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Nursing Facilities (NF) & Intermediate Care
Facilities for Individuals with an Intellectual
Disability or Related Conditions (ICF/IID)
Webinar
August 20, 2013
September 11, 2013
1
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
Overview
Who can participate?
How can entities enroll?
What is the process for calculating payments?
What is the process for fund transfers and
payments?
Summary and Timeline
Questions
2
The Texas Health and Human Services
Commission (HHSC) is implementing a new
Upper Payment Limit (UPL) Supplemental
Payment Program for:


Non-state government-owned nursing facilities (NF)
Non-state government-owned Intermediate Care Facilities for
Individuals with an Intellectual Disability or Related Conditions
(ICF/IID)
3
Eligibility for participation in the program, and
the methodology for calculating the
supplemental payment amount, is governed by
Title 1 of the Texas Administrative Code (TAC)
NF
§355.314
ICF/IID
§355.458
4
Federal regulations* allow states to claim federal
matching funds under Medicaid up to what Medicare
would pay for a similar service. Under this Upper
Payment Limit (UPL) supplemental payment program,
the state share of the supplemental payment comes in
the form of Inter-Governmental Transfers (IGTs) from
non-state government owned entities.
*Title 42 Code of Federal Regulations 447.272
5
The UPL Supplemental Payment Program will follow
the Federal Fiscal Year (FFY).

Starts October 1, 2013

Quarterly payments will be made to participants

The first payment for October – December 2013 is
scheduled for May 2014
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7
To participate, a governmental entity other
than the State of Texas MUST:
NF
Hold the license and be party to
the facility’s Medicaid contract
ICF/IID
Be party to the facility’s
Medicaid Contract
8
A non-state governmental entity may be a:
• County
• City
• Hospital District or Hospital Authority
• Healthcare District
Participation is voluntary.
9
If the facility undergoes a Change of Ownership
while participating in this program, the entity
must notify HHSC within 30 days after such
change.
10
If the facility undergoes a Change of Ownership
and becomes eligible to participate in this
program, the Change of Ownership must be
effective on or before:
Federal Fiscal Year Quarters
September 30, 2013
Participate starting first
quarter
Starts 10/01/2013
December 31, 2013
Participate starting second Starts 01/01/2014
quarter
March 31, 2014
Participate starting third
quarter
Starts 04/01/2014
June 30, 2014
Participate fourth quarter
Starts 07/01/2014
11
Change of Ownership is processed by the
Department of Aging and Disability Services
(DADS).
For more information on Change of Ownership
http://www.dads.state.tx.us/providers/NF/howto.html
Be aware of the DADS deadlines for Change of
Ownership Forms.
12
13




Submit the completed Certification Form
Participate in TEXNET
Have a Texas Identification Number (TIN)
Have direct deposit established
14
The facility certifies:

It is a non-state government-owned facility where:


NF
A non-state government entity holds the license
and is party to the facility’s Medicaid contract
ICF/IID
A non-state government entity is party to the
facility’s Medicaid contract
All funds transferred via Inter-Governmental Transfer (IGT)
will be public funds
No part of the supplemental payment will be used to pay a
contingent fee, consulting fee, or legal fee associated with
receipt of the funds
15
The person signing the certification must be
legally authorized to bind the facility and to
certify the matters described in the application.
FORM MUST BE NOTARIZED
The certification form is available electronically.
16
Signatory for Nursing Facilities
At this website you can enter a 9 digit contract
number for a nursing facility and it will give
the name of the authorized signatories.
To add or change a name, complete a DADS
Government Authority Resolution Form (Form
2031 or Form 2031-G) and submit to DADS.
17
ICF / IID Contract Specialist
(512) 438-2630
Option 3
To verify or change the authorized signatory
Business Organization
DADS Form 2031
Government Entity
DADS Form 2031-G
18
Certification Forms MUST be received by
HHSC by these dates to participate:
September 30, 2013
First through Fourth Quarter
December 31, 2013
Second through Fourth Quarter
March 31, 2014
Third through Fourth Quarter
June 30, 2014
Fourth Quarter Only
19
The following forms must be completed in
order to participate:
 TEXNET 89-103
 Texas Identification Number AP-152
 DADS Authorization for Direct Deposit 4108
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TEXNET website
The Inter-Governmental Transfer (IGT) of funds will be
transferred between the State and your facility electronically
using TEXNET.
 To sign up for TEXNET, please complete form 89-103
 This form should be mailed or faxed to the Comptroller of Public Accounts at
the address listed on the form.
Do not submit a form 89-103 if you already use TEXNET (that is,
you already have a User ID and Password).
21
Both the facility and the controlling entity will need a
Texas Identification Number.
 If the facility or the controlling entity doesn’t
already have a TIN, complete:
 Form AP-152: Application for Texas Identification Number
22



The TIN is derived from the 9 digit Federal
Identification Number (FEIN).
It is used to link a facility name, address, and
bank account.
A typical TIN is 14 digits long and looks
something like this: 1 700000000 9 005
23



