Long-term Services & Supports

Overview

The Provider Finance Department (PFD) develops reimbursement methodology rules for determining payment rates or rate ceilings for recommendation to the Health and Human Service as Commission (HHSC) for Medicaid payment rates and non-Medicaid payment rates for programs operated by the Health and Human Services Commission (HHS) and the Department of Family and Protective Services (DFPS). PFD develops payment rates or rate ceilings in accordance with these rules and agency policy guidelines.

Announcements

American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments (Updated 03/10/2023)

The Health and Human Services Commission (HHSC) American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments is part of the HHSC APRA Spending Plan.

The HCBS ARPA Retention Payments were distributed as a temporary rate add-on on eligible service claims with dates of service from March 1, 2022 to August 31, 2022, to agency providers and consumer-directed services (CDS) employers. HCBS ARPA Provider Retention payments should support recruitment and retention efforts for direct care staff delivering HCBS services. Eligible providers can use the temporary add-on to provide one-time financial compensation directed toward direct care staff. Compensation can include lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.

HHSC adopted Texas Administrative Code rule 1 TAC 355.207 governing the HCBS ARPA Retention Payments, including the attestation and reporting requirements. Eligible providers who receive the add-ons, but fail to complete the required attestation and reporting, will be subject to recoupment of the associated payment add-ons.

HHSC requires providers who deliver eligible HCBS services with service dates between March 1, 2022, and August 31, 2022, to submit an attestation, an initial report, and a final report. The attestation, initial, and final reports are due 30 calendar days after the end of the federally declared COVID-19 Public Health Emergency (PHE). If the deadline falls on a  weekend day, national holiday, or state holiday, then the deadline will fall on the following business day. The official federally-declared COVID-19 PHE notifications can be viewed here.

Attestation and Initial Report Submission

Provider Agencies and CDS Employers who wish to submit individually, Click here to submit the required attestation and initial report due 30 calendar days after the end of the federally-declared COVID-19 PHE. If the deadline falls on a  weekend day, national holiday, or state holiday, then the deadline will fall on the following business day. The official federally-declared COVID-19 PHE notifications can be viewed here. A PDF copy of the attestation and initial report can be previewed under HCBA ARPA Provider Retention Payment Resources below.

Final Report Submission

Provider Agencies and CDS Employers who wish to submit individually, Click here to submit the required final report due 30 calendar days after the end of the federally declared COVID-19 PHE. If the deadline falls on a  weekend day, national holiday, or state holiday, then the deadline will fall on the following business day. The official federally-declared COVID-19 PHE notifications can be viewed here.  A PDF copy of the attestation and initial report can be previewed under HCBA ARPA Provider Retention Payment Resources below.

HCBS ARPA Provider Retention Payments Compliance List

HHSC will be posting a list of providers whose Attestation, Initial Report, and Final Report submissions have been reviewed. The list will be updated every 14 calendar days.

Financial Management Services Agencies (FMSAs)

FMSA/CDS Employer Attestation and Initial Report Submission Template

Click here (.xslx) to download the template to submit the attestation and initial report for multiple CDS employers. Please return the completed template via email to PFD-LTSS@hhs.texas.gov.

FMSA/CDS Employer Final Report Submission Template

Click here (.xslx) to download the template to submit the required final report for multiple CDS employers.

The CDS participant, as the employer of record, may choose to submit the required attestation and reports or work with the Financial Management Services Agency (FMSA) to submit the attestation and reports on the CDS participant’s behalf. FMSAs may also reach out to the CDS participants to offer assistance in submitting the attestation and reports. FMSAs can submit the required information for multiple CDS participants in the FMSA HCBS ARPA Attestation and Initial Report Template. To be eligible for the temporary rate add-on, according to 1 TAC 355.207(c)(4), providers must submit required reports regarding the use of funds and provide data to document vacancy rates in direct care staff and other indicators. If completing the attestation and reports on behalf of a CDS participant, FMSAs should work with the CDS participant to collect all required data. The deadline for the attestation, initial and final reporting has been extended to 30 calendar days after the end of the federally-declared COVID-19 PHE. If the deadline falls on a  weekend day, national holiday, or state holiday, then the deadline will fall on the following business day. The official federally-declared COVID-19 PHE notifications can be viewed here.

