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The employee's supervisor must sign the timesheets each payroll period
or at least monthly. Work schedules are unacceptable documentation
for staff whose duties include multiple direct service types, both
direct and indirect service component types, and both direct hands-on
support and first-level supervision of direct care workers.
(II) For the Intermediate Care Facilities for Individuals
with an Intellectual Disability or Related Conditions (ICF/IID), Home
and Community-based Services (HCS), and Texas Home Living (TxHmL)
programs, staff required to maintain continuous daily timesheets include
staff whose duties include multiple direct service types, both direct
and indirect service component types and/or both direct hands-on support
and first-level supervision of direct care workers.
(xiii) Management fees paid to related parties must
be documented as to the actual costs of the related party for materials,
supplies, and services provided to the individual provider and upon
which the management fees were based. If the cost to the related party
includes owner compensation or compensation to related parties, documentation
guidelines for those costs are specified in clause (xi) of this subparagraph.
Documentation must be maintained that indicates stated objectives,
periodic assessment of those objectives, and evaluation of the progress
toward those objectives.
(xiv) For central office and/or home office costs,
documentation must be maintained that indicates the organization of
the business entity, including position, titles, functions, and compensation.
For multi-state organizations, documentation must be maintained that
clearly defines the relationship of costs associated with any level
of management above the individual Texas contracted entity allocated
to the individual Texas contracted entity.
(xv) Documentation regarding depreciable assets includes,
at a minimum, historical cost, date of purchase, depreciable basis,
estimated useful life, accumulated depreciation, and the calculation
of gains and losses upon disposal.
(xvi) Providers must maintain documentation clearly
itemizing their employee relations expenditures. For employee entertainment
expenses, documentation must show the names of all persons participating,
along with a classification of the person attending, such as employee,
nonemployee, owner, family of employee, client, or vendor.
(xvii) Adequate documentation substantiating the offsetting
of grants and contracts from federal, state, or local governments
prior to reporting either the net expenses or net revenue must be
maintained by the provider. As specified in §355.103(b)(18) of
this subchapter, such offsetting is required prior to reporting on
the cost report. The provider must maintain written documentation
as to the purpose for which the restricted revenue was received and
the offsetting of the restricted revenue against the allowable and
unallowable costs for which the restricted revenue was used.
(xviii) During the course of an audit or an audit desk
review, the provider must furnish any reasonable documentation requested
by HHSC auditors within ten working days of the request or a later
date as specified by the auditors. If the provider does not present
the requested material within the specified time, the audit or audit
desk review is closed, and HHSC automatically disallows the costs
in question.
(xix) Any expense that cannot be adequately documented
or substantiated is disallowed. HHSC is not responsible for the contracted
provider's failure to adequately document and substantiate reported
costs.
(xx) Any cost report that is determined to be unauditable
through a field audit or that cannot have its costs verified through
a desk review will not be used in the reimbursement determination
process.
(3) Cost report and methodology certification. Providers
must certify the accuracy of cost reports submitted to HHSC in the
format specified by HHSC. Providers may be liable for civil and/or
criminal penalties if the cost report is not completed according to
HHSC requirements or is determined to contain misrepresented or falsified
information. Cost report preparers must certify that they read the
cost determination process rules, the reimbursement methodology rules,
the cost report cover letter, and cost report instructions, and that
they understand that the cost report must be prepared in accordance
with the cost determination process rules, the reimbursement methodology
rules and cost report instructions. Not all persons who contributed
to the completion of the cost report must sign the certification page.
However, the certification page must be signed by a responsible party
with direct knowledge of the preparation of the cost report. A person
with supervisory authority over the preparation of the cost report
who reviewed the completed cost report may sign a certification page
in addition to the actual preparer.
(4) Requirements for cost report completion.
(A) A completed cost report must:
(i) be completed according to the cost determination
rules of this chapter, program-specific allowable and unallowable
rules, cost report instructions, and policy clarifications;
(ii) contain a signed, notarized, original certification
page or an electronic equivalent where such equivalents are specifically
allowed under HHSC policies and procedures;
(iii) be legible with entries in sufficiently dark
print to be photocopied;
(iv) contain all pages and schedules;
(v) be submitted on the proper cost report form;
(vi) be completed using the correct cost reporting
period; and
(vii) contain a copy of the state-issued cost report
training certificate except for cost reports submitted through the
State of Texas Automated Information and Reporting System (STAIRS).
(B) Providers are required to report amounts on the
appropriate line items of the cost report pursuant to guidelines established
in the methodology rules, cost report instructions, or policy clarifications.
Refer to program-specific reimbursement methodology rules, cost report
instructions, or policy clarifications for guidelines used to determine
the placement of amounts on cost report line items.
(i) For nursing facilities, placement on the cost report
of an amount, which was determined to be inaccurately placed, may
result in vendor hold as specified in §355.403 of this chapter
(relating to Vendor Hold).
(ii) For School Health and Related Services (SHARS),
placement on the cost report of an amount, which was determined to
be inaccurately placed, may result in an administrative contract violation
as specified in §355.8443 of this chapter (relating to Reimbursement
Methodology for School Health and Related Services (SHARS)).
(iii) For all other programs, placement on the cost
report of an amount, which was determined to be inaccurately placed,
constitutes an administrative contract violation. In the case of an
administrative contract violation, procedural guidelines and informal
reconsideration and/or appeal processes are specified in §355.111
of this subchapter.
(C) A completed cost report must be filed by the cost
report due date.
(i) For nursing facilities, failure to file a completed
cost report by the cost report due date may result in vendor hold
as specified in §355.403 of this chapter.
(ii) For SHARS, failure to file a completed cost report
by the cost report due date constitutes an administrative contract
violation. In the case of an administrative contract violation, procedural
guidelines and informal reconsideration and/or appeal processes are
specified in §355.8443 of this chapter.
(iii) For all other programs, failure to file a completed
cost report by the cost report due date constitutes an administrative
contract violation. In the case of an administrative contract violation,
procedural guidelines and informal reconsideration and/or appeal processes
are specified in §355.111 of this subchapter.
(D) HHSC may excuse providers from the requirement
to submit a cost report. A provider that is not enrolled in Attendant
Compensation Rate Enhancement as described in §355.112 of this
subchapter (relating to Attendant Compensation Rate Enhancement) for
a specific program or the Nursing Facility Direct Care Staff Rate
enhancement as described in §355.308 of this chapter (relating
to Direct Care Staff Rate Component) during the reporting period for
the cost report in question, is excused from the requirement to submit
a cost report for such program if the provider meets one or more of
the following conditions:
(i) For all programs, if the provider performed no
billable services during the provider's cost-reporting period.
(ii) For all programs, if the cost-reporting period
would be less than or equal to 30 calendar days or one entire calendar
month.
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