Upper Payment Limit (UPL) Supplemental Payment Program

1. Upper Payment Limit (UPL)Supplemental Payment Program Nursing Facilities (NF) & Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Webinar August 20, 2013 September 11, 2013

2. Topics • 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

3. Overview 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)

4. Overview (continued) 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)

5. Overview (continued) 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

6. Overview (continued) 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

7. Who can participate?

8. Non-State Governmental Entities 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

9. Non-State Governmental Entities (continued) A non-state governmental entity may be a: • County • City • Hospital District or Hospital Authority • Healthcare District Participation is voluntary.

10. Change of Ownership If the facility undergoes a Change of Ownership while participating in this program, the entity must notify HHSC within 30 days after such change.

11. Change of Ownership (continued) 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:

12. Change of Ownership (continued) 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.

13. How can entities enroll?

14. How Can Entities Enroll? • Submit the completed Certification Form • Participate in TEXNET • Have a Texas Identification Number (TIN) • Have direct deposit established

15. Certification Form The facility certifies: • It is a non-state government-owned facility where: • 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

16. Certification Form (continued) 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.

17. Signatory for Nursing Facilities 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.

18. Signatory for ICF/IID Facilities ICF / IID Contract Specialist (512) 438-2630 Option 3 To verify or change the authorized signatory

19. Deadlines for Participation Certification Forms MUST be received by HHSC by these dates to participate:

20. ADDITIONAL FORMS The following forms must be completed in order to participate: • TEXNET 89-103 • Texas Identification Number AP-152 • DADS Authorization for Direct Deposit 4108

21. TEXNET 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).

22. Texas Identification Number (TIN) 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

23. TIN • 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

24. TIN • 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.

25. Direct Deposit Direct Deposit Authorization • Used by recipients to receive payments from the state of Texas. • The controlling entity and facilityboth: • complete form 4108 Direct Deposit Authorization • DO NOT complete if: both already have current direct deposit with the Texas Comptroller

26. Direct Deposit 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.

27. Direct Deposit 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.

28. Direct Deposit 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

29. What is the process for calculating payments?

30. Step One HHSC determines the Aggregate Supplemental Payment Amount NURSING FACILITIES • 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 • 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

31. Step One (continued) 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 government-owned NFs • The Aggregate Supplemental Payment Amount for possible payment in FFY2014 is based on FFY2013 data

32. Step One (continued) ICF/IID FACILITIES • 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 • The Aggregate Medicaid Payment is the sum of Medicaid Level of Need (LON) payments as captured on the most recent audited Medicaid cost report

33. Step One (continued) 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 government-owned 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

34. Step Two HHSC determines the Medicaid Supplemental Payment Limit for each participating entity. For the first quarter, this is based on FFY2014 First Quarter (October 1st through December 31, 2013)

35. Step Three (continued) 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

36. Step Three (continued) • 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.

37. Step Three (continued) 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%

38. What is the process for fund transfers and paymentS?

39. TEXNET & IGT Transfer 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.

40. Inter-Governmental Transfers After the funds are sent by IGT, the non-state governmental entity will be emailed a Trace Sheet.

41. Inter-Governmental TransfersTrace Sheet (example) Health and Human Services Commission TRAVIS COUNTY-  Allandale Community Medical CenterAccount # 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

42. Inter-Governmental Transfers 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.

43. Payments • 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

44. Payments (continued) 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.

45. Payments (continued) 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).

46. Payments (continued) 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).

47. Payments (continued) 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).

48. Multiple Facilities 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).

49. Recoupments • 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.

50. Summary and Timeline