Most facilities and controlling entities
contracting with the state probably already
have a TIN.
Check to see if your facility and controlling
entity have a TIN.
DO NOT complete the TIN form for any
facility or controlling entity that already has a
TIN.
24
Direct Deposit Authorization


Used by recipients to receive payments from the state
of Texas.
The controlling entity and facility both:
 complete
form 4108 Direct Deposit Authorization
 DO NOT complete if:
both already have current direct deposit with the
Texas Comptroller
25
It is critical that the information entered on
the TIN form and the Direct Deposit form is
exactly the same.
For example, do not enter:
“Kirk County Hospital District”
and
“Kirk Cnty Hospital District”
on another form.
26
If the controlling entity or facility already has a
TIN, then you will need to refer to your
documents to ensure you fill out the name the
same way on the Direct Deposit forms.
Both the facility and the controlling entity must
be signed up for Direct Deposit.
27
Please submit Direct Deposit Form 4108 to the
Department of Aging and Disability Services
(DADS) for processing.
DADS Accounting, TINs Team E-411
Texas Department of Aging and Disability Services
P.O. Box 149030
Austin, TX 78714-9030
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29
NURSING FACILITIES
A.
Aggregate Medicare Upper Payment Limit is the aggregate
amount that would be paid for the services furnished by the
non-state governmental NFs under Medicare principles
B.
Aggregate Medicaid Payment is the sum of Medicaid RUG*
payments and Medicaid payments for pharmacy services,
specialized services, emergency dental services and
customized wheelchairs
* Resource Utilization Group
30
Aggregate Supplemental Payment Amount is
the difference between the Aggregate Medicare
Upper Payment Limit and the Aggregate
Medicaid Payment.
This amount is based on all non-state governmentowned NFs
 The Aggregate Supplemental Payment Amount for
possible payment in FFY2014 is based on FFY2013
data

31
ICF/IID FACILITIES
A.
The Aggregate Medicare Upper Payment Limit is the
aggregate amount that would be paid for the services
furnished by the non-state governmental ICF/IID
under Medicare principles
B.
The Aggregate Medicaid Payment is the sum of
Medicaid Level of Need (LON) payments as captured
on the most recent audited Medicaid cost report
32
Aggregate Supplemental Payment Amount is
the difference between the Aggregate Medicare
Upper Payment Limit and the Aggregate
Medicaid Payment.



This amount is based on all non-state governmentowned ICF/IIDs
The Aggregate Supplemental Payment Amount for
possible payment in FFY2014 is anticipated to be based
on the 2012 Medicaid Cost Report
The Aggregate Supplemental Payment Amount for
NFs is determined separately from ICF/IIDs
33
For the first quarter, this is based on FFY2014 First
Quarter (October 1st through December 31, 2013)
34
HHSC notifies participating entities:



Each entity’s Medicaid Supplemental Payment Limit
The maximum Inter-Governmental Transfer (IGT)
amount that can be transferred based on the Federal
Medical Assistance Percentage (FMAP) in place at the
time the notice is given, and
The deadline for completing the transfer
35
• Inter-governmental transfers (IGTs) are
transfers of funds from one level of
government to another.
• For this program, the non-state governmental
entity would transfer funds to the state.
These funds will be used to pull down
federal matching funds. The sum of the
transfer and the federal funds will make up
the supplemental payment.
36
The maximum IGT amount that the facility can
transfer represents the “state share” as
calculated using the Federal Medical
Assistance Percentages (FMAP).
 As of the dates of the webinar, the “state share”
using existing FMAP for FFY2014 is 41.31%
37
38
It is important that you do not use the back
button on your browser while using TEXNET.
Enter your Identification Number, Location, and Password. Click
Submit, and on the next screen, click on the ADD button. The
Payment Window should pop up, allowing you to enter a
TEXNET transaction. You should enter your information under
Nursing Facility UPL or Intermediate Care Facility UPL, as
appropriate. Enter your payment total and Settlement Date (the
date the funds will transfer). You will need to provide the Texas
Identification Number for both the facility and for the controlling
governmental entity.
39
After the funds are sent by IGT, the non-state
governmental entity will be emailed a Trace
Sheet.
40
Health and Human Services Commission
TRAVIS COUNTY- Allandale Community Medical Center
Account #
Identification #: xxxxx Location #: xxxxx
Transaction Complete
Trace #: xxxxxxxx
Payment Total $YY,YYY.00
Settlement Date 05/29/2014
Nursing Facility UPL Amount $YY,YYY.00
41
An IGT that is not received by the date
specified by HHSC will not be accepted. The
IGT will be returned to the non-state
governmental entity.
In that case, the facility will not be eligible to
receive a supplemental payment.
42
 Payments to the facility will be made quarterly
 Each quarter’s payments are calculated for that
quarter for each facility
 Fourth quarter payments will vary depending
on whether or not the facility transferred the
maximum amount in the first three quarters
43
The Amount of the Supplemental Payment to each
facility will be calculated in proportion to the amount
transferred by the non-state governmental entity.
If the maximum amount is transferred by IGT, the
facility will receive the Medicaid Supplemental
Payment Limit amount.
If less than the maximum is transferred, the facility will
receive a payment that is proportionate to the
percentage of the maximum IGT that was actually
transferred.
44
EXAMPLE “Z”:



