temporary covid-19 rate increases for nursing facilities (nf...

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HHSC Provider Attestation Nursing Facility Vendor/Facility ID Provider Name Attestation Received (Yes/No) 000400001 SEVEN ACRES JEWISH SENIOR CAR Yes 000403104 HERITAGE CONVALESCENT CENTER Yes 000404801 EDEN HOME INC Yes 000407502 MENARD MANOR Yes 000407904 COON MEMORIAL HOME Yes 000408402 JOHN PAUL II NURSING HOME No 000409002 ST FRANCIS NURSING HOME No 000409501 ROBERT LEE CARE CENTER Yes 000415903 HIGHLAND NURSING CENTER Yes 000416101 HOLIDAY HILL INC No 000417603 TOWN HALL ESTATES-HILLSBORO, No 000417903 SAN JOSE NURSING CENTER Yes 000418305 WINDSOR CARE CENTER Yes 000420206 KENT COUNTY NURSING HOME Yes 000421004 PARKVIEW NURSING CARE CENTER Yes 000422101 MITCHELL COUNTY HOSPITAL No 000422703 HOUSTON COUNTY NURSING HOME No 000426102 COUNTRY VILLAGE CARE INC Yes Temporary COVID-19 rate increases for Nursing Facilities (NF) and the Home and Community-Based Services (HCS) Waiver Program effective April 1, 2020. The attestation form can be found here. Please utilize Chrome (Preferred Browser), Firefox or Safari. The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September. The payment rate add-ons for the HCS waiver only apply to providers delivering in-home day habilitation services to persons with intellectual disabilities or related conditions residing in three or four-bed group homes and receiving Supervised Living or Residential Support Services. These rate increases will apply to the current day habilitation rates so that providers delivering services in group homes can maintain hourly direct care staff wages due to reduced client to staff ratios. NF providers may utilize the additional funding for COVID-related expenses; including direct care staff salary and wages, personal protective equipment (PPE), and dietary needs/supplies. As it relates to direct care staff salary and wages, NF providers may only use the additional funding to increase staff compensation through reimbursement of overtime or lump sum bonuses, including bonuses for hazard pay, or other methodologies that will not result in future reductions in hourly wages when the temporary rate increases are discontinued. Per TAC 355.205 - Emergency Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID- 19), HCS and NF providers receiving increased funding associated with add-on payments for COVID-19 must submit an attestation affirming that the rate increases will be used only in the manner prescribed above. HCS and NF providers who receive add-ons but fail to complete the required attestation will be subject to recoupment of the associated payment add-ons. HHSC Provider Finance Page 1 of 28

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Page 1: Temporary COVID-19 rate increases for Nursing Facilities (NF ...muellerprost.com/wp-content/uploads/2020/09/NF...2020/08/29  · 001004282 COUNTRYSIDE NURSING AND REHAB No 001004288

HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

000400001 SEVEN ACRES JEWISH SENIOR CAR Yes000403104 HERITAGE CONVALESCENT CENTER Yes000404801 EDEN HOME INC Yes000407502 MENARD MANOR Yes000407904 COON MEMORIAL HOME Yes000408402 JOHN PAUL II NURSING HOME No000409002 ST FRANCIS NURSING HOME No000409501 ROBERT LEE CARE CENTER Yes000415903 HIGHLAND NURSING CENTER Yes000416101 HOLIDAY HILL INC No000417603 TOWN HALL ESTATES-HILLSBORO, No000417903 SAN JOSE NURSING CENTER Yes000418305 WINDSOR CARE CENTER Yes000420206 KENT COUNTY NURSING HOME Yes000421004 PARKVIEW NURSING CARE CENTER Yes000422101 MITCHELL COUNTY HOSPITAL No000422703 HOUSTON COUNTY NURSING HOME No000426102 COUNTRY VILLAGE CARE INC Yes

Temporary COVID-19 rate increases for Nursing Facilities (NF) and the Home and Community-Based Services (HCS) Waiver Program effective April 1, 2020.

The attestation form can be found here. Please utilize Chrome (Preferred Browser), Firefox or Safari.

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

The payment rate add-ons for the HCS waiver only apply to providers delivering in-home day habilitation services to persons with intellectual disabilities or related conditions residing in three or four-bed group homes and receiving Supervised Living or Residential Support Services. These rate increases will apply to the current day habilitation rates so that providers delivering services in group homes can maintain hourly direct care staff wages due to reduced client to staff ratios.

NF providers may utilize the additional funding for COVID-related expenses; including direct care staff salary and wages, personal protective equipment (PPE), and dietary needs/supplies. As it relates to direct care staff salary and wages, NF providers may only use the additional funding to increase staff compensation through reimbursement of overtime or lump sum bonuses, including bonuses for hazard pay, or other methodologies that will not result in future reductions in hourly wages when the temporary rate increases are discontinued.

Per TAC 355.205 - Emergency Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID-19), HCS and NF providers receiving increased funding associated with add-on payments for COVID-19 must submit an attestation affirming that the rate increases will be used only in the manner prescribed above. HCS and NF providers who receive add-ons but fail to complete the required attestation will be subject to recoupment of the associated payment add-ons.

HHSC Provider Finance Page 1 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

000436301 CEDAR LAKE NURSING HOME Yes000437301 SARAH ROBTS FRENCH HOME INC No000440202 TOWN HALL ESTATES-KEENE No000445204 SHADY ACRES HEALTH & REHAB Yes000446304 SENIOR VILLAGE NURSING HOME Yes000449901 AUTUMN LEAVES NURSING & REHAB Yes000451204 LAURENWOOD NURSING & REHABILI Yes000454002 SAN JUAN NURSING HOME INC Yes000455003 VALLEY VIEW CARE CENTER Yes000460901 JULIETTE FOWLER COMMUNITIES No000464001 C C YOUNG MEMORIAL HOME No000465403 GOLDEN AGE NURSING HOME No000467501 SCHLEICHER COUNTY MEDICAL CTR No000472709 THE ATRIUM REHABILITATION CEN Yes000480903 TOWN HALL ESTATES-WHITNEY, IN No000486101 TWILIGHT HOME No000488901 STERLING COUNTY NURSING HOME No000490001 BRONTE HEALTH AND REHAB Yes000490304 LBJ MEDICAL CENTER No000490505 INSPIRATION HILLS REHABILITAT Yes000497101 CHRISTIAN CARE CENTER Yes000501905 COLLINWOOD CARE CENTER Yes000502401 MCCAMEY CONVALESCENT CENTER No000504803 PASADENA CARE CENTER Yes000506401 CROCKETT COUNTY CARE CENTER Yes000509302 FARWELL CARE AND REHAB No000511001 COLDWATER MANOR NURSING HOME No000516001 GRANDVIEW NURSING AND REHABIL Yes000517601 HANSFORD MANOR Yes000518001 WHITE ACRES GOOD SAMARITAN No000518701 REAGAN COUNTY CARE CENTER No000518903 WOOLDRIDGE PLACE NURSING CTR No000519101 MARBRIDGE VILLA Yes000523501 PARK PLACE MANOR INC Yes000524601 TWIN OAKS MANOR Yes000524901 MEMORIAL NURSING AND REHABILI No000528401 BRIARCLIFF HEALTH CENTER No000528501 HARBOURVIEW CARE CENTER INC No000528701 SCHULENBURG REGENCY NSG CTR Yes000530301 REGENT CARE CENTER OF LAREDO No000531801 RUNNINGWATER DRAW CARE CENTER Yes000533201 MEMORIAL HEALTH CARE CENTER No000536601 REGENT CARE CENTER OF THE WOO No

HHSC Provider Finance Page 2 of 28

Page 3: Temporary COVID-19 rate increases for Nursing Facilities (NF ...muellerprost.com/wp-content/uploads/2020/09/NF...2020/08/29  · 001004282 COUNTRYSIDE NURSING AND REHAB No 001004288

HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

000537101 FIRESIDE LODGE RETIREMENT No000537501 WARE MEMORIAL CARE CENTER No000538001 MOUNTAIN VILLA NURSING CENTER Yes000538401 MABEE HEALTH CARE CENTER Yes001000459 SAINT DOMINIC VILLAGE No001000765 LENNWOOD NURSING & REHABILITA Yes001000846 RENAISSANCE PARK MULTI CARE C No001001122 LAKE WORTH NURSING CENTER No001001123 DECATUR NURSING & REHABILITAT No001001207 LIFE CARE CENTER OF PLANO No001001701 CARRIAGE HOUSE MANOR Yes001001761 CREATIVE SOLUTIONS IN HEALTH Yes001001770 PINE RIDGE HEALTH CARE LLP No001001771 SILSBEE OAKS HEALTH CARE LLP No001001772 MAGNOLIA PLACE HEALTH CARE LL No001001790 AFTON OAKS HEALTHCARE AND REH Yes001002987 REGENT CARE OF MEDICAL CENTER No001002989 KNOPP HEALTHCARE REHAB CENTER Yes001002990 THE MEADOWS Yes001002993 KNOPP NURSING & REHAB CENTER Yes001003191 PLEASANT VALLEY HEALTHCARE CE Yes001003207 VILLAGE CREEK NURSING HOME Yes001003580 MCKINNEY HEALTHCARE CENTER Yes001003700 BISHOP DAVIES NURSING CENTER No001003942 HAVENCARE NURSING & REHAB CTR Yes001003959 MONTE SIESTA NURSING & REHABI No001003963 CRESTVIEW RETIREMENT COMMUNIT No001003965 LINDAN PARK CARE CENTER LP Yes001004004 SHINER NURSING AND REHABILITA No001004051 TERRACE WEST NURSING & REHABI No001004052 BLUEBONNET NURSING AND REHABI No001004055 COTTONWOOD NURSING & REHAB No001004056 Oak Manor Nursing and Rehabil No001004063 MRC CREEKSIDE No001004089 REGENT CARE CENTER OF WOODWAY No001004112 RIVERVIEW NURSING AND REHABIL No001004117 SPRING CREEK NURSING AND REHA No001004118 NAVASOTA NURSING AND REHABILI No001004234 WOODLAND MANOR NURSING & REHA No001004282 COUNTRYSIDE NURSING AND REHAB No001004288 CHRISTIAN CARE CENTER No001004295 SEABREEZE NURSING & REHABILIT No001004353 LAKE LODGE NURSING AND REHAB No

HHSC Provider Finance Page 3 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001004401 LYNWOOD NURSING AND REHAB No001004411 FALFURRIAS NURSING AND REHAB No001004430 TOWN HALL ESTATES-ARLINGTON, No001004432 REGENCY VILLAGE CARE CENTER Yes001004439 LAWRENCE STREET HEALTH CARE C Yes001004440 SUGAR LAND HEALTH CARE CENTER Yes001004442 RICHMOND HEALTH CARE CENTER Yes001004444 WEST JANISCH HEALTH CARE CENT Yes001004445 CONROE HEALTH CARE CENTER Yes001004448 CLEVELAND HEALTH CARE CENTER Yes001004449 HUNTSVILLE HEALTH CARE CENTER Yes001004450 LIBERTY HEALTH CARE CENTER Yes001004452 BEAUMONT HEALTH CARE CENTER Yes001004468 FREDERICKSBURG NURSING & REHA No001004469 COUNTRY CLUB NURSING & REHABI No001004482 NOLAN NURSING & REHABILITATIO No001004487 WILLIS NURSING & REHABILITATI No001004488 BONHAM NURSING & REHABILITAT No001004489 DENISON NURSING & REHABILITAT No001004515 LA BAHIA NURSING & REHABILITA No001004526 PERMIAN RESIDENTIAL CARE CENT No001004655 MCCULLOUGH HALL NURSING CENTE Yes001004778 RANGER CARE CENTER No001004795 MISSION CARE CENTERS - ALL SE No001004816 WOODVILLE II ENTERPRISES LLC Yes001004826 TWIN OAKS HEALTH & REHABILITA Yes001004827 PINE TREE LODGE NURSING CENTE Yes001004849 UNIVERSITY PARK NURSING AND R No001004850 BLANCO VILLA NURSING & REHABI No001004851 BROWNWOOD NURSING & REHABILIT No001004854 BIRCHWOOD NURSING & REHABILIT No001004855 WELLINGTON OAKS NURSING & REH No001004858 PINEHURST NURSING & REHABILIT No001004859 HERITAGE VILLA NURSING & REHA No001004863 CLIFTON NURSING & REHABILITAT No001004865 WESTRIDGE NURSING & REHABILIT No001004869 NORTH POINTE NURSING & REHABI No001004871 OAKWOOD NURSING & REHABILITAT No001004873 MANSFIELD NURSING & REHABILIT No001004874 GARLAND NURSING & REHABILITAT No001004875 KEENELAND NURSING & REHABILIT No001004876 COUNTRY VIEW NURSING & REHABI No001004877 IRVING NURSING AND REHAB No

HHSC Provider Finance Page 4 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001004880 MARINE CREEK NURSING & REHABI No001007560 SPANISH MEADOWS Yes001012007 WILL-O-BELL Yes001012068 SEVEN OAKS NURSING & REHABILI No001012175 MERKEL NURSING CENTER No001012218 BIVINS MEMORIAL NURSING HOME No001012229 ASHTON PARKE CARE CENTER Yes001012932 FAITH MEMORIAL NURSING HOME Yes001012953 HACIENDA OAKS NURSING AND REH No001013030 KINGSLAND HILLS CARE CENTER No001013038 GULF HC CENTER GALVESTON No001013262 MERIDIAN CARE Yes001013347 RETAMA MANOR NSG/SA WEST Yes001013355 RETAMA MANOR/ RIO GRANDE CITY No001013462 BANGS NURSING HOME Yes001013529 CORRIGAN LTC PARTNERS Yes001013530 HEMPHILL CARE CENTER Yes001013537 HURST PLAZA NURSING AND REHAB No001013538 HACIENDA OAKS OT BEEVILLE No001013564 CIMARRON PLACE HEALTH AND REH No001013568 GIBSON CARE CENTER No001013639 SPANISH MEADOWS NURSING & REH Yes001013684 THE ARBORS No001013717 PARKVIEW NURSING AND REHABILI Yes001013854 FALCON LAKE NURSING HOME No001014062 THE VILLAGE AT RICHARDSON Yes001014143 MATAGORDA HOUSE HEALTHCARE CE No001014208 CASTLE PINES HEALTH & REHABIL Yes001014307 SUMMER MEADOWS Yes001014345 CHISOLM TRAIL NURSING AND REH Yes001014428 FAIRFIELD NURSING & REHABILIT Yes001014465 SALADO CREEK LIVING & REHAB Yes001014479 HERITAGE TRAILS NURSING AND R No001014519 ALVARADO MEADOWS Yes001014616 BRIARWOOD NSG & REHAB No001014774 AZALEA TRAIL NURSING HOME No001014787 SAN MARCOS NRSG & REHAB No001014815 HYGULEY NRSG & REHAB No001014992 GREENBRIER NURSING & REHABILI Yes001014994 GREENBRIER NURSING & REHABILI Yes001015118 COURTYARD GARDENS Yes001015135 LIFE CARE CENTER OF HALTOM No001015186 BALLINGER HEALTHCARE AND REHA Yes

HHSC Provider Finance Page 5 of 28

Page 6: Temporary COVID-19 rate increases for Nursing Facilities (NF ...muellerprost.com/wp-content/uploads/2020/09/NF...2020/08/29  · 001004282 COUNTRYSIDE NURSING AND REHAB No 001004288

HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001015187 NORMANDY TERRACE HEALTHCARE A Yes001015188 DIVERSICARE OF LAKE HIGHLANDS Yes001015228 ESTATES HEALTHCARE AND REHAB Yes001015229 TREEMONT HEALTHCARE AND REHAB Yes001015231 OAKMONT HEALTHCARE AND REHAB Yes001015296 REGENT CARE CENTER OF LEAGUE No001015340 REGENT CARE CENTER OF KINGWOO No001015371 BUENA VIDA NURSING AND REHAB No001015376 BRENTWOOD TERRACE NURSING Yes001015400 CASTRO CNTY NANDR Yes001015682 MADISONVILLE CARE CENTER Yes001015690 FRANKLIN NURSING CENTER Yes001015868 AVANTE REHABILITATION CENTER No001015874 HUNTINGTON HEALTH CARE Yes001015917 MILLBROOK HEALTHCARE & REHABI Yes001016043 GOLDEN ESTATES REHABILITATION Yes001016103 THE GRACE CARE CENTER OF KATY Yes001016127 LYTLE NURSING HOME Yes001016152 CEDAR MANOR NURSING AND REHAB Yes001016156 HERITAGE PARK OF KATY Yes001016157 MERIDIAN CARE OF HEBBRONVILLE Yes001016297 GRACE CARE CENTER OF CYPRESS Yes001016370 GROVETON NURSING HOME Yes001016371 CORNERSTONE GARDENS HEALTH No001016429 ROLLING MEADOWS Yes001016458 EDEN II ENTERPRISES LLC Yes001016477 MERIDIAN CARE OF ALICE Yes001016577 BAYOU PINES CARE CENTER Yes001016642 GEORGIA MANOR NURSING HOME Yes001016653 WELLINGTON CARE CENTER Yes001016678 MCLEAN CARE CENTER Yes001016679 SLATON CARE CENTER Yes001016680 MEMPHIS CONVALESCENT CENTER Yes001016719 WINDCREST NURSING AND REHABIL Yes001016908 VINTAGE HEALTH CARE CENTER No001016926 MULLICAN CARE CENTER No001016938 WHITESBORO HEALTH & REHAB CTR No001016941 OASIS NURSING & REHABILITATIO Yes001016942 EL PASO I ENTERPRISES LLC Yes001016944 RED OAK HEALTH AND REHABILITA Yes001016945 ROCKWALL NURSING CARE CENTER No001016956 SENIOR CARE HEALTH AND REHABI No001016957 SENIOR CARE BELTLINE No

