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2024 Rate Enhancement Attendant Compensation Information

Overview

The 76th Texas Legislature established the Direct Care Staff Enhancement program for nursing facilities and Attendant Compensation Rate Enhancement Program for community care providers (Rate Enhancement). The 81st Texas Legislature expanded the Rate Enhancement programs for providers serving individuals with intellectual and developmental disabilities (IDD). These programs provide funding to incentivize increased compensation, including increased wages and benefits, for attendants and direct care staff.

Rate Enhancement programs are voluntary programs for Long-Term Services and Supports (LTSS) providers. Participating providers receive additional funding to their Medicaid attendant rates and agree to use that funding on compensation for attendant or direct care staff compensation. Program providers agree to spend funds to meet program requirements, or they will be subject to recoupment.

The Provider Finance Department has prepared an informational video on the Rate Enhancement Programs to inform interested providers about the programs’ benefits and requirements. The annual open enrollment period begins July 1, 2023.

Enrollment FAQs

When is Open Enrollment?

For state fiscal year 2024, Open Enrollment begins on July 1, 2023, and ends on July 31, 2023.

Which programs are eligible?

A provider must be contracted with the Texas Health and Human Services Commission (HHSC) for one of the following programs to be eligible for rate enhancement:

  • Community Living Assistance and Support Services (CLASS) - Direct Service Agency (DSA)
  • Day Activity and Health Services (DAHS)
  • Deaf-Blind with Multiple Disabilities Waiver (DBMD)
  • Home and Community-based Services (HCS)
  • Intermediate Care Facilities for Individuals with Intellectual Disability or Related Conditions (ICF/IID)
  • Nursing Facilities (NF)
  • Primary Home Care (PHC)
  • Residential Care (RC)
  • Texas Home Living (TxHmL)
How does a provider enroll in the program?

A contracted provider must complete an enrollment contract amendment that is signed by an authorized representative. Please see the HHSC signature authority designation form for additional information.

What if I’m a STAR+PLUS Provider?

HHSC only conducts open enrollment for contracted providers who deliver services in the programs listed above through fee-for-service. Managed Care Organizations (MCOs) are required to offer a rate enhancement program for their contracted providers delivering services in STAR+PLUS. Please contact your MCO to find out additional information regarding their rate enhancement program and its enrollment process.

What if I’m an Individualized Skills and Socialization Service Provider?

Effective March 1, 2023, Individualized Skills and Socialization Services replaced Day Habilitation Services. Since Individualized Skills and Socialization Services is delivered hourly and Day Habilitation was delivered daily, the rate enhancement participation level cannot roll over to Individualized Skills and Socialization Services. 

All HCS and TxHmL providers who wish to participate in Rate Enhancement for Individualized Skills and Socialization Services will need to complete a revised enrollment and submit an Enrollment Contract Amendment (ECA) during the 2024 enrollment period beginning on July 1, 2023. Providers who do not complete an Enrollment Contract Amendment to participate in Rate Enhancement for Individualized Skills and Socialization Services, will be a non-participant in Rate Enhancement for the rate year that begins on September 1, 2023.

View Information Letter here. (.pdf)

How do I modify my Enrollment?

After initial enrollment, participating and nonparticipating providers may request to modify their enrollment status during an open enrollment period; for example:

  • A participant can request to change participation level.
  • A participant can request to become a nonparticipant.
  • A participant can request to change participation level.

During the first open enrollment period after the limitation, providers (1) whose prior year enrollment was limited and (2) who requested to increase their enrollment levels will be limited to increases of three or fewer enhancement levels. Providers subject to an enrollment limitation may request to participate at any level during open enrollment, beginning two years after the limitation.

When is a request to modify a provider’s enrollment due?

Requests to modify a provider's enrollment status during an open enrollment period must be received by HHSC’s Provider Finance Department by the last day of the open enrollment period.
If the last day of open enrollment is on a weekend day, state holiday, or national holiday, the next business day will be considered the last day requests will be accepted.

If the Provider Finance Department does not receive a valid request to modify an enrollment by the last day of the open enrollment period, the provider will continue at the level of participation in effect during the open enrollment period, subject to fund availability.

Providers will remain enrolled unless the provider notifies the Provider Finance Department they are longer participating. Alternatively, enrollment will end when the provider’s enrollment is limited.

New contracts and component codes

New Contract: a new contract is defined as a contract or component code whose effective date is on or after the first day of the open enrollment period for that rate year.

New contracts will be mailed information from HHSC regarding their enrollment. The enrollment contract amendment form must be signed by an authorized representative, as per the HHSC signature authority designation form applicable to the provider's contract or ownership type. HHSC’s Provider Finance Department must receive the form within 30 days of the mailing sent to the provider notifying that such an enrollment contract amendment must be submitted.

If the 30th day is on a weekend day, state holiday, or national holiday, the next business day will be considered the last day requests will be accepted. Contracts that underwent a contract assignment or change of ownership, and new contracts that are part of an existing component code, are not considered new contracts.

For new contracts that request to participate in the attendant compensation rate enhancement on an acceptable enrollment contract amendment, the attendant compensation rate is adjusted effective on the first day of the month following receipt by HHSC of an acceptable enrollment contract amendment.
If the granting of newly requested enhancements was limited during the most recent enrollment, enrollment for new contracts would be subject to that same limitation. If the most recent enrollment was canceled, new contracts will not be permitted to be enrolled.

Supporting Documents and Resources:

Please see below for an overview of two Rate Enhancement Programs: 

Overview of Community Care and IDD Attendant Compensation Rate Enhancement (.pdf)

Overview of Nursing Facility Direct Care Staff Enhancement & Accountability (.pdf)

2024 Enrollment Information Letter:

View the Open Enrollment Notification Letter (.pdf)

2024 Enrollment Forms and Instructions:

View the Participation Status - Levels Awarded

View the Enrollment Contract Amendment Instructions

Complete the Enrollment Contract Amendment form 

View the Enrollment Worksheets and Instructions

2024 Enrollment Training Materials:

The recording of the webinars, in conjunction with the PowerPoint slides, are provided for informational purposes only.  If you have any specific questions regarding enrollment, please view the enrollment instructions and worksheets and/or contact the LTSS Center for Information and Training at PFD-LTSS@hhs.texas.gov.

View the training presentation for CLASS, DBMD, PHC, DAHS, HCS/TxHmL, ICF/IID, NF and RC (.pdf)

Download the recorded webinar training presentation for CLASS, DBMD, PHC, DAHS, HCS/TxHmL, ICF/IID, NF and RC (.wmv)

Legal Authority - Rate Enhancement Program Rules:

Community Care and IDD Providers: 1 Tex. Admin. Code Section 355.112

Nursing Facility Providers: 1 Tex. Admin. Code Section 355.308