Rider 40 of the 2016-2017 General Appropriations Act (Article II, House Bill 1, 84th Legislature, Regular Session, 2015) appropriated funds for rate increases non-state Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) program. The new reimbursement rates are included in this letter as Attachment 1. As a part of the appropriations, Rider 40 requires HHSC to establish a system of spending accountability that ensures each ICF/IID provider expends at least 90 percent of all funds received through the ICF/IID Medicaid payment rates on ICF/IID Medicaid services as captured by the provider’s Medicaid cost report. If, after examining their historical revenues and expenditures, an ICF/IID provider believes they will not meet the spending accountability requirements for a particular rate period, HHSC will allow the provider to choose not to receive the rate increases for the ICF/IID program (“opt out”). An ICF/IID provider who opts out of receiving the rate increases will not be subject to the spending accountability requirements. If an ICF/IID provider chooses to receive the ICF/IID rate increases, they will be subject to the spending accountability requirements referenced in the ICF/IID reimbursement methodology at Title 1 of the Texas Administrative Code, §355.456, and may be subject to recoupment of the rate increase if at least 90 percent of all funds received through the ICF/IID Medicaid payment rates are not expended on ICF/IID Medicaid services as captured by the provider’s Medicaid Cost Report. HHSC will limit possible recoupments under the new spending accountability provisions to the rate increases from funds appropriated under Rider 40 for the ICF/IID program.
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