HHSC Provider Finance Page 6 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001016966 HONEY GROVE NURSING CENTER No001016967 SENIOR CARE HEALTH & REHAB CT No001017009 PARK PLAZA Yes001017097 SUMMIT AT LAKEWAY HEALTHCARE No001017145 SAN JACINTO MANOR No001017186 HAMPTON AT WILLOWBROOK No001017208 KENDALL HOUSE WELLNESS AND RE No001017625 CIBOLO CREEK Yes001017743 VIDOR I ENTERPRISES LLC Yes001017816 GRACE CARE CENTER AT NORTHPOI Yes001017847 SULPHUR SPRINGS HEALTH AND RE Yes001017848 ROSENBERG SNF LLC Yes001017850 EL PASO HEALTH AND REHABILITA Yes001017859 VISTA HILLS HEALTH CARE CENTE Yes001017861 HENDERSON HEALTH AND REHABILI Yes001017863 COLONIAL MANOR Yes001017864 MCALLEN SNF LLC Yes001017865 SOUTHEAST SNF LLC Yes001017866 ADVANCED REHABILITATION & HEA Yes001017867 BALCH SPRINGS NURSING HOME Yes001017868 GREENVILLE HEALTH AND REHABIL Yes001017872 THE RENAISSANCE AT KESSLER PA Yes001017873 MESQUITE NH SNF LLC Yes001017884 CLARKSVILLE NURSING CENTER Yes001017889 THE LAKES AT TEXAS CITY Yes001017908 LONGHORN VILLAGE No001017912 ALTA VISTA REHAB & HEALTHCARE Yes001017924 GRAND TERRACE REHAB & HEALTHC Yes001017994 MERIDIAN CARE MONTE VISTA Yes001018006 SENIOR SUITE CARE & REHAB LLC No001018127 VICTORIA GARDENS OF ALLEN Yes001018128 THE HOMESTEAD OF DENISON Yes001018129 VISTA RIDGE NURSING AND REHAB Yes001018130 WINTERS PARK NSG & REHAB CTR Yes001018132 VICTORIA GARDENS OF FRISCO Yes001018315 ADVANCED HEALTHCARE AND REHAB Yes001018369 THE MERIDIAN Yes001018472 SHINNERY OAKS COMMUNITY Yes001018522 KENEDY I ENTERPRISES LLC Yes001018546 DEVINE HEALTH & REHABILITATIO Yes001018708 VILLAGES OF LAKE HIGHLANDS Yes001018741 BROWNWOOD II ENTERPRISES LLC Yes001018774 PARKVIEW NURSING AND REHABILI No

HHSC Provider Finance Page 7 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001018853 OAK PARK NURSING AND REHABILI No001018855 BROWNWOOD III ENTERPRISES LLC Yes001018883 OAK GROVE NURSING HOME No001018911 SILVER TREE NURSING & REHABIL Yes001018943 COLONIAL BELLE NURSING HOME Yes001018947 BRIARWOOD MANOR CARE CENTER Yes001018948 COLONIAL BELLE NURSING HOME S Yes001018970 MISSION NURSING AND REHABILIT Yes001018971 REMARKABLE HEALTHCARE OF SEGU Yes001018974 ABRI AT STEPHENVILLE Yes001019000 RAYBURN HEALTH CARE &REHAB Yes001019001 COUNTY OF LA SALLE No001019201 PARKVIEW MANOR NURSING AND RE Yes001019296 THE ROSEWOOD RETIREMENT COMMU Yes001019309 DECATUR I ENTERPRISES LLC Yes001019310 INDIAN OAKS LIVING CENTER Yes001019311 HILL COUNTRY REHAB AND NURSIN Yes001019318 CROWN POINT HEALTH SUITES Yes001019340 SOUTH DALLAS NURSING AND REHA No001019361 REMARKABLE HEALTHCARE OF FORT Yes001019424 BROOKHAVEN NURSING No001019484 THE ATRIUM OF BELLMEAD, L.L.C No001019486 BALLINGER I ENTERPRISES LLC Yes001019722 MERIDIAN CARE AT GRAYSON SQUA Yes001019736 SENIOR CARE OF HEWITT Yes001019739 HOLLY HALL Yes001019880 GREEN OAKS NURSING & REHAB Yes001019881 HARBOR LAKES NURSING & REHAB Yes001019884 SENIOR CARE OF STALLINGS COUR Yes001019885 SENIOR CARE OF CROWLEY Yes001019888 CARTHAGE LTC PARTNER Yes001019892 HERITAGE HOUSE NURSING AND RE Yes001019897 BEAUMONT NURSING AND REHABILI Yes001019945 GLEN ROSE I ENTERPRISES LLC Yes001020082 WINNIE L NURSING AND REHAB Yes001020121 ROCK CREEK HEALTH & REHABILIT No001020141 BAYWOOD CROSSING Yes001020253 EAGLE PASS I ENTERPRISES LLC Yes001020257 DEL RIO I ENTERPRISES LLC Yes001020268 SOUTHERN SPECIALTY REHABILITA Yes001020378 GREAT PLAINS NURSING & REHABI Yes001020554 ABRI AT BROWNWOOD Yes001020654 HIGHLAND SPRINGS INC No

HHSC Provider Finance Page 8 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001020691 STEPHENVILLE NURSING AND REHA Yes001020783 WESTWARD NURSING & REHAB No001020805 CONTINUING CARE-EAGLES TRACE No001020831 LUBBOCK II ENTERPRISES LLC Yes001020841 HONDO NURSING AND REHABILITAT No001020856 REMARKABLE HEALTHCARE OF DALL Yes001020860 THE MEDICAL RESORT AT BAY ARE No001020867 MINERAL WELLS NURSING & REHAB Yes001020870 GLEN ROSE NURSING AND REHAB C No001020877 MUNDAY NURSING CENTER Yes001020909 WILLOW REHAB & NURSING Yes001020948 TREEMONT HEALTCARE CENTER Yes001020961 HERITAGE HOUSE AT PARIS REHAB Yes001021009 CAPROCK NURSING & REHABILITAT Yes001021028 CEDAR CREEK NURSING AND REHAB Yes001021085 GILMER NURSING & REHABILITATI No001021138 ABRI AT EDINBURG Yes001021148 WHISPERING OAKS REHAB & NURSI Yes001021151 ROCK HAVEN NURSING HOME No001021200 SAN RAFAEL NURSING AND REHABI No001021230 HICO NURSING AND REHAB Yes001021250 CHEROKEE TRAILS NURSING HOME Yes001021281 MOUNT MORIAH NURSING & REHAB No001025385 AMARILLO CENTER FOR SKILLED N Yes001025390 AZLE MANOR HEALTH CARE No001025398 NORTH TOWER CARE GROUP No001025414 EAGLE LAKE NURSING & REHABILI No001025439 LOCKNEY HEALTH AND REHABILITA Yes001025440 STONEMERE REHABILITATION CENT Yes001025448 THE SPRINGS NURSING CENTER Yes001025459 HUEBNER CREEK HEALTH & REHABI Yes001025476 HILLTOP ON MAIN No001025483 PARKWOOD PLACE HEALTHCARE Yes001025489 TULIA HEALTH AND REHABILITAT Yes001025490 WINDSOR PLACE NURSING CENTER Yes001025492 ARLINGTON RESIDENCE Yes001025518 HOLMGREEN CENTER No001025553 THE REHABILITATION & WELLNESS Yes001025580 COPPERAS HALLOW NURSING AND R Yes001025586 SENIOR CARE OF CORPUS CHRISTI No001025631 THE PARK IN PLANO Yes001025632 WELLS LTC NURSING AND REHAB Yes001025635 GIDDINGS RESIDENCE Yes

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001025657 THE HEIGHTS OF GONZALES Yes001025686 WHARTON NURSING AND REHABILIT Yes001025687 CUERO NURSING AND REHABILITAT Yes001025692 TWIN PINES NORTH NURSING AND No001025697 THE RIO AT MAINLAND CENTER Yes001025701 CORNERSTONE RETIREMENT COMMUN No001025706 LUBBOCK HEALTH CARE CENTER Yes001025709 WESTVIEW MANOR Yes001025710 PORT LAVACA NURSING AND REHAB Yes001025711 STEVENS NURSING AND REHABILIT Yes001025756 SOUTHBROOKE MANOR NURSING AND Yes001025771 SHADY OAK NURSING AND REHABIL No001025772 TWIN PINES NURSING AND REHABI No001025773 GANADO NURSING AND REHABILITA No001025779 MATAGORDA NURSING AND REHABIL No001025824 HEREFORD NURSING & REHAB Yes001025829 BURLESON COUNTY HOSPITAL No001025841 ST. JOSEPH MANOR No001025843 REUNION PLAZA No001025849 THE WATERTON HEALTHCARE No001025881 HARMONEE HOUSE No001025904 LUBBOCK HOSPITAL NURSING Yes001025911 CRANE NURSING & REHAB CENTER No001025912 TRINITY NURSING & REHABILITAT No001025915 TRINITY NURSING & REHABILITAT No001025917 TRINITY NURSING & REHABILITAT No001025918 CEDAR HILLS GERIATRIC CENTER Yes001025919 GUADALUPE VALLEY NURSINC CENT Yes001025929 TOWN AND COUNTRY MANOR Yes001025945 THE CLAIRMONT TYLER Yes001025953 TRINITY NURSING & REHABILITAT No001025954 TRINITY NURSING & REHABILITAT No001025957 TRINITY NURSING & REHABILITAT No001025967 GALLERIA RESIDENCE AND REHABI Yes001025969 COPPERAS COVE NURSING Yes001025975 OAK CREST NURSING CENTER Yes001025976 CLAIRMONT LONGVIEW Yes001025977 LIVE OAK NURSING CENTER Yes001025984 HOPKINS COUNTY HOSPITAL Yes001026005 WINNIE-STOWELL HOSPITAL Yes001026006 MEDINA COUNTY HOSP DISTRICT Yes001026023 FORT WORTH TRANSITIONAL CARE Yes001026028 SPRING BRANCH TRANSITIONAL No

