| (a) Any service purchased or reimbursed by DARS may
be monitored at the discretion of DARS or HHSC.
(b) DARS and HHSC may conduct compliance monitoring
reviews of the contractor's services to determine if the contractor
is in compliance with the contract and with program rules and requirements.
These reviews are conducted at the location where the contractor is
providing the services unless DARS or HHSC specifies a different location.
DARS and HHSC assess contractor performance based on contract standards.
(c) During the monitoring review, the contractor must
provide:
(1) adequate working space for reviewing the records;
(2) every record DARS or HHSC requests for review;
and
(3) copies, or access for DARS and HHSC staff to make
needed copies, of documents.
(d) During the monitoring review, DARS or HHSC may:
(1) review a sample of consumer records to determine
the contractor's compliance with contract requirements;
(2) interview consumers and staff members;
(3) observe consumers and staff members;
(4) consult with others, as appropriate; and
(5) conduct other activities, as appropriate.
(e) DARS or HHSC may expand a compliance monitoring
review period or the review sample at any time.
(f) DARS and HHSC also conduct fiscal monitoring, which
is the review of documentation that supports the contractor's billing,
as it exists at the time the DARS or HHSC staff reviews the billing
documentation. DARS or HHSC may recoup payment if the service delivery
documentation does not support the contractor's billing.
(g) DARS and HHSC may conduct a fiscal monitoring review:
(1) in conjunction with a compliance monitoring review;
(2) independent of a compliance monitoring review;
(3) when a contract is terminated;
(4) as a result of a complaint; or
(5) at other times as DARS or HHSC considers necessary.
(h) Fiscal monitoring is designed to ensure that:
(1) DARS received the goods or services paid for;
(2) The total amount paid by DARS was allowable under
the contract; and
(3) The contractor maintained the financial records
and internal controls necessary to adequately account for claims under
the contract.
(i) DARS and HHSC may use sampling methods in monitoring
and auditing contracts.
(j) The contractor has the burden of proof in establishing
entitlement to payments made under the contract.
(k) The contractor must provide the same accommodations
for fiscal monitoring as related to compliance monitoring.
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