| (a) General requirements. The Texas Health and Human
Services Commission (HHSC) applies the general principles of cost
determination as specified in §355.101 of this title (relating
to Introduction).
(b) Cost reporting. Provider agencies must follow the
cost-reporting guidelines as specified in §355.105 of this title
(relating to General Reporting and Documentation Requirements, Methods
and Procedures).
(1) Number of cost reports to be submitted. Every legal
entity must submit a cost report unless the entity meets one or more
of the conditions in §355.105(b)(4)(D) of this title.
(A) Contracted providers participating in the attendant
compensation rate enhancement.
(i) At the same level of enhancement. If all the contracts
under the legal entity participate in the enhancement at the same
level of enhancement, the contracted provider must submit one cost
report for the legal entity.
(ii) At different levels of enhancement. If all the
contracts under the legal entity participate in the enhancement but
they participate at more than one enhancement level, the contracted
provider must submit one cost report for each level of enhancement.
(B) Contracted providers not participating in the attendant
compensation rate enhancement. If all the contracts under the legal
entity do not participate in the enhancement, the contracted provider
must submit one cost report for the legal entity.
(C) Contractors participating and not participating
in attendant compensation rate enhancement.
(i) At the same level of enhancement. If some of the
contracts under the legal entity do not participate in the enhancement
and the rest of the contracts under the legal entity participate at
the same level of enhancement, the contracted provider must submit:
(I) one cost report for the contracts that do not participate;
and
(II) one cost report for the contracts that do participate.
(ii) At different levels of enhancement. If some of
the contracts under the legal entity do not participate in the enhancement
and the rest of the contracts under the legal entity participate in
the enhancement but they participate at more than one enhancement
level, the contracted provider must submit:
(I) one cost report for the contracts that do not participate;
and
(II) one cost report for each level of enhancement.
(2) Provider agencies are responsible for reporting
only allowable costs on the cost report, except where cost report
instructions indicate that other costs are to be reported in specific
lines or sections. Only allowable cost information is used to determine
recommended reimbursement. HHSC excludes from reimbursement determination
unallowable expenses included in the cost report and makes the appropriate
adjustments to expenses and other information reported by provider
agencies. The purpose is to ensure that the database reflects costs
and other information which are necessary for the provision of services
and are consistent with federal and state regulations. Individual
cost reports may not be included in the database used for reimbursement
determination if:
(A) there is reasonable doubt as to the accuracy or
allowability of a significant part of the information reported; or
(B) an auditor determines that reported costs are not
verifiable.
(c) Reimbursement determination. Reimbursement is determined
in the following manner.
(1) Cost determination by cost area. Allowable costs
are combined into three cost areas, after allocating payroll taxes
to each salary line item on the cost report on a pro rata basis based
on the portion of that salary line item to the amount of total salary
expense and after applying employee benefits directly to the corresponding
salary line item.
(A) Service support cost area. This includes field
supervisors' salaries and wages, benefits, and mileage reimbursement
expenses. This also includes building, building equipment, and operation
and maintenance costs; administration costs; and other service costs.
Administration expenses equal to $0.18 per priority unit of service
are allocated to priority. The administration costs remaining after
this allocation are summed with the other service support costs.
(B) Non-priority attendants cost area. This includes
non-priority attendants' salaries and wages, benefits, and mileage
reimbursement expenses. This cost area is calculated as specified
in §355.112 of this title (relating to Attendant Compensation
Rate Enhancement).
(C) Priority attendants cost area. This includes priority
attendants' salaries and wages, benefits, and mileage reimbursement
expenses. This cost area is calculated as specified in §355.112
of this title.
(2) Recommended reimbursement by cost area. For the
service support cost area described in paragraph (1)(A) of this subsection
the following is calculated:
(A) Projected costs. Each contract's total allowable
costs, excluding depreciation and mortgage interest, per unit of service
are projected from each contract's reporting period to the next ensuing
reimbursement period, as described in §355.108 of this title
(relating to Determination of Inflation Indices) to calculate the
projected expenses. Reimbursement may be adjusted where new legislation,
regulations, or economic factors affect costs as specified in §355.109
of this title (relating to Adjusting Reimbursement When New Legislation,
Regulations, or Economic Factors Affect Costs).
(B) Projected cost per unit of service. To determine
the projected cost per unit of service for each contract, the total
projected allowable costs for the service support cost area are divided
by total units of service, including non-priority services, priority
services, and STAR+PLUS services, in order to calculate the projected
cost per unit of service.
(C) Projected cost arrays. Each contract's projected
allowable costs per unit of service are rank ordered from low to high,
along with each contract's corresponding units of service for each
cost area.
(D) Recommended reimbursement for the service support
cost area. The total units of service for each contract are summed
until the median hour of service is reached. The corresponding projected
expense is the weighted median cost component. The weighted median
cost component is multiplied by 1.044 to calculate the recommended
reimbursement for the service support cost area. The service support
cost area recommended reimbursement is limited, if necessary, to available
appropriations.
(3) Total recommended reimbursement.
(A) For non-priority clients. The recommended reimbursement
is determined by summing the recommended reimbursement described in
paragraph (2) of this subsection and the cost area component from
paragraph (1)(B) of this subsection.
(B) For priority clients. The recommended reimbursement
is determined by summing the recommended reimbursement described in
paragraph (2) of this subsection and the cost area component from
paragraph (1)(C) of this subsection.
(d) Reimbursement determination authority. The reimbursement
determination authority is specified in §355.101 of this title.
(e) Desk reviews and field audits of cost reports.
Desk reviews or field audits are performed on cost reports for all
provider agencies. The frequency and nature of the field audits are
determined by HHSC to ensure the fiscal integrity of the program.
Desk reviews and field audits will be conducted in accordance with §355.106
of this title (relating to Basic Objectives and Criteria for Audit
and Desk Review of Cost Reports), and provider agencies will be notified
of the results of a desk review or an audit in accordance with §355.107
of this title (relating to Notification of Exclusions and Adjustments).
Provider agencies may request an informal review and, if necessary,
an administrative hearing to dispute an action taken under §355.110
of this title (relating to Informal Reviews and Formal Appeals).
(f) Factors affecting allowable costs. Provider agencies
must follow the guidelines in determining whether a cost is allowable
or unallowable as specified in §355.102 of this title (relating
to General Principles of Allowable and Unallowable Costs) and §355.103
of this title (relating to Specifications for Allowable and Unallowable
Costs).
(g) Reporting revenues. Revenues must be reported on
the cost report in accordance with §355.104 of this title (relating
to Revenues).
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| Source Note: The provisions of this §355.5902 adopted to be effective September 1, 1996, 21 TexReg 7890; amended to be effective September 1, 1997, 22 TexReg 6461; duplicated effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective June 25, 2000, 25 TexReg 5867; amended to be effective July 1, 2002, 27 TexReg 5164; amended to be effective May 7, 2003, 28 TexReg 3711; amended to be effective December 25, 2003, 28 TexReg 11253; amended to be effective June 1, 2004, 29 TexReg 5055; amended to be effective February 3, 2008, 33 TexReg667;amended to be effective April 1, 2012, 37 TexReg 2068; amended to be effective November 25, 2012, 37 TexReg 9086 |
