1. (a) Intellectual and Developmental Disabilities (IDD) Facility Class. The purpose of this special class is to recognize, through the adoption of a special payment rate, the cost differences that exist in a nursing facility (NF) that predominately serves individuals with an IDD diagnosis.

2. (b) Definitions. The following terms, when used in this section, have the following meanings unless otherwise stated.

   1. (1) Intellectual and Developmental Disabilities (IDD)--A range of conditions that can affect a person's ability to learn, communicate, and function independently. These disabilities typically originate before the age of 18 and can continue throughout a person's life.
   2. (2) IDD NF--An IDD NF is an entire facility that has maintained an average daily census in which 90 percent of residents have a Preadmission Screening and Resident Review (PASRR) positive screen for IDD for the six-month period prior to its entry into the IDD care facility class based on the entire licensed facility. To remain an IDD NF, the IDD NF in its entirety must maintain an average daily census in which 90 percent of residents have a PASRR positive screen for IDD.

3. (c) Payment rate determination. Payment rates will be determined in the following manner.

   1. (1) Cost reports for IDD nursing facilities are governed by the requirements specified in Subchapter A of this chapter (relating to Cost Determination Process).
   2. (2) The payment rate methodology for this class of service equals the nursing and non-therapy ancillary components contained in the federal per diem rate for rural Medicare skilled NFs for the most recent federal fiscal year as published in the Federal Register, adjusted by applying the highest case-mix index (CMI). Payment rates are based on available funds and are limited to legislative appropriations.
   3. (3) The payment rate described in paragraph (2) of this subsection will be paid for all Medicaid residents of a qualifying IDD NF.
4. (d) Qualification for membership. A NF that wishes to be a member of the special reimbursement class must submit a letter to HHSC Provider Finance Department via an email to PFD-LTSS@hhs.texas.gov with a request to be considered for membership. HHSC will verify the NF meets the definition of IDD NF as defined in subsection (b)(2). HHSC will respond in writing to the facility within 30 days of receiving its request for membership. HHSC will review the status of any members within the special reimbursement class on an annual basis to verify that all members meet requirements defined in subsection (b)(2) of this section.
5. (e) Disqualification for membership. If HHSC determines that an NF no longer qualifies as a member of such class according to subsection (b) of this section, HHSC will notify the facility in writing. A facility that is disqualified as a member of the special reimbursement class, can request to reenter the class by sending a letter to HHSC as specified in subsection (d) of this section after no less than 365 days from its notification of disqualification in the class.

Source Note:The provisions of this §355.321 adopted to be effective September 11, 2025, 50 TexReg 5931.