The non-state governmental entity “Z” is informed by
HHSC that the quarter’s Medicaid Supplemental
Payment Limit is $100,000‡ and that the maximum IGT
amount is $41,310. ‡ ‡
Non-state governmental entity “Z” IGTs the full IGT
amount of $41,310.
The supplemental payment to the facility will be
$100,000. ‡ ‡ ‡
The figure is for illustration only and does not reflect any entities actual amount.
‡ ‡ This is based on the FMAP at the time of the webinar.
‡ ‡ ‡ There are specific limitations for fourth quarter payments specified in 1 TAC
§355.314(h)(3) and §355.458(h)(2).
‡
45
EXAMPLE “Q”:



The non-state governmental entity “Q” is informed by
HHSC that the quarter’s Medicaid Supplemental
Payment Limit is $100,000‡ and that the maximum IGT
amount is $41,310. ‡ ‡
Non-state governmental entity “Q” IGTs half of the
maximum IGT amount, of $20,655.
The supplemental payment to the facility will be
$50,000. ‡ ‡ ‡
The figure is for illustration only and does not reflect any entities actual amount.
‡ ‡ This is based on the FMAP at the time of the webinar.
‡ ‡ ‡ There are specific limitations for fourth quarter payments specified in 1 TAC
§355.314(h)(3) and §355.458(h)(2).
‡
46
Payments to other facilities will not be increased
due to any individual facility transferring less than
the maximum IGT amount.
A non-state government owned facility that does
not transfer the maximum IGT in one or more of
the first three quarters can fund the remaining
Medicaid Supplemental Payment Limit during the
fourth quarter, subject to the limitations specified
in 1 TAC §355.314(h)(3) and §355.458(h)(2).
47
For a governmental entity that owns multiple
facilities and transfers less than the maximum
IGT amount for all of its facilities, each facility
will receive a proportion of the Medicaid
Supplemental Payment Limit Amount based on
the proportion that was transferred.
For details, refer to 1 TAC §355.314(h)(2)(B) or 1 TAC §355.458
(h)(2)(B).
48
Recoupment is allowed if a facility receives an
overpayment or if CMS disallows federal
participation.
 Recoupment is equal to the amount of supplemental
payments overpaid if disallowed.
 HHSC may withhold all Medicaid payments if the
recoupment is not paid in full within 30 days of
written receipt.
49
50






Overview
Who can participate?
How can entities enroll?
What is the process for calculating payments?
What is the process for fund transfers and
payments?
What next? Proposed rule change?
51
September 30, 2013
Certification Form due to HHSC for first quarter
participation
January 2014
HHSC determines Aggregate Supplemental Payment
Amount
April 2014
HHSC determines the Medicaid Supplemental
Payment Limit for each participating entity; the
maximum Inter-Governmental Transfer (IGT); the
deadline for completing IGT
April 2014
Providers IGT funds to Comptroller of Public Accounts
April – May 2014
HHSC calculates First Quarter Amount of
Supplemental Payment for each facility
May 2014
First Quarter payments made
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Regular Mail
Overnight or
Special Delivery
Health and Human Services
Commission
Rate Analysis, Mail Code H-400
Attn: S. Hambrick
P.O. Box 149030
Austin, TX 78714-9030
Health and Human Services
Commission
Rate Analysis, Mail Code H-400
Attn: S. Hambrick
4900 N. Lamar
Austin, TX 78751-2316
53
Sarah Hambrick
Manager – Rate Policy Development
HHSC Rate Analysis
Phone: (512) 707-6066
[email protected]
54
Application for TIN AP-152
http://www.window.state.tx.us/taxinfo/taxforms/ap152.pdf
DADS Form 2031
http://www.dads.state.tx.us/forms/2031/
DADS Form 2031-G
http://www.dads.state.tx.us/forms/2031-G/
DADS Form 4108
http://www.dads.state.tx.us/forms/4108/
How to become a NF provider
http://www.dads.state.tx.us/providers/NF/howto.html
NF Signatory
http://www.dads.state.tx.us/providers/nf/signatories.cfm
ICF Signatory
Call: (512) 438-2630 Option 3
TEXNET Form 89-103
http://www.hhsc.state.tx.us/rad/hospitalsvcs/downloads/tex-net-enroll-form.pdf
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The UPL Supplemental Payment Programs for NFs and ICFs are
governed by the administrative rule codified at Title 1, Texas
Administrative Code §355.314 and §355.458. This PowerPoint
presentation and webinar are intended to help providers
understand and implement the policies reflected in those rules. If
any information in this presentation or webinar appears to conflict
with the language of the rule, the language of the rule prevails.
Please contact HHSC Rate Analysis staff listed in this webinar so
that any potential discrepancies can be corrected or explained.
56
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