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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355REIMBURSEMENT RATES
SUBCHAPTER JPURCHASED HEALTH SERVICES
DIVISION 23EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT)
RULE §355.8443Reimbursement Methodology for School Health and Related Services (SHARS)

(k) In addition to the requirements of this section, the LEA must comply with all provisions outlined in §354.1341 of this title and §354.1342 of this title.

(l) Administrative contract violations. HHSC may take the following actions against an LEA for administrative contract violations.

  (1) Time study. For failure to participate in or meet all time study requirements, HHSC will recoup all interim payments made during the cost reporting period and will not allow the LEA to submit a cost report for that reporting period.

  (2) Interim claims. The LEA is ineligible to submit a cost report if they fail to submit interim claims in the manner and format prescribed by HHSC, or its designee, including the requirements in subsection (e)(2) of this section. If a service category, student, employee, or related cost is claimed in the cost report without having been appropriately claimed in compliance with program requirements, that specific service category, student, employee, or related cost will be disallowed from the cost report.

  (3) Cost reports.

    (A) For failure to submit a cost report by the due date, HHSC will recoup all interim payments made during the cost reporting period.

    (B) HHSC will remove all unallowable costs and reserve the right to update a certified cost report if inaccurate information is identified or reported by the LEA.

  (4) Other administrative contract violations. For all other administrative contract violations, HHSC will recoup all interim payments made during the cost reporting period.

  (5) Appeals. An LEA may request a hearing to appeal HHSC's action concerning an administrative contract violation. Formal appeals are conducted in accordance with the provisions of Chapter 357, Subchapter I of this title (relating to Hearings under the Administrative Procedure Act). If there is a conflict between an applicable section of Chapter 357 of this title (relating to Hearings) and the provisions of this chapter, the provisions of this chapter will prevail.


Source Note: The provisions of this §355.8443 adopted to be effective October 1, 2011, 36 TexReg 4656; amended to be effective May 17, 2015, 40 TexReg 2527; amended to be effective November 27, 2017, 42 TexReg 6615; amended to be effective October 9, 2022, 47 TexReg 6425

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