Section 355.9090 - Reimbursement Methodology for Community First Choice(a) General information. The Texas Health and Human Services Commission (HHSC) applies the general principles of cost determination as specified in § RSA 355.101 of this title (relating to Introduction).(b) Reimbursement Methodology. Community First Choice (CFC) rates are established using pre-existing rates as follows. (1) CFC State Plan Rate--Attendant and Habilitation: Rates will be equal to a weighted average of rates established for Community Living Assistance and Support Services (CLASS) habilitation services according to the reimbursement methodology for the CLASS program under § RSA 355.505 of this title (relating to Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program) and proxy rates for attendant services used in the calculation of the STAR+PLUS managed care capitation rates for the Home and Community-based Services (HCBS) risk group. The weighted average will include applicable attendant compensation rate enhancements. (A) Proxy rates are equal to rates established for attendant services under the Community Based Alternatives (CBA) waiver prior to its termination, updated for changes in allowable reported expenses and units of service.(B) Weighting factors assume that 30 percent of personal attendant services historically provided to existing recipients in the STAR+PLUS HCBS risk group and 100 percent of personal attendant services provided to newly eligible recipients under CFC will be for habilitation.(2) CLASS--Attendant and Habilitation CFC: Rates will be equal to rates established for CLASS habilitation services, including applicable attendant compensation rate enhancements, under § RSA 355.505 of this title.(3) Deaf-Blind with Multiple Disabilities (DBMD)--Attendant and Habilitation CFC: Rates will be equal to rates established for DBMD Residential Habilitation, including applicable attendant compensation rate enhancements, under § RSA 355.513 of this title (relating to Reimbursement Methodology for the Deaf-Blind with Multiple Disabilities Waiver Program).(4) Home and Community-Based Services (HCS)--Supported Home Living (SHL) CFC: Rates will be equal to rates established for HCS SHL, including applicable attendant compensation rate enhancements, under § RSA 355.723 of this title (relating to Reimbursement Methodology for Home and Community-Based Services and Texas Home Living Programs).(5) Texas Home Living (TxHmL)--Community Support Services (CSS) CFC: Rates will be equal to rates established for TxHmL CSS, including applicable attendant compensation rate enhancements, under § RSA 355.723 of this title.(6) Personal Care Services (PCS)--Habilitation CFC: Rates will be equal to rates established for PCS attendant services for recipients with a behavioral health condition under § RSA 355.8441 of this title (relating to Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services).(7) Personal Care Services (PCS)--Attendant CFC: Rates will be equal to the rates established for PCS attendant services for recipients without a behavioral health condition under § RSA 355.8441 of this title.(8) Consumer Directed Services (CDS)--CFC: Rates will be equal to rates established for CDS for the equivalent non-CFC service under § RSA 355.114 of this title (relating to Consumer Directed Services Payment Option).(9) Support Consultation Services--CFC: Rates will be equal to rates established for Support Consultation Services under § RSA 355.114 of this title.(10) CFC State Plan rate for Financial Management Services Agencies (FMSA) (only authorized for individuals receiving all of their CDS services under CFC): Rates will be equal to rates established for FMSAs for an equivalent non-CFC service under § RSA 355.114 of this title.(11) Emergency Response Services (ERS)--CFC: Rates will be equal to rates established for ERS under § RSA 355.510 of this title (relating to Reimbursement Methodology for Emergency Response Services (ERS)).1 Tex. Admin. Code § 355.9090
Adopted by Texas Register, Volume 40, Number 21, May 22, 2015, TexReg 2750, eff. 6/1/2015