HHSC Provider Finance Page 10 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001026029 MONUMENT REHABILITATION Yes001026030 HALLETTSVILLE REHABILITATION Yes001026035 BRIARCLIFF NURSING & REHAB Yes001026044 ARBOR TERRACE HEALTH CARE Yes001026046 SWEETWATER HEALTHCARE CENTER Yes001026049 MARSHALL MANOR WEST No001026050 ROSE HAVE RETREAT No001026056 CITYVIEW CARE CENTER Yes001026065 GRACE CARE CENTER OF HENRIETT Yes001026067 BORGER HEALTHCARE CENTER Yes001026068 CORONADO NURSING CENTER Yes001026076 SILVER SPRING No001026080 SAGECREST ALZHEIMER'S CARE CE No001026081 HERITAGE OAKS NURSING Yes001026084 GRANBURY REHAB AND NURSING Yes001026090 BRADY WEST REHAB & NURSING Yes001026104 OAKLAND MANOR NURSING CENTER No001026108 CLAIRMONT BEAUMONT Yes001026129 REMARKABLE HEALTHCARE OF PRES Yes001026130 HASKELL HEALTHCARE CENTER Yes001026133 SNYDER OAKS CARE CENTER Yes001026136 VICTORIA RESIDENCE AND REHAB No001026137 GRACE CARE CENTER OF OLNEY Yes001026138 MARSHALL MANOR NURSING & REHA No001026152 OAK MANOR NURSING CENTER Yes001026161 GRACY WOODS NURSING CENTER No001026169 HIGHLAND PARK CARE CENTER No001026184 THE MANOR HEALTHCARE RESIDENC No001026186 WESTERN HILLS HEALTHCARE RESI No001026187 CRESTVIEW HEALTHCARE No001026188 WINDSON HEALTHCARE RESIDENCE No001026191 FAIRVIEW HEALTHCARE RESIDENCE No001026192 GARRISON NURSING HOME & REHAB No001026193 GOLDEN VILLA No001026197 CORONADO HEALTHCARE CENTER Yes001026204 MIDLOTHIAN HEALTHCARE CENTER No001026206 CHILDRESS HEALTHCARE CENTER Yes001026211 BIG SPRING CENTER FOR SKILLED Yes001026213 COLONIAL MANOR NURSING CENTER Yes001026215 WALNUT HILLS NURING Yes001026227 COLEMAN HEALTHCARE CENTER Yes001026234 QUALITY CARE OF WACO Yes001026235 PRAIRIE HOUSE LIVING CENTER Yes

HHSC Provider Finance Page 11 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001026239 PALO PINTO NURSING CENTER Yes001026240 WEDGEWOOD NURSING HOME Yes001026241 GRACE CARE CENTER OF NOCONA Yes001026242 WHITE SETTLEMENT NURSING CENT Yes001026243 CLYDE NURSING CENTER Yes001026245 PAMPA NURSING CENTER Yes001026246 GOLDEN YEARS NURSING AND REHA Yes001026247 LEVELLAND NURSING AND REHABIL Yes001026248 GARDENT TERRACE HEALTHCARE Yes001026252 LAKE SHORE VILLAGE HEALTHCAR Yes001026254 JACKSBORO HEALTHCARE CENTER Yes001026260 FLORESVILLE RESIDENCE & REHAB Yes001026266 WEATHERFORD HEALTHCARE CENTER No001026267 PEACH TREE PLACE Yes001026268 GREENVIEW MANOR Yes001026274 SANTA FE HEALTH & REHABILITAT Yes001026275 BROOKSHIRE HEALTH AND REHAB C Yes001026276 HERITAGE HOUSE AT KELLER REHA Yes001026277 SEYMOUR REHABILITATION Yes001026281 STOCKDALE HEALTH AND REHAB CE Yes001026283 BENBROOK NURSING & REHAB Yes001026285 PARK VIEW CARE CENTER Yes001026286 ADVANCED REHABILITATION AND H Yes001026287 ADVANCED REHABILITATION AND Yes001026295 SAGE HEALTHCARE CENTER No001026301 CYPRESS WOODS CARE CENTER No001026308 PLAINVIEW HEALTHCARE CENTER Yes001026313 GRAPEVINE MEDICAL LODGE Yes001026314 HILLSIDE HEIGHTS REHABILITATI Yes001026315 EVERGREEN HEALTHCARE CENTER Yes001026318 RIDGMAR MEDICAL LODGE Yes001026352 LAKESIDE REHABILITATION AND C Yes001026410 APEX SECURE CARE BROWNFIELD No001026414 WINDSOR NURSING AND REHABILIT Yes001026415 LAKE JACKSON HEALTHCARE CENTE Yes001026416 HAMILTON HEALTHCARE CENTER Yes001026417 RALLS NURSING HOME No001026418 MANSFIELD MEDICAL LODGE Yes001026419 CORPUS CHRISTI NURSING AND RE Yes001026421 ELECTRA HEALTHCARE CENTER Yes001026432 EDWARD ABRAHAM MEMORIAL No001026433 PATHWAYS MEMORY CARE AT VILLA Yes001026455 COLLEGE PARK REHAB No

HHSC Provider Finance Page 12 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001026457 COLLEGE STREET HEALTH CARE CE No001026481 PALO DURO NURSING HOME No001026483 KINGSVILLE NURSING AND REHABI No001026487 SENIOR REHAB & SKILLED NRSG No001026494 JEFFERSON NURSING AND REHABIL Yes001026504 DFW NURSING AND REHAB Yes001026514 BASTROP LOST PINES NURSING AN Yes001026515 MAGNOLIA MANOR Yes001026516 ASHFORD GARDENS Yes001026517 CORONADO AT STONE OAK Yes001026518 PALMA REAL Yes001026523 MAGOLIA LIVING & REHAB Yes001026524 THE BROADMOOR AT CREEKSIDE PA Yes001026525 WOODVILLE HEALTH AND REHAB CE Yes001026537 TEXAN NURSING & REHAB Yes001026541 WINDSOR NURSING AND REHABILIT Yes001026546 CRESTVIEW COURT No001026547 THE MADISON ON MARSH No001026551 GOLDEN ACRES LIVING Yes001026561 LEGACY REHABILITATION AND LIV Yes001026565 THE VILLA AT MOUNTAIN VIEW No001026566 NORTHERN OAKS LIVING & REHABI No001026568 COLONNADES AT REFLECTION BAY Yes001026569 LA PALOMA NURSING CENTER Yes001026574 GRAHAM OAKS CARE CENTER Yes001026577 RETAMA MANOR - LAREDO WEST Yes001026578 RETAMAN MANOR NURSING CENTER/ Yes001026582 RETAMA MANOR - LAREDO SOUTH No001026583 LAREDO NURSING & REHABILITATI Yes001026584 THE CRESCENT Yes001026585 SOLERA AT WEST HOUSTON Yes001026586 FORT BEND HEALTHCARE CENTER Yes001026587 BEL AIR AT TERAVISTA Yes001026595 HILLTOP VILLAGE N & R CENTER Yes001026597 RIO GRANDE CITY NURSING AND R Yes001026598 WILLOW PARK REHABILITATION AN No001026599 GARNET HILL REHAB & SKILLED C Yes001026602 WOODLAND SPRINGS NURSING HOME Yes001026605 WISTERIA PLACE Yes001026606 SILSBEE CONVALESCENT CENTER Yes001026607 MAVERICK NURSING AND REHABILI Yes001026610 CROSS COUNTRY HEALTHCARE CENT Yes001026611 ELGIN NURSING AND REHABILITAT Yes

