out Information Session
Date: Friday, August 21, 2015
Time: 9:00 AM - 10:00 AM CST (recommended log in time 8:45 AM)
Sign up at: https://attendee.gotowebinar.com/register/7524139856884253186

Class: Medicaid Spending Requirement, Opt Out Information Session
Date: Friday, August 21, 2015
Time: 10:15 AM - 11:15 AM CST (recommended log in time 10:00 AM)
Sign up at: https://attendee.gotowebinar.com/register/3771536358098705922