HCBS ARPA Provider Retention Payment Resources

Please contact the HHSC Provider Finance Department, Long-term Services and Supports Customer Information Team at PFD-LTSS@hhs.texas.gov or (737) 867 7817 if you have questions regarding HCBS ARPA Provider Retention Payments.

SB 809 / Rider 143 COVID-19 Reporting Healthcare Institution List (Updated 01/28/2023)

SB809/Rider 143 Submission List as of January 28, 2023

The Health and Human Services Commission (HHSC) has posted the list of healthcare institutions who must submit reports in compliance with Senate Bill 809 or Rider 143. The list shows providers who haven’t submitted a SB 809 / Rider 143 Report as well as those HHSC staff are helping complete the report. The list can be found here (.xlsx) This list was updated with completed reports received by January 28, 2023.

Note that this list is derived at a point in time and not all inclusive as providers may enroll or change at various times. Any provider that is identified as a “Health Care Institution” defined in Section 74.001 of the Civil Practice and Remedies Code is required to complete the reports. The list has been updated to align with licensing agencies. All questions related to SB 809 / Rider 143 should be emailed to HHSC_RAD_Survey@hhs.texas.gov. There may be a delay in response due to volume.

HHSC has the authority to pursue disciplinary actions for facilities that fail to report. The health and safety of those we serve is always our top priority.

The first quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published March 1, 2022 and can be found here.

The second quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published June 1, 2022 and can be found here.

The third quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published September 1, 2022 and can be found here.

The fourth quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published December 1, 2022 and can be found here.

The fifth quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published March 1, 2023 and can be found here.

SB 8, from the 87th Legislature’s third special session, authorizes grants to rural hospitals, nursing homes, home health agencies, intermediate care facilities and community attendants from the Coronavirus State Fiscal Recover Fund, established under the American Rescue Plan Act. We are required to prioritize grants to grantees who are compliant with the reporting requirements identified above. Failure to submit reports required by Senate Bill 809 or Rider 143 could limit the funding a provider may receive from the grants or disqualify them completely. Providers must submit an Initial Form, which includes funding and cost data covering the period January 2020 through August 2021. If you are delinquent in submitting the Initial Form, please email us at HHSC_RAD_Survey@hhs.texas.gov. Providers must also submit this monthly form every month. The reports are due one month after the reporting period ends. (for example, the report for December 2021 data will be due Feb. 1).

2022 COVID-19 Grant Programs

December 16, 2021

Pursuant to Senate Bill (S.B.) 8, 87th Legislature, 3rd Called Session, 2021, the Health and Human Services Commission will administer one-time grants for the following providers:

  • $75,000,000 million for rural hospitals (S.B. 8, Section 12);
    • $38,000,000 ($250,000 per rural hospital) via direct grant awards;
    • $37,000,000 distributed via a competitive grant process;
  • $200,000,000 for nursing facilities (S.B. 8, Section 33);
    • $90,000,000 ($75,000 per licensed facility) in direct grant awards;
    • $110,000,000 distributed via a competitive grant process;
  • $178.3 million for assisted living facilities, home health agencies, intermediate care facilities for individuals with intellectual and developmental disabilities or related conditions, and providers of community attendant services (S.B. 8, Section 33) distributed via a competitive grant process.

More information will be published at the following link under “COVID-19 in Healthcare Relief Grants” as it becomes available: https://www.hhs.texas.gov/business/grants/grants-awarded-hhs

Monthly SB 809 / Rider 143 COVID-19 Reporting (Updated 02/25/2022)

December 12, 2021 Update:

The 87th Texas Legislature directed the Health and Human Services Commission (HHSC) to report federal COVID-19 funding from specific health care institutions, and certain costs those providers have spent related to COVID-19 public health emergency. HHSC has developed a monthly report to obtain the information required by Rider 143 (.pdf) (2022-23 General Appropriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular Session, 2021 (Article II, HHSC, Rider 143) and S.B. 809 (.pdf) (87th Legislature, Regular Session, 2021). 

