| (a) Submittal of cost reports. On a biennial basis,
providers must submit cost reports to Texas Health and Human Services
Commission (HHSC) Provider Finance Department only in even years,
beginning with providers' 2018 cost reports. HHSC applies the general
principles of cost determination as specified in §355.101 of
this title (relating to Introduction).
(1) Attendant service costs. Attendant service costs
are defined in §355.112 of this title (relating to Attendant
Compensation Rate Enhancement).
(2) Staff who provide both attendant and non-attendant
services. For staff whose duties include work other than the provision
of attendant services for the provider, time spent providing attendant
services and associated expenses may be reported as attendant service
costs if properly documented in accordance with §355.105 of this
title (relating to General Reporting and Documentation Requirements,
Methods, and Procedures).
(3) Providers must report the following costs:
(A) Staff wages related to the delivery of attendant
services.
(B) These costs may be either the provider's actual
expense or contracted expenditures.
(b) Reviews of exclusions or adjustments. A provider
who disagrees with HHSC's exclusion or adjustment of items in cost
reports may request an informal review and, when appropriate, an administrative
hearing as specified in §355.110 of this title (relating to Informal
Reviews and Formal Appeals).
(c) Field audit and desk review. 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).
(d) Notification of exclusions and adjustments. HHSC
will notify a provider of the results of a desk review or field audit
in accordance with §355.107 of this title (relating to Notification
of Exclusions and Adjustments).
(e) Cost reporting guidelines. Providers must follow
the cost-reporting guidelines as specified in §355.105 of this
title.
(f) 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).
(g) Revenues. Revenues must be reported on the cost
report in accordance with §355.104 of this title (relating to
Revenues).
(h) Related parties. Allowable compensation for owners
and related parties and definitions of owners and related parties
are specified in §355.102(i) and §355.103(b)(2) of this
title.
(1) Time sheet requirement. Owners and related parties
who provide multiple types of attendant service (e.g., direct care
workers, direct care trainers, and job coaches) or both attendant
services and non-attendant services must maintain daily time sheets
that record the time spent on activities in each area. The provider
must maintain documentation relating to the compensation, bonuses,
and benefits of each owner or related party in accordance with §355.105(b)(2)(B)(xi)
of this title.
(2) Calculation of allowable hourly wage rate and benefits.
Allowable hourly wage rate and benefits for attendant service work
must be the lesser of the actual hourly wage rate paid and benefits
paid or the hourly wage rate and benefits for a comparable attendant
assumed in the fully-funded model. The fully-funded model is the model
as calculated under §355.723(d) of this title (relating to Reimbursement
Methodology for Home and Community-based Services) prior to any adjustments
made in accordance with §355.101 of this title and §355.109
of this title (relating to Adjusting Reimbursement When New Legislation,
Regulations or Economic Factors Affect Costs) for the rate period.
(3) Calculation of allowable hours for attendants.
Allowable hours per unit of service for an attendant when the reported
hours include related-party hours, are determined as follows:
(A) Step 1. Determine the hours per unit of service
for a comparable attendant-service staff-type assumed in the fully-funded
model as defined in paragraph (2) of this subsection, adjusted for
the provider's average Level of Need (LON) during the reporting period.
For TxHmL, until such time as LONs are established, the provider's
average LON is assumed to be LON 5.
(B) Step 2. Determine the hours per unit of service
encompassed by the 90th percentile in the array of hours per unit
of service for comparable attendant-service staff-types as reported
by those contracted providers not reporting any related-party hours
for that staff-type, adjusted for the provider's average LON during
the reporting period. For TxHmL, until such time as LONs are established,
the provider's average LON is assumed to be LON 5.
(C) Step 3. Determine the greater of Step 1 and Step
2.
(D) Step 4. Determine the actual hours worked by the
staff-type per unit of service.
(E) Step 5. Determine the lesser of Step 4 and Step
3. This value is the allowable hours per unit of service for the attendant-service
staff-type in question.
(4) Exception to related-party adjustment. If at least
40 percent of total labor hours in a specific related-party's attendant-service
staff-type were provided by non-related-parties, the related-party's
hourly wage rate may be the higher of the model assumption for that
attendant-service staff-type described in paragraph (2) of this subsection
or the non-related party average for that attendant-service staff-type,
so long as the non-related party average does not exceed the related-party's
actual hourly wage.
(5) Maximum attendant-care hours. During any single
fiscal year, the sum of all attendant-care hours reported on any cost
report(s) for any individual owner or related party cannot exceed
2,600.
(6) Classification of hours over the limit. Hours,
hourly wages and benefits above the limits described in paragraphs
(2) - (5) of this subsection are to be reported as administrative
hours, hourly wages and benefits.
(i) Adjusting reported cost. Each provider's total
reported allowable costs, excluding depreciation and mortgage interest,
are projected from the historical cost-reporting period to the prospective
reimbursement period as described in §355.108 of this title (relating
to Determination of Inflation Indices). HHSC may adjust reimbursement
if new legislation, regulations, or economic factors affect costs,
according to §355.109 of this title.
(j) Fiscal Accountability for HCS. This subsection
applies to services delivered on or before August 31, 2009 and only
for HCS program services.
(1) General principles. Fiscal accountability is a
process used to gauge the ongoing financial performance under the
reimbursement rates.
(2) Annual reporting. Fiscal accountability will consist
of the annual reporting of the direct service costs including wages,
and benefits, from all providers. The data will be collected on a
cost report designed by HHSC in accordance with §355.105(b) of
this title.
(A) The Department of Aging and Disability Services
(DADS) will place a vendor hold on payments to a provider whose provider
agreement is being assigned or terminated. The provider will submit
a cost report for the current reporting period to HHSC. Upon receipt
of an acceptable cost report and repayment of any amounts due in accordance
with this section, the vendor hold will be released.
(B) Providers that do not submit a cost report completed
in accordance with all applicable rules and instructions within 60
days of the placement of a vendor hold due to the failure to submit
the cost report are subject to an immediate recoupment of funds related
to fiscal accountability as described in paragraph (4)(E) of this
subsection. The recouped funds will not be restored until the provider
submits an acceptable cost report and has paid the actual amount due
as specified in paragraphs (5) - (7) of this subsection. If an acceptable
cost report is not received within 365 days of the due date, the recoupment
will become permanent.
(C) Providers with an ownership change from one legal
entity to a different legal entity or a contract termination that
do not submit a cost report for the fiscal year of the ownership change
or contract termination within 60 days of the change of ownership
or contract termination are subject to recoupment of funds related
to fiscal accountability as described in paragraph (4)(E) of this
subsection. The recouped funds will not be restored until the provider
submits an acceptable cost report and has paid the actual amount due
as specified in paragraphs (5) - (7) of this subsection. If an acceptable
cost report is not received within 365 days of the change of ownership
or contract termination date, the Cont'd... |
