| cost report. A person
with supervisory authority over the preparation of the cost report
who reviewed the completed cost report may sign a certification page
in addition to the actual preparer.
(4) Requirements for cost report completion.
(A) A completed cost report must:
(i) be completed according to the cost determination
rules of this chapter, program-specific allowable and unallowable
rules, cost report instructions, and policy clarifications;
(ii) contain a signed, notarized, original certification
page or an electronic equivalent where such equivalents are specifically
allowed under HHSC policies and procedures;
(iii) be legible with entries in sufficiently dark
print to be photocopied;
(iv) contain all pages and schedules;
(v) be submitted on the proper cost report form;
(vi) be completed using the correct cost reporting
period; and
(vii) contain a copy of the state-issued cost report
training certificate except for cost reports submitted through the
State of Texas Automated Information and Reporting System (STAIRS).
(B) Providers are required to report amounts on the
appropriate line items of the cost report pursuant to guidelines established
in the methodology rules, cost report instructions, or policy clarifications.
Refer to program-specific reimbursement methodology rules, cost report
instructions, or policy clarifications for guidelines used to determine
placement of amounts on cost report line items.
(i) For nursing facilities, placement on the cost report
of an amount, which was determined to be inaccurately placed, may
result in vendor hold as specified in §355.403 of this title
(relating to Vendor Hold).
(ii) For School Health and Related Services (SHARS),
placement on the cost report of an amount, which was determined to
be inaccurately placed, may result in an administrative contract violation
as specified in §355.8443 of this title (relating to Reimbursement
Methodology for School Health and Related Services (SHARS)).
(iii) For all other programs, placement on the cost
report of an amount, which was determined to be inaccurately placed,
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.
(C) A completed cost report must be filed by the cost
report due date.
(i) For nursing facilities, failure to file a completed
cost report by the cost report due date may result in vendor hold
as specified in §355.403 of this title.
(ii) For SHARS, failure to file a completed cost report
by the cost report due date 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.
(iii) For all other programs, failure to file a completed
cost report by the cost report due date 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.
(D) HHSC may excuse providers from the requirement
to submit a cost report. A provider that is not enrolled in Attendant
Compensation Rate Enhancement as described in §355.112 of this
title (relating to Attendant Compensation Rate Enhancement) for a
specific program or the Nursing Facility Direct Care Staff Rate enhancement
as described in §355.308 of this title (relating to Direct Care
Staff Rate Component) during the reporting period for the cost report
in question, is excused from the requirement to submit a cost report
for such program if the provider meets one or more of the following
conditions:
(i) For all programs, if the provider performed no
billable services during the provider's cost-reporting period.
(ii) For all programs, if the cost-reporting period
would be less than or equal to 30 calendar days or one entire calendar
month.
(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) For the Department of Family and Protective
Services (DFPS) 24-Hour Residential Child-Care program, if:
(I) the contract was not renewed;
(II) only Basic Level services were provided;
(III) the total number of state-placed days (DFPS days
and other state agency days) was 10 percent or less of the total days
of service provided during the cost-reporting period;
(IV) the total number of DFPS-placed days was 10 percent
or less of the total days of service provided during the cost-reporting
period;
(V) for facilities that provide Emergency Care Services
only, the occupancy rate was less than 30 percent during the cost-reporting
period; or
(VI) 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.
(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 which are 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.
Cont'd... |
