| (B) Individual cost reports may not be included in
the database used for reimbursement determination if:
(i) there is reasonable doubt as to the accuracy or
allowability of a significant part of the information reported; or
(ii) an auditor determines that reported costs are
not verifiable.
(5) Allowable and unallowable costs. Providers must
follow the guidelines in determining whether a cost is allowable or
unallowable as specified in §355.102 and §355.103 of this
title (relating to General Principles of Allowable and Unallowable
Costs, and Specifications for Allowable and Unallowable Costs), in
addition to the following.
(A) Client room and board expenses are not allowable,
except for those related to respite care.
(B) The actual cost of adaptive aids, medical supplies,
dental services, and home modifications are not allowable for cost
reporting purposes. Allowable labor costs associated with acquiring
adaptive aids, medical supplies, dental services, and home modifications
should be reported in the cost report. Any item purchased for participants
in this program and reimbursed through a voucher payment system is
unallowable for cost reporting purposes. Refer to §355.103(b)(20)(K)
of this title.
(f) Reporting revenue. Revenues must be reported on
the cost report in accordance with §355.104 of this title (relating
to Revenues).
(g) Reviews and field audits of cost reports. Desk
reviews or field audits are performed on cost reports for all contracted
providers. 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 providers will be notified of
the results of a desk review or a field audit in accordance with §355.107
of this title (relating to Notification of Exclusions and Adjustments).
Providers 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).
|
| Source Note: The provisions of this §355.503 adopted to be effective September 1, 1996, 21 TexReg 7890; transferred effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective June 21, 1998, 23 TexReg 6197; amended to be effective June 25, 2000, 25 TexReg 5867; amended to be effective October 9, 2000, 25 TexReg 10131; amended to be effective September 1, 2001, 26 TexReg 6297; amended to be effective July 1, 2002, 27TexReg 5164; amended to be effective April 13, 2003, 28 TexReg 3047; amended to be effective August 16, 2004, 29 TexReg 7965; amended to be effective January 19, 2006, 31 TexReg 286; amended to be effective October 28, 2007, 32 TexReg 7461; amended to be effective February 3, 2008, 33 TexReg 667; amended to be effective September 3, 2008, 33 TexReg 7153; amended to be effective September 1, 2009, 34 TexReg 5654; amended to be effective June 20, 2011, 36 TexReg 3707; amended to be effective April 1, 2012, 37 TexReg 2068; amended to be effective November 25, 2012, 37 TexReg 9086; amended to be effective September 1, 2013, 38 TexReg 5435; amended to be effective January 1, 2015, 39 TexReg 9193 |
