(a) The department will periodically audit a program
provider to monitor compliance with §419.219 of this subchapter
(relating to Provider Reimbursement) and Division Six (relating to
Personal Funds). The department will notify the program provider of
the audit date.
(b) A program provider must maintain the following
records;
(1) personal funds records, as described in §419.256(h)
of this title (relating to Program Provider-Managed Personal Funds);
(2) trust fund account ledgers, as described in §419.256(c)(1)(A)
and (c)(2)(A) of this title (relating to Program Provider-managed
Personal Funds);
(3) statements from financial institutions regarding
trust fund accounts;
(4) petty cash fund ledgers as described in §419.256(d)(3)
of this title (relating to Program Provider-Managed Personal Funds);
(5) written requests for personal funds from trust
fund accounts, as described in §419.257 of this title (relating
to Requests for Personal Funds from Trust Fund Accounts);
(6) documentation of expenditures and deposits of personal
funds, as described in §419. 256(i) of this title (relating to
Program Provider-Managed Personal Funds);
(7) documentation of an individual's ability to manage
personal funds and decisions regarding management of personal funds,
as described in §419.253 of this title (relating to Determining
Management of Personal Funds);
(8) documentation regarding requests for specific types
or brands of items and services, as described in §419. 255(a)
of this title (relating to Items and Services Purchased With Personal
Funds);
(9) applied income ledgers, as described in §419.260(c)
of this title (relating to Applied Income);
(10) applied income payment plans from TDHS;
(11) agreements to hold the individual's residential
placement in the facility as described in §419.227(j) of this
title (relating to Discharge From a Facility);
(12) statements from financial institutions regarding
operating accounts;
(13) facility census and admission/discharge records;
(14) leave records as described in §419.226 of
this title (relating to Leaves); and
(15) IPP's and supporting documentation.
(c) If the records required by subsection (b) of this
section, or any other records required to be maintained by this subchapter,
are not made available by the program provider when requested by the
department, or the department determines that the records are not
auditable, the department may impose a vendor hold on payments due
to the program provider under the provider agreement until the records
are available and auditable. If the program provider does not provide
such records in accordance with instructions from the department,
the department may terminate the provider agreement.
(d) The department will provide the program provider
with a report of the audit findings, which may include corrective
actions that must be taken by the program provider and internal control
recommendations that may be followed by the program provider. Corrective
actions include making refunds to individuals or the department, entering
ledger adjustments, submitting unidentified funds to the department,
and establishing and maintaining records and systems. The program
provider may request an administrative hearing in accordance with
Division Eight of this subchapter (relating to Administrative Hearings)
to contest corrective actions required by the department pursuant
to this subsection.
(e) If the report of audit findings requires corrective
actions and the program provider does not make a request for an administrative
hearing in accordance with Division 8 of this subchapter (relating
to Administrative Hearings), the program provider must complete corrective
actions within 60 days after receiving the report of audit findings.
(f) If the program provider does not complete corrective
actions required by the department within 60 days after receiving
the report of audit findings, the department may:
(1) impose a vendor hold on payments due to the program
provider under the provider agreement until the program provider completes
corrective actions;
(2) recoup payments due to the program provider under
the provider agreement to make refunds to individuals or the department;
and
(3) terminate the provider agreement.
(g) Notwithstanding the other provisions set forth
in this section, the department may terminate the provider agreement
for repeated failure to comply with §419.219 of this subchapter
(relating to Provider Reimbursement) and Division Six (relating to
Personal Funds), as determined by audits conducted in accordance with
this section.
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Source Note: The provisions of this §261.269 adopted to be effective September 1, 2001, 26 TexReg 5384; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127 |