Frequently Asked Questions (FAQ):

View the HHSC created list of “frequently asked questions ” (FAQ) (.pdf) (Updated 03/18/2022) with the answers to common questions to assist providers in completing the report.

Reporting: 

Providers must submit an Initial Form, which includes funding and cost data covering the period January 2020 through August 2021. If you are delinquent in submitting the Initial Form, please contact us at HHSC PFD Survey. The ongoing monthly reports (located here) will be ongoing and will cover a single month; each monthly report will be due on the 1st of the second following month following the end of the month (for example, the report for January 2022 data will be due March 1, 2022.)

For those providers with multiple submissions, the offline form here (.xlsx) can be used. Do not change the format in any way as this might cause your information to not be submitted. Complete the questions that apply to your specific provider type and send to HHSC_RAD_Survey@hhs.texas.gov once complete.

You will receive a confirmation page once your report has been fully completed and submitted. No email confirmation will be sent.

A pdf version of the ongoing report is available here (.pdf) for review prior to submitting the reports.

If you are unable to meet the reporting deadline, please contact the Provider Finance Department at HHSC_RAD_Survey@hhs.texas.gov for assistance.

Failure to submit:

Failure to complete and/or submit the required monthly report(s) on-time will result in:

A report to the Department of State Health Services or HHSC Regulatory Services and potential adverse actions on your licensure and/or  HHSC may initiate payment holds for providers who fail to submit the required monthly reports.

List of Providers Required to Complete Reports: 

The following entities are required to complete the report:

  • Ambulatory Surgical Centers;
  • Assisted Living Facilities licensed under Chapter 247, Health and Safety Code;
  • Emergency Medical Services Providers;
  • Health Services Districts created under Chapter 287, Health and Safety Code;
  • Home and Community Support Services Agencies;
  • Hospice Providers;
  • Hospitals;
  • Hospital Systems;
  • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID);
  • Community Living Assistance and Support Services (CLASS) or Case Management Agency (CMA) Providers;
  • Deaf-Blind with Multiple Disabilities (DBMD) Providers;
  • Home and Community-Based Services (HCS) Providers;
  • Texas Home Living (TxHmL) Providers;
  • Nursing Facilities; and
  • End-Stage Renal Disease Facilities licensed under Section 251.011, Health and Safety Code

Please email the HHSC Provider Finance Survey for assistance at HHSC_RAD_Survey@hhs.texas.gov.

Cost/Accountability Reports Information

For your convenience, Provider Finance has provided links to the webpages routinely utilized for cost/accountability reports. In addition, these links can also be found on your program webpage. Links to your program and to the cost report training page can be found on the left hand navigation.

Cost Report Reform Training and Cycle

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 Provider Finance Department (PFD) 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 Provider Finance Department 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 if they continue to be non-participants in the rate enhancement program. 

Cost Reporting Cycle

CPC (Primary Home Care (PHC), Community Living Assistance and Support Services (CLASS)-Direct Service Agency (DSA), Community Living Assistance and Support Services (CLASS)-Case Management Agency (CMA)), and Day Activity and Health Services (DAHS) 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, 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.

Deaf-Blind Multiple Disabilities Waiver providers enrolled in the Rate Enhancement program will submit their accountability reports every year.

Below is the cost reporting cycle for all LTSS programs:

Even-Year Cost Reports

Even Year cost reports collected in the Odd Year. (i.e. 2020 reports collected in 2021)

Report Type Reports Collected
CR 24RCC
CR HCS/TxHmL
CR ICF/IDD
CR NF
CR RC
   
AR CPC
AR DAHS
AR DBMD

Odd-Year Cost Reports

Odd Year cost reports collected in the Even Year. (i.e. 2019 reports collected in 2020)

Report Type Reports Collected
CR 24RCC
CR CPC
CR DAHS
   
AR DBMD
AR HCS/TxHmL
AR ICF/IDD
AR NF
AR RC

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.

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.

The temporary COVID-19 rate increases were effective April 1, 2020, and is estimated to conclude at the end of the federally-declared public health emergency (PHE). The PHE is anticipated to end on May 11, 2023, unless the PHE is withdrawn before this date or extended. The official PHE notifications can be viewed here.