HHSC Provider Finance Page 13 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001026614 NESBIT LIVING AND RECOVERY Yes001026617 SOUTHPARK MEADOWS NURSING Yes001026618 CARECHOICE OF BOERNE Yes001026627 HILLTOP PARK REHABILITATION A No001026628 THE HEIGHTS ON HUEBNER Yes001026639 DUNCANVILLE HEALTHCARE AND RE No001026641 DEER CREEK OF WIMBERLEY Yes001026642 MULBERRY MANOR Yes001026643 THE VILLAGES ON MACARTHUR Yes001026644 CISCO NURSING AND REHABILITAT Yes001026646 CAMBRIDGE HEALTH Yes001026647 RETIREMENT AND NURSING CENTER No001026648 BRENTWOOD PLACE THREE No001026653 PARK HAVEN NURSING & REHAB No001026657 AMISTAD NURSING AND REHABILIT No001026658 WESTCHASE H R CTR Yes001026660 THE PLAZA AT RICHARDSON Yes001026661 WILLIAMSBURG VILLAGE HEALTHCA Yes001026664 RETAMA MANOR NURSING Yes001026665 ALPINE TERRACE Yes001026666 NORTHGATE HEALTH AND REHABILI No001026669 DEL RIO NURSING AND REHABILIT Yes001026670 PFLUGERVILLE NURSING AND REHA Yes001026671 SENIOR CARE HEALTH & REHAB Yes001026673 CISCO NURSING & REHABILITATIO Yes001026675 WINDSOR GARDENS No001026677 BRENTWOOD PLACE FOUR No001026678 RETAMA MANOR - ALICE Yes001026679 WINDFLOWER HEALTH CENTER Yes001026681 LAUREL COURT Yes001026683 SOUTHLAND REHABILITATION Yes001026684 TIMBERWOOD NURSING Yes001026685 RETAMA MANOR NURSING CENTER- Yes001026686 RETAMA MANOR NC - PLEASANTON Yes001026687 TOWN EAST REHAB & HEALTHCARE No001026689 SETTLERS RIDGE CARE CENTER Yes001026693 COUNTRY CARE MANOR Yes001026694 THE HEIGHTS Yes001026695 KIRKWOOD MANOR Yes001026698 BRAZOSVIEW HEALTHCARE CENTER Yes001026699 PRAIRIE ESTATES No001026700 THE WESTBURY PLACE No001026701 FIRST COLONY HEALTH AND REHAB No

HHSC Provider Finance Page 14 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001026702 BRENHAM NURSING AND REHABILIT Yes001026703 EDGEWATER CARE CENTER Yes001026705 OCEANVIEW HEALTHCARE No001026706 WEST SIDE CAMPUS OF CARE No001026707 SUNNY SPRINGS NURSING AND REH No001026709 BRENTWOOD PLACE ONE No001026710 BRENTWOOD PLACE TWO No001026711 BAYBROOKE VILLAGE CARE AND RE Yes001026712 ACCEL AT WILLOW BEND Yes001026716 OAKS NURSING CENTER Yes001026717 WINDSOR HOUSTON No001026719 FORTH WORTH SOUTHWEST NURSING No001026720 ROSEWOOD REHABILITATION AND C Yes001026721 WILLOWBEND NURSING AND REHAB No001026723 THE PLAZA AT LUBBOCK Yes001026724 VILLA TOSCANA AT CYPRESS WOOD Yes001026726 WINDSOR QUAIL VALLEY POST-ACU Yes001026727 ABORETUM NURSING No001026728 PLUM CREEK HEALTHCARE CENTE Yes001026751 THE MANOR AT SEAGOVILLE No001026800 ALAMEDA OAKS NURSING CENTER No001026802 CROSSROADS NURSING & REHABILI Yes001026807 TREVISO TRANSITIONAL CARE No001026825 HIGH HOPE CARE CENTER OF BREN Yes001026832 THE MEDICAL RESORT AT SUGARLA No001026844 COUNTRY TRAILS WELLNESS AND R Yes001026850 IMMANUELS HEALTHCARE No001026854 CHELSEA GARDENS NH Yes001026860 THE VILLA AT TEXARKANA No001026891 COTTONWOOD CREEK HEALTHCARE C No001026906 BRUSH CUNTRY NURSING AND REHA No001026925 WEST REST HAVEN Yes001026926 THE PAVILION AT CREEKWOOD Yes001026961 SCC AT VALLEY GRANDE No001026963 LEXINGTON MEDICAL LODGE Yes001026964 MERIDIAN OF TEMPLE No001026977 ST. CATHERINE CENTER Yes001026994 HERITAGE OAKS Yes001026996 RIDGECREST RETIREMENT AND HEA No001026999 SCC AT CLEAR BROOK CROSSING R No001027008 SWEENY HOUSE Yes001027009 COLUMBUS OAKS HEALTHCARE COMM No001027044 THE ARBORS HEALTHCARE AND REH Yes

HHSC Provider Finance Page 15 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001027060 RETAMA MANOR NURSING Yes001027203 RETAMA MANOR NURSING CENTER - No001027208 WOODLAND PLACE REHAB Yes001027222 PINE SHADOW RETREAT No001027258 VISTA LIVING OF VERNON Yes001027269 MANORCARE HEALTH SERVICES No001027296 WEST HOUSTON REHABILITATION No001027313 THE HEALTHCARE RESORT OF PLAN No001027318 VISTA LIVING OF ARCHER Yes001027377 SENIOR CARE AT HOLLAND LAKE Yes001027382 GOLDEN AGE HEALTHCARE No001027383 STONEGATE NURSING & REHAB Yes001027384 THE LODGE AT BEAR CREEK Yes001027407 LAS PALMAS HEALTHCARE CENT No001027420 SAN ANTONIO RESIDENCE & REHAB Yes001027423 EBONY LAKE NURSING AND REHABI Yes001027424 MRC THE CROSSINGS No001027434 SHARPVIEW RESIDENCE & REHAB C Yes001027447 WEBSTER RESIDENCE & REHAB CEN No001027448 HARLINGEN NURSING AND REHABIL Yes001027453 BROWNSVILLE NURSING AND REHAB Yes001027469 WINDSOR CALALLEN Yes001027489 THE LEGACY AT WILLOW BEND Yes001027493 STONE OAK CARE CENTER Yes001027527 TOWERS NURSING HOME Yes001027545 PINECREST RETIREMENT COMMUNIT No001027555 ONPOINTE TEXAS HEALTH ARLINGT Yes001027576 RENAISSANCE VILLA Yes001027596 PARMER COUNTY HOSPITAL Yes001027626 WALNUT PLACE No001027695 EDINBURG NURSING AND REHABILI Yes001027726 CRYSTAL CREEK AT PRESTON HOLL No001027823 GRACE CARE CENTER AT VETERANS No001027911 THE BRAZOS OF WACO Yes001027954 OAKCREST NURSING AND REHAB Yes001027972 FALL CREEK REHAB & HC No001027973 CLARENDON NURSING HOME Yes001028068 WOODLAND PARK NURSING AND REH Yes001028176 PINECREST NURSING & REHAB CTR Yes001028205 HIGHLAND PINES NURSING HOME Yes001028208 THE ENCLAVE Yes001028287 BRIGHTPOINTE AT RIVERSHIRE Yes001028328 PECAN MANOR NURSING AND REHAB No

HHSC Provider Finance Page 16 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001028346 SHERIDAN MEDICAL LODGE Yes001028351 TRINITY NURSING AND REHAB No001028393 KLEMENT HEALTHCARE INC Yes001028396 E F & BERTHA KRUSE MEM L V Yes001028408 SENIOR CARE HEALTH & REHAB No001028430 WOODLAKE NURSING CENTER Yes001028442 SENIOR CARE HEALTH & REHAB No001028447 BROADMOOR MEDICAL LODGE No001028448 STERLING OAKS REHABILITATION Yes001028455 PALOMINO PLACE Yes001028456 PENNSYLVANIA NURSING & REHAB Yes001028457 NORTHWEST HEALTH AND REHABILI Yes001028459 ROYSE CITY HEALTH AND REHABIL No001028461 OAK BROOK HEALTH CARE CENTER No001028462 VAN HEALTHCARE Yes001028466 WINDSONG CARE CENTER Yes001028477 ONPOINTE TRANSITIONAL CARE Yes001028503 THE HALLMARK No001028506 COMMUNITY CARE CENTER OF HOND Yes001028517 FOCUSED CARE AT LINDEN No001028518 FOCUSED CARE AT HUNTSVILLE No001028520 FOCUSED CARE AT HUMBLE No001028521 FOCUSED CARE AT BAYTOWN No001028523 FOCUSED CARE OF WAXAHACHIE No001028526 FOCUSED CARE OF CENTER No001028528 LA HACIENDA DE PAZ REHABILITA No001028531 FOCUSED CARE AT ALLENBROOK No001028533 CARE INN OF LA GRANGE No001028534 WINCHESTER LODGE HEALTHCARE C Yes001028539 SHERMAN HEALTHCARE CENTER No001028543 FOCUSED CARE AT BEECHNUT No001028545 FOCUSED CARE AT MOUNT PLEASAN No001028546 HOMESTEAD NUR&REHAB OF ITASCA Yes001028547 HOMESTEAD NURSING AND REHAB Yes001028554 FOCUSED CARE OF GILMER No001028567 WINDCREST HEALTH AND REHABILI Yes001028570 HOMESTEAD NURSING AND REHAB Yes001028573 LULING CARE CENTER Yes001028575 AUTUMN WINDS LIVING & REHAB Yes001028576 WINDSOR ATRIUM Yes001028584 TRAIL LAKE NURSING & REHAB Yes001028585 SIGNATURE POINTE No001028591 ARBOR GRACE WELLNESS CENTER No

