(iii) For all programs, if circumstances beyond the
provider's control, such as the loss of records due to natural disasters
or removal of records from the provider's custody by a regulatory
agency, make cost-report completion impossible.
(iv) For all programs, if all of the contracts that
the provider is required to include in the cost report have been terminated
before the cost-report due date.
(v) For the Nursing Facility, ICF/IID, Assisted Living/Residential
Care (AL/RC), and Residential Care (RC) programs, if the total number
of days that the provider performed service for recipients during
the cost-reporting period is less than the total number of calendar
days included in the cost-reporting period.
(vi) For the Day Activity and Health Services (DAHS)
program, if the provider's total units of service provided to recipients
during the cost-reporting period is less than the total number of
calendar days included in the cost-reporting period times 1.5.
(vii) For the Home-Delivered Meals program, if a provider
agency served an average of fewer than 500 meals a month for the designated
cost report period.
(viii) On or after September 1, 2023, for the Department
of Family and Protective Services (DFPS) 24-Hour Residential Child-Care
program, if:
(I) the provider has no current contract(s) within
the state for 24-Hour Residential Child-Care program;
(II) the total number of DFPS-placed days and Single
Source Continuum Contractor (SSCC)-placed days was 10 percent or less
of the total days of service provided during the cost-reporting period;
(III) for facilities that provide Emergency Care Services
only, the occupancy rate was less than 30 percent during the cost-reporting
period; or
(IV) for all other facility types except child-placing
agencies and those providing Emergency Care Services, the occupancy
rate was less than 50 percent during the cost-reporting period.
(5) Cost report year. A provider's cost report year
must coincide with the provider's fiscal year as used by the provider
for reports to the Internal Revenue Service (IRS) or with the state
of Texas' fiscal year, which begins September 1 and ends August 31,
except for SSCC providers in the DFPS 24-Hour Residential Child Care
program whose cost report year must coincide with the state fiscal
year.
(A) Providers whose cost report year coincides with
their IRS fiscal year are responsible for reporting to HHSC Provider
Finance Department any change in their IRS fiscal year and subsequent
cost report year by submitting written notification of the change
to HHSC Provider Finance Department along with supportive IRS documentation.
HHSC Provider Finance Department must be notified of the provider's
change in IRS fiscal year no later than 30 days following the provider's
receipt of approval of the change from the IRS.
(B) Providers who chose to change their cost report
year from their IRS fiscal year to the state fiscal year or from the
state fiscal year to their IRS fiscal year must submit a written request
to HHSC Provider Finance Department by August 1 of state fiscal year
in question.
(6) Failure to report allowable costs. HHSC is not
responsible for the contracted provider's failure to report allowable
costs; however, any omitted costs identified during the desk review
or audit process will be included in the cost report or brought to
the attention of the provider to correct by submitting an amended
cost report.
(c) Cost report due dates.
(1) Providers must submit cost reports to HHSC Provider
Finance Department no later than 90 days following the end of the
provider entity's fiscal year or 90 days from the transmittal date
of the cost report forms, whichever due date is later. Beginning with
the 2018 cost reports, due dates per program are determined by HHSC
and are published on the HHSC website.
(2) For SHARS, providers must submit cost reports to
HHSC Provider Finance Department as specified in §355.8443 of
this title.
(3) HHSC may grant extensions of due dates for good
cause. A good cause is defined as a circumstance which the provider
could not reasonably be expected to control and for which adequate
advance planning and organization would not have been of any assistance.
Providers must submit requests for extensions in writing to HHSC Provider
Finance Department. Requests for extensions must be received by HHSC
Provider Finance Department prior to the cost report due date. HHSC
staff will respond in writing to requests within 15 days of receipt.
(4) HHSC may require additional financial and other
statistical information, in the form of special surveys or reports,
to ensure the fiscal integrity of the program. Providers must submit
such additional information and/or special surveys or reports to HHSC
Provider Finance Department upon request by the date specified by
HHSC Provider Finance Department in its transmittal or cover letter
to the special survey, report, or request for additional information.
(d) Amended cost report due dates. HHSC accepts submittal
of provider-initiated or HHSC-requested amended cost reports as follows.
(1) Provider-initiated amended cost reports must be
received no later than the date in subparagraph (A) or (B) of this
paragraph, whichever occurs first. Amended cost reports received after
the required date have no effect on the reimbursement determination.
Amended cost report information that cannot be verified will not be
used in reimbursement determinations. Provider-initiated amended cost
reports must be received no later than the earlier of:
(A) 60 days after the original due date of the cost
report; or
(B) 30 days prior to the public hearing on proposed
reimbursement or reimbursement parameter amounts.
(2) HHSC-required amendments to the cost reports must
be received on or before the date specified by HHSC in its request
for the amended cost report. Failure to submit the requested amendment
to the cost report by the due date is considered a failure to complete
a cost report as specified in subsection (b)(4)(C) of this section.
(e) Field audit standards. HHSC performs cost report
field audits in a manner consistent with Government Auditing Standards
issued by the Comptroller General of the United States.
(f) Cost of out-of-state audits. As specified in §355.106
of this title (relating to Basic Objectives and Criteria for Audit
and Desk Review of Cost Reports), HHSC conducts desk reviews of all
cost reports not selected for field audit. HHSC also conducts field
audits of provider records and cost reports. Although the number of
field audits performed each year may vary, HHSC seeks to maximize
the number of field audited cost reports available for use in its
cost projections. Whenever possible, all the records necessary to
verify information submitted to HHSC on cost reports, including related
party transactions and other business activities engaged in by the
provider, must be accessible to HHSC audit staff within the state
of Texas within fifteen working days of field audit or desk review
notification. When records are not available to HHSC audit staff within
the state of Texas, the provider must pay the actual costs for HHSC
staff to travel and review the records out-of-state. HHSC must be
reimbursed for these costs within 60 days of the request for payment.
(1) For nursing facilities, failure to reimburse HHSC
for these costs within 60 days of the request for payment may result
in vendor hold as specified in §355.403 of this title.
(2) For SHARS, failure to reimburse HHSC for these
costs within 60 days of the request for payment 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 title.
(3) For all other programs, failure to reimburse HHSC
for these costs within 60 days of the request for payment 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 title.
(g) Public hearings.
(1) Uniform reimbursements. For programs where reimbursements
are uniform by class of service and/or provider type, HHSC will hold
a public hearing on proposed reimbursements before HHSC approves reimbursements.
The purpose of the hearing is to give interested parties an opportunity
to comment on the proposed reimbursements. Notice of the hearing will
be provided to the public. The notice of the public hearing will identify
the name, address, and telephone number to contact for the materials
pertinent to the proposed reimbursements. At least ten calendar days
before the public hearing takes place, material pertinent to the proposed
statewide uniform reimbursements will be made available to the public.
This material will include the proposed reimbursements, the inflation
adjustments used to determine them, and the impact on reimbursements
of the major cost limits. This Cont'd... |