HHSC Provider Finance Page 17 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001028592 LEGEND OAKS H&R OF ENNIS Yes001028596 WELLINGTON REHAB & HEALTHCARE Yes001028599 GREEN VALLEY HEALTHCARE AND R No001028600 BROOKDALE GUADALUPE RIVER No001028601 PARADIGM AT WOODWIND LAKES No001028602 BAY VILLA HCC Yes001028603 KOUNTZE NURSING CENTER Yes001028604 BASTROP NURSING CENTER Yes001028605 GOLDEN CREEK HEALTHCARE Yes001028606 PARK MANOR OF QUAIL No001028607 MEMORIAL MEDICAL NURSING CENT Yes001028608 MONAHANS MANAGED CARE CENTER No001028609 TEXOMA HCC Yes001028610 THE BRADFORD AT BROOKSIDE Yes001028611 PARK HIGHLAND N&R CENTER Yes001028612 EASTLAND MEMORIAL HOSPITAL DI Yes001028613 THE MEADOWS HEALTH & REHAB No001028614 FOCUSED CARE AT FORT STOCKTON No001028615 PINE ARBOR Yes001028616 PFLUGERVILLE CARE CENTER No001028617 PARK PLACE CARE CENTER No001028618 SEABURY NURSING & REHAB No001028619 HOGAN PARK NURSING & REHAB No001028620 TEXHOMA CHRISTIAN CARE CENTER Yes001028621 MILDRED & SHIRLEY Yes001028622 ROCKWOOD MANOR No001028623 LARKSPUR NP Yes001028624 THE COURTYARD REHAB & HC CTR Yes001028627 LEGEND OAKS HC & REHAB - KYLE No001028628 SAN MARCOS REHAB Yes001028629 THE WESLEYAN A SCENIC No001028630 MORNINGSIDE MANOR Yes001028631 MESA SPRINGS HEALTHCARE CENTE Yes001028635 LAS COLINAS OF WESTOVER No001028636 SKILLED CARE OF MEXIA Yes001028637 WINDSOR ARBOR VEW Yes001028638 GRANITE MESA HEALTHCARE CENTE Yes001028640 PARK MANOR HEALTH CARE Yes001028641 LEGEND OAKS HC & REHAB N AUST Yes001028643 ALAMO HEIGHTS HEALTH AND REHA Yes001028648 S.P.J.S.T. REST HOME 2 Yes001028651 LEGEND OAKS HEALTHCARE Yes001028655 HERITAGE AT TURNER PARK H&R Yes

HHSC Provider Finance Page 18 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001028656 LAPORTE HEALTHCARE CENTER Yes001028657 LEGEND OAKS HC & RE - W SAN A Yes001028658 TRAYMORE NURSING CENTER Yes001028660 RICHLAND HILLS REHAB & HC CTR Yes001028667 HERITAGE GARDENS REHAB & H C Yes001028668 CARROLLTON HEALTH & REHAB CT Yes001028669 CEDAR HILL HEALTHCARE CENTER Yes001028671 THE RESORT AT TEXAS CITY No001028673 AVALON PLACE WHARTON Yes001028674 BRIARCLIFF SKILLED NURSING FA Yes001028677 PARK MANOR OF CYFAIR No001028678 THE COURTYARDS AT PASADENA Yes001028683 LEGEND OAKS HEALTH- EULESS Yes001028684 SILVER CREEK MANOR Yes001028688 PARK MANOR OF CYPRESS STATION No001028690 PARK MANOR OF HUMBLE No001028691 OAKWOOD MANOR NURSING HOME Yes001028692 LLANO NURSING AND REHAB Yes001028694 COLONIAL NURSING & REHAB CENT No001028695 SONTERRA HEALTH CENTER Yes001028697 POST NURSING AND REHABILITATI No001028698 WESLACO NURSING & REHAB CTR Yes001028699 CROSS TIMERS REHAB AND HC No001028700 LEGEND HEALTHCARE-GREENVILLE Yes001028701 PARK PLACE NURSING & REHAB CT Yes001028702 LA DORA NURSING & REHAB CTR No001028704 FARMERSVILLE HEALTH & REHAB Yes001028706 PARK MANOR OF WESTCHASE No001028707 LONGMEADOW HCC Yes001028711 PONDEROSA NURSING AND REHAB No001028712 MIDWESTERN HEALTHCARE CENTER No001028715 BROWNFIELD REHABILITATION AND Yes001028724 VILLAGE CREEK REHAB & N CTR No001028725 AUTUMN LEAVES No001028727 HERITAGE HOUSE OF MARSHALL No001028728 PARK MANOR OF CONROE No001028730 WILLOW SPRINGS HEALTH & REHAB Yes001028736 KIRKLAND COURT HEALTH & REHAB Yes001028740 LEGEND OAKS HC & REHAB W HOUS Yes001028742 PLEASANT SPRINGS HCC Yes001028743 PINE GROVE NURSING CENTER Yes001028744 CANTON OAKS Yes001028745 CROSBYTON NURSING & REHAB CTR Yes

HHSC Provider Finance Page 19 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001028746 CORINTH REHABILITATION SUITES Yes001028749 RIDGECREST HEALTHCARE & REHAB No001028750 LEGACY AT JACKSONVILLE No001028751 THE HEIGHTS OF TOMBALL Yes001028757 MIRA VISTA COURT Yes001028758 TWIN LAKES REHABILITATION No001028761 CREEKSIDE TERRACE REHABILITAT Yes001028762 THE HOMESTEAD OF SHERMAN No001028766 MEADOWBROOK CARE CENTER Yes001028767 COLONIAL PINES HEALTHCARE CTR Yes001028768 FOUNDERS PLAZA NURS & REHAB No001028769 HERITAGE PLAZA NURSING CTR Yes001028770 THE HEIGHTS OF TYLER Yes001028771 EDGEWOOD REHABILITATION AND C Yes001028776 AVALON PLACE TRINITY No001028778 MONARCH PAVILION REHAB SUITES Yes001028779 EMERALD HILLS REHAB & H C CTR No001028781 HERITAGE AT LONGVIEW HC No001028783 RIDGEVIEW REHAB & SKILLED NUR No001028786 ESTRELLA OAKS REHABILITATION No001028789 DENTON REHAB & NURSING CTR No001028792 RIVER VALLEY HEALTH AND REHAB Yes001028793 THE TERRACE AT DENISON Yes001028795 SANDY LAKE REHABILITATION AND Yes001028808 GRACE HILL NURSING CENTER Yes001028810 RAPID RECOVERY CENTER OF WACO No001028811 AVALON PLACE KIRBYVILLE No001028812 BRIDGECREST REHABILITATION SU Yes001028813 THE HILLCREST OF NORTH DALLAS Yes001028814 INTERLOCHEN HEALTH &REHAB CTR Yes001028815 VILLA HAVEN HEALTH AND REHABI Yes001028816 LEGEND HC&REHAB CTR GALDWATER Yes001028817 GREEN OAK REHAB AND NURSING Yes001028818 SAN GABRIEL REHABILITATION AN Yes001028819 RISING STAR NURSING CENTER No001028821 PRESTONWOOD REHAB No001028822 WINFIELD REHAB & NURSING Yes001028823 CROWELL NURSING CENTER Yes001028824 STILLHOUSE REHAB & HC CENTER Yes001028826 NEW HOPE MANOR No001028830 DOWNTOWN HEALTH & REHAB CTR Yes001028835 BREMOND NURSING AND REHABILIT Yes001028836 LAKEWEST REHAB & SKILLED CARE No

HHSC Provider Finance Page 20 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001028837 COLONIAL CARE CENTER Yes001028838 CENTERVILLE HEALTHCARE CENTER Yes001028839 GRACY WOODS II LIVING CENTER No001028841 COMMUNINTY CARE CTR CROCKETT Yes001028842 LEGEND HCARE & REHAB-PARIS Yes001028843 NORTH PARK HEALTH & REHAB CTR Yes001028844 IOWA PARK HEALTHCARE CENTER Yes001028845 WESLEY WOODS Yes001028846 WHITEHALL REHAB & NURSING Yes001028847 THE HEIGHTS OF NORTH HOUSTON Yes001028848 SAN PEDRO MANOR No001028849 RIVER HILLS HEALTH&REHAB CTR Yes001028850 SOUTH PLACE REHAB & SKILLED Yes001028856 LEGEND OAKS HEALTH AND REHAB Yes001028858 LEGEND OAKS HEALTHCARE Yes001028859 MISTY WILLOW HEALTHCARE AND R Yes001028861 LEGEND OAKS HC & REHAB CTR Yes001028864 REUNION PLAZA SR CARE & REHA Yes001028895 BRAZOS VALLEY CARE HOME Yes001028910 VISTA NURSING AND REHAB Yes001028915 PARKS HEALTH CENTER Yes001028955 CARRARA Yes001028961 GRACE POINTE WELLNESS CENTER No001028964 OAK VILLAGE HEALTHCARE Yes001028967 CREEKSIDE VILLAGE Yes001028994 VALLEY GRANDE MANOR Yes001028997 JACINTO NURSING AND REHAB CE Yes001028998 VIBRALIFE OF EL PASO REHAB No001029000 SUNRISE NURSING & REHAB CTR No001029011 CEDAR POINTE HEALTH & WELLNES Yes001029032 HOMEPLACE MANOR Yes001029051 ASHTON MEDICAL LODGE Yes001029071 KENNEDY REHAB AND HC LLC No001029108 FOCUSED CARE AT PECOS No001029109 KILGORE HEALTH AND REHABILITA No001029110 HILLSIDE MEDICAL LODGE Yes001029111 BELTERRA HEALTH AND REHAB No001029130 MPD BENDER TERRACE OF LUBBOCK No001029166 PARKWOOD HEALTHCARE COMMUNITY No001029179 MOUNTAIN VIEW HEALTH & REHABI Yes001029186 THE MEDICAL RESORT AT PEARLAN No001029187 NORTH HOUSTON TRANSITIONAL No001029204 HOMESTEAD NURSING & REHABILIT Yes

HHSC Provider Finance Page 21 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001029213 HOUSTONIDENCE OPCO LLC No001029252 THE MEDICAL RESORT AT WILLOWB No001029258 RAPID RECOVERY CENTER OF RR No001029268 COURTYARD NURSING & REHAB Yes001029286 TRUCARE LIVING CENTERS No001029289 SPJST REST HOME 1 Yes001029290 KAUFMAN HEALTHCARE CENTER Yes001029291 S.P.J.S.T. REST HOME 3 Yes001029292 TRUCARE LIVING CENTERS-COLUMB No001029294 THE HIGHLANDS OF DALLAS Yes001029295 ENNIS CARE CENTER No001029296 MAGNOLIA PLACE SK NURS & REHA No001029297 TRINITY HEALTHCARE RESIDENCE Yes001029298 SORRENTO Yes001029300 LAKERIDGE NURSING AND REHAB Yes001029301 TRINITY REHABILITATION Yes001029302 LEGACY AT TOWN CREEK No001029311 SILVER PINES NURSING & REHAB Yes001029312 TOMBALL REHAB & NURSING Yes001029313 PARK MANOR OF TOMBALL No001029314 RETAMA MANOR NUR - VICTORIA S Yes001029318 DEERBROOK SKILLED NUR & REHAB No001029323 STARR COUNTY HOSPITAL DISTRIC Yes001029324 ROBSTOWN NURSING & REHAB CTR Yes001029325 MEMORIAL CITY HEALTH & REHAB Yes001029326 RETAMA MANOR NUR CTR HARLINGE Yes001029327 ROLLINGBROOK REHAB & HC No001029329 TERRELL HEALTHCARE CENTER No001029330 GAINESVILLE CONVALESCENT No001029334 RETAMA MANOR NURSING Yes001029343 THE HEIGHTS OF ALAMO Yes001029344 PARK MANOR OF THE WOODLANDS No001029346 MEXIA LTC NURSING AND REHAB Yes001029347 TEAGUE NURSING AND REHAB Yes001029351 GROESBECK NURSING AND REHAB Yes001029352 PARK MANOR OF SOUTH BELT No001029353 NAZARETH LIVING CARE CENTER No001029360 WHISPERING PINES NURSING AND No001029367 MATADOR H&R CTR Yes001029387 MI CASITA NURSING AND REHAB Yes001029406 LEONARD MANOR NURSING & REHAB No001029410 WHEELER NURSING Yes001029440 REFUGIO NURSING AND REHAB No

HHSC Provider Finance Page 22 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001029441 LEGACY NURSING AND REHABILITA Yes001029461 FOCUSED CARE AT CLARKSVILLE No001029481 LANCASTER LTC PARTNERS INC Yes001029505 CORPUS NURSING AND REHABILITA No001029513 ST GILES NURSING AND REHAB Yes001029532 ANDERSON NURSING CENTER Yes001029535 BER NURSING AND REHAB LP No001029550 RAPID RECOVERY FORT WORTH No001029559 FRIENDSHIP HAVEN HC & REHAB No001029568 PREMONT NURSING & REHAB No001029569 ELKHART OAKS CARE CENTER No001029572 DESOTO LTC PARTNERS INC Yes001029573 RAPID RECOVERY CENTER No001029636 TERRA BELLA HEALTH Yes001029647 ALLEGIANT WELLNESS No001029669 ADORA MIDTOWN PARK Yes001029671 THE RESERVE AT RICHARDSON Yes001029676 HOLIDAY NURSING & REHAB No001029683 ATHENS HEALTHCARE & REHAB Yes001029722 MISSION VALLEY NURSING Yes001029739 POTEET NURSING AND REHAB No001029795 SAN SABA REHABILITATION, L.P. No001029809 SAN ANTONIO WELLNESS & REHAB Yes001029824 SIMPSON PLACE Yes001029864 GLENVIEW WELLNESS AND REHABIL No001029923 MADISON MEDICAL RESORT Yes001029926 PALESTINE HEALTHCARE CENTER Yes001029927 WICHITA FALLS SNF LLC Yes001029928 REGENCY I H S OF VAL VERDE LL Yes001029930 WINDSOR MISSION OAKS Yes001029931 FT.WORTH WELLNESS AND REHABIL No001029932 REGENCY I H S OF PEARSALL LLC Yes001029933 HEARTLAND HEALTH CARE CENTER No001029934 JACKSONVILLE HEALTHCARE CENTE Yes001029939 SLP CARTHAGE LLC Yes001029941 OVERTON HEALTHCARE CENTER Yes001029942 WINDSOR NURSING AND REHABILIT Yes001029945 AUSTIN WELLNESS & REHAB No001029947 THE BARTLETT SKILLED NURSING No001029949 VIBRALIFE OF KATY REHAB CTR No001029956 YOAKUM NURSING AND REHABILITA Yes001029959 PARIS HEALTHCARE CENTER Yes001029969 AMARILLO VII ENTERPRISES, LLC Yes

HHSC Provider Finance Page 23 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001029979 LINDALE HEALTHCARE CENTER Yes001029981 THE MEDICAL RESORT AT WOODLAN No001029987 SEDONA TRACE HEALTH AND WELLN Yes001030006 HERITAGE PARK REHABILITATION Yes001030067 KERENS CARE CENTER Yes001030071 SHERWOOD HEALTH CARE INC Yes001030072 PEBBLE CREEK NURSING CENTER Yes001030118 THE RIO AT MISSION TRAILS Yes001030120 ROYAL MANOR II LLC Yes001030122 KEMP CARE CENTER Yes001030125 GREENHILL VILLAS No001030127 SONGBIRD LODGE No001030128 WHISPERING PINES LODGE Yes001030207 STAMFORD RESIDENCE & REHAB Yes001030236 WINDMILL NURSING & REHAB CT Yes001030237 ARLINGTON VILLAS REHAB & HEAL No001030238 SUNFLOWER PARK HEALTH CARE Yes001030239 LAS BRISAS REHAB AND WELLNESS Yes001030240 GOLDTHWAITE HEALTH & REHAB No001030241 ACCEL AT COLLEGE STATION No001030242 ST. TERESA NURSING Yes001030246 FOX HOLLOW POST ACUTE Yes001030247 BAYWIND WILLAGE CONVALESCENT Yes001030248 ST. JAMES HOUSE OF BAYTOWN Yes001030252 LAS VENTANAS DE SOCORRO Yes001030253 RIVER CITY CARE CENTER Yes001030299 LANDMARK OF PLANO REHAB Yes001030318 WEST WHARTON COUNTY Yes001030334 ST ANTHONYS CARE CENTER Yes001030339 TIMBERIDGE NURSING Yes001030346 CRIMSON HEIGHTS HEALTH AND WE Yes001030348 PARK MANOR BEE CAVE No001030354 EASTLAND MEMORIAL HOSPITAL No001030357 LEGEND OAKS HC & REHAB - FW Yes001030373 MATLOCK PLACE HEALTH No001030374 THE WATERTON AT COWHORN CREEK No001030376 WINDMILL NURSING & REHAB CTR No001030377 MINEOLA HEIGHTS HEALTCARE CTR No001030388 HOUSTON HEIGHTS HEALTHCARE CE No001030390 LS QUITMAN OPERATOR LLC No001030401 LA HACIENDA NURSING No001030402 THE VILLAGE AT HERITAGE OAKS No001030404 LAS ALTURAS NURSING & TRANSIT Yes

HHSC Provider Finance Page 24 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001030406 FOCUSED CARE AT HAMILTON No001030408 FC AT STONEBRIAR No001030411 VERANDA REHABILITATION Yes001030413 EASTLAND MEMORIAL HOSPITAL Yes001030416 ONION CREEK NURSING & REHAB Yes001030418 WEST LAKE HEALTHCARE RES No001030419 FORUM PARKWAY HEALTH & REHAB No001030420 EPIC NURSING & REHABILITATION Yes001030424 HILL COUNTRY NURSING & REHAB Yes001030427 GULF HC CENTER - PORT ARTHUR No001030429 ARBROOK PLAZA No001030431 PECAN TREE REHAB & HC CENTER No001030433 WEST OAKS NURSING & REHAB CTR No001030434 RAPID RECOVERY CENTER No001030435 LEGACY AT JACKSONVILLE No001030436 SENIOR CARE OF MIDLAND Yes001030437 LOS ACROS DEL NORTE CARE CENT Yes001030439 LAKESIDE NURSING & REHAB Yes001030440 PARK MANOR OF McKINNEY No001030441 BLUEBONNET REHAB AT ENNIS No001030442 RIVERSIDE NURSING & REHAB CTR Yes001030443 HILLVIEW NURSING & REHAB No001030444 BRODIE RANCH NURSING & REHAB Yes001030445 GULF POINTE PLAZA No001030446 LEGACY WEST REHAB & HEALTHCAR No001030449 SOUTH LIMESTONE HOSPITAL No001030451 WOOD MEMORIAL NURSING & REHAB Yes001030452 BRIARCLIFF HEALTH CENTER No001030454 FALCON RIDGE REHABILITATION Yes001030458 COUNTRY MEADOWS HEALTH Yes001030460 THE VILLAGES OF DALLAS No001030462 DIVERSICARE OF LULING No001030463 BANDERA NURSING & REHAB Yes001030464 THE SPRINGS HEATLHCARE &REHAB Yes001030466 MYSTIC PARK NURSING Yes001030468 GUADALUPE COUNTY HOSPITAL Yes001030469 SAN ANGELO NURSING Yes001030470 0 Yes001030471 FOCUSED CARE AT ORANGE No001030472 LAMPASAS NURSING AND REHAB CE No001030474 PARKLANE WEST HEALTHCARE CTR Yes001030479 HUNTERS POND REHAB AND H C No001030480 YORKTOWN NURSING AND REHAB CE No

HHSC Provider Finance Page 25 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001030483 NORTHGATE PLAZA NURSING & REH No001030485 HERITAGE NURSING & REHAB Yes001030489 ASHFORD HALL Yes001030492 THE HEIGHTS OF BULVERDE Yes001030497 SLP JEFFERY PLACE LLC Yes001030499 COASTAL PALMS NURSING & REHAB Yes001030502 WEST OAKS NURSIN & REHAB Yes001030506 OAKMONT HEALTHCARE & REHAB No001030508 RIVER RIDGE NURSING & REHAB Yes001030527 FOCUSED CARE AT PASADENA No001030528 FOCUSED CARE AT SUMMER PLACE No001030529 FOCUSED CARE AT CEDAR BAYOU No001030541 REGENCY MANOR Yes001030545 FOCUSED CARE AT BURNET BAY No001030547 FOCUSED CARE AT CORPUS No001030552 WILLOW CREEK HEALTHCARE CTR No001030566 FOCUSED CARE AT WEBSTER No001030569 PATRIOT REHAB AND WELLNESS No001030579 COUNTRY VIEW LIVING No001030586 GOLDEN PALMS REHAB & RETIRE Yes001030589 FOCUSED CARE AT WESTWOOD No001030609 THE PREMIERE SNF OF ALICE No001030614 CHEYENNE MEDICAL LODGE Yes001030625 MESA VISTA INN HEALTH CENTER Yes001030627 THE OAKS AT RADFORD HILLS Yes001030628 BUENA VIDA NURSING & REHAB OD Yes001030643 CYPRESS CREEK REHABILITATION No001030644 THE EVANGELICAL LUTHERAN Yes001030646 RIVER OAKS NURSING Yes001030647 STEVENS HEALTH CARE Yes001030651 BUENA VIDA NURSING & REHAB Yes001030658 RIVERWOOD HEALTHCARE Yes001030662 GOODALL WITCHER NURSING Yes001030664 HOLLYMEAD No001030666 SAN REMO No001030668 BEACON HILL No001030676 RENAISSANCE CARE CENTER No001030677 GARDEN VILLA NURSING HOME Yes001030678 THE EVANGELICAL LUTHERAN Yes001030680 KPC PROMISE SKILLED NURSING No001030681 THE CARLYLE AT STONEBRIDGE No001030684 THE HARRISON AT HERITAGE No001030686 THE BELMONT AT TWIN CREEKS No

HHSC Provider Finance Page 26 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001030689 SUNSET HOME Yes001030715 EDGEWOOD MANOR Yes001030716 ARLINGTON HEIGHTS Yes001030717 CEDAR HILL HEALTHCARE CENTRE No001030719 CYPRESSWOOD TX HEALTHCARE LLC Yes001030728 SAGE TERRANCE HEALTHCARE INC No001030739 FORTRESS NURSING AND REHAB Yes001030749 HUNTERS POND REHAB AND H C Yes001030752 LAMPSTAND NURSING AND REHAB Yes001030753 LE REVE REHAB & MEMORY CARE No001030760 COLONIAL MANOR CARE Yes001030767 GREEN MOUNTAIN HEALTHCARE INC Yes001030773 RETAMA MANOR NURSING CENTER Yes001030805 THE HEIGHTS ON VALLEY RANCH Yes001030807 FORNEY LAKE HEALTHCARE INC No001030816 HEARTSTONE NURSING No001030824 PECAN VALLEY REHABILITAITON Yes001030825 TRINITY CARE CENTER Yes001030826 PARK BEND HEALTH CENTER No001030828 MYRTLE SPRINGS HEALTHCARE Yes001030830 WINDCREST NURSING & REHAB Yes001030831 CARADAY TEMPLE WEST LLC Yes001030832 CARADAY TEMPLE EAST LLC Yes001030833 BLACK RIDGE CANYON HEALTHCARE Yes001030834 MEADOW CREEK NURSING & REHAB No001030835 WESTON INN NURSING & REHAB No001030836 THE MONTEVISTA OF CORONDO No001030837 KELLER OAKS HEALTHCARE CTR Yes001030838 WURZBACH NURSING & REHAB Yes001030841 NORTH RUNNELS COUNTY HOSPITAL No001030850 PLEASANT MANOR HCARE & REHAB Yes001030851 WESTERN HILLS NURSING & REHAB Yes001030853 CRESTWOOD HEALTH & REHAB Yes001030854 CARADAY SAGEBROOK LLC No001030855 CARADAY REGENCY LLC No001030856 MABANK NURSING HOME Yes001030884 DEERING NURSING AND REHAB Yes001030890 WILLOWBROOK NURSING No001030895 TUSCANY VILLAGE Yes001030901 HARBOR VALLEY HEALTH Yes001030917 THE PALMS NURSING & REHAB No001030918 BRIGHT POINT AT LYTLE LAKE No001030924 CIMARRON PARK NURSING & REHAB Yes

HHSC Provider Finance Page 27 of 28

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HHSC Provider Attestation

Nursing Facility Vendor/Facility ID Provider Name

Attestation Received (Yes/No)

The following is a list of Nursing Facility (NF) providers who have submitted the requested attestation as of August 29, 2020 . The deadline to submit the attestation is September 30, 2020 and HHSC will be recouping the rate add-ons if attestation is not received. This list will be updated weekly on Tuesdays throughout September.

001030929 DE LEON NURSING & REHAB Yes001030930 HIGHLAND MEADOWS Yes001030932 LILY SPRINGS HEALTHCARE Yes001030947 MEMORIAL MEDICAL CENTER Yes001030949 PRINCETON MEDICAL LODGE Yes001030953 SIENNA NURSING AND REHABILITA Yes001030955 CYPRESS POINTE HEALTH & WELLN Yes001030970 ARDEN PLACE OF BEAUMONT Yes001030976 FANNIN COUNTY HOSPITAL No001030981 PILOT POINT HEALTHCARE Yes001030982 SOUTH LIMESTONE HOSPITAL No001030986 SUNDANCE INN HEALTH Yes001030987 VAL VERDE COUNTY HOSPITAL Yes001030988 FANNIN COUNTY HOSPITAL No001030998 FOCUSED CARE AT BRENHAM No001031001 LONE STAR RANCH HEALTHCARE Yes001031002 ARDEN PLACE OF BEEVILLE Yes001031004 ARDEN PLACE OF GRAPEVINE Yes001031005 ARDEN HEIGHTS Yes001031010 HIGHLAND VILLAGE SKILLED CARE No001031011 PARK VALLEY INN Yes001031012 BONNIE VIE Yes001031014 ARDEN WOOD Yes001031021 WHISPERING SPRINGS HEALTHCARE Yes001031022 KILLEEN NURSING & REHAB Yes001031038 PRAIRIE MEADOWS HEALTHCARE Yes001031040 STONEBRIDGE HEALTH REHAB Yes001031042 MOUNT BELVIEU RHC LLC Yes001031046 ALTAMONTE CARE OF RICHLAND HI Yes001031047 ARDEN PLACE Yes001031050 CORYELL COUNTY MEMORIAL No001031051 EL PASO COUNTY HOSITAL DISTRI No001031125 BROADMOOR MEDICAL LODGE Yes

HHSC Provider Finance Page 28 of 28