| (a) Day Activity and Health Care Services. Day activity
and health care facilities provide noninstitutional care to clients
residing in the community through rehabilitative nursing and social
services. The Texas Department of Aging and Disability Services (DADS)
reimburses Day Activity and Health Services (DAHS) provider agencies
for the services they provide to clients.
(b) General requirements. For the completion and submittal
of cost reports pertaining to providers' fiscal years ending in calendar
year 1997 and subsequent years, providers must apply the information
in this section. The Texas Health and Human Services Commission (HHSC)
applies the general principles of cost determination as specified
in §355.101 of this title (relating to Introduction).
(c) Cost-reporting guidelines. Providers must follow
the cost-reporting guidelines as specified in §355.105 of this
title (relating to General Reporting and Documentation Requirements,
Methods, and Procedures).
(d) Exclusion of cost reports.
(1) Providers are responsible for reporting only allowable
costs on the cost report, except where cost report instructions indicate
that other costs are to be reported in specific lines or sections.
Only allowable cost information is used to determine recommended reimbursement.
HHSC excludes from reimbursement determination any unallowable expenses
included in the cost report and makes the appropriate adjustments
to expenses and other information reported by providers. The purpose
is to ensure that the database reflects costs and other information
which are necessary for the provision of services and are consistent
with federal and state regulations.
(2) Individual cost reports may not be included in
the database used for reimbursement determination if:
(A) there is reasonable doubt as to the accuracy or
allowability of a significant part of the information reported; or
(B) an auditor determines that reported costs are not
verifiable.
(e) Review of cost reports. HHSC may perform desk reviews
or field audits on cost reports for all contracted providers. HHSC
determines the frequency and nature of the desk reviews and field
audits 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 and, if necessary, an administrative
hearing to dispute an action taken by HHSC under §355.110 of
this title (relating to Informal Reviews and Formal Appeals).
(f) Reimbursement determination. HHSC determines reimbursement
in the following manner.
(1) A contracted provider must submit a cost report
unless the provider meets one or more of the conditions in §355.105(b)(4)(D)
of this title.
(2) HHSC staff allocate payroll taxes and employee
benefits to each salary line item on the cost report on a pro rata
basis based on the portion of that salary line item to the amount
of total salary expense. The employee benefits for administrative
staff are allocated directly to the corresponding salaries for those
positions. The allocated payroll taxes are Federal Insurance Contributions
Act (FICA) or Social Security, Workers' Compensation Insurance (WCI),
Federal Unemployment Tax Act (FUTA), and the Texas Unemployment Compensation
Act (TUCA).
(3) HHSC staff project all allowable expenses, excluding
depreciation and mortgage interest, for the period from each provider's
reporting period to the next ensuing reimbursement period. HHSC staff
determine reasonable and appropriate economic adjusters as described
in §355.108 of this title (relating to Determination of Inflation
Indices) to calculate the projected expenses. HHSC staff also adjust
reimbursement if new legislation, regulations, or economic factors
affect costs as specified in §355.109 of this title (relating
to Adjusting Reimbursement When New Legislation, Regulations, or Economic
Factors Affect Costs).
(4) HHSC staff combine allowable reported costs into
the following four cost areas:
(A) Attendant cost area. This cost area is calculated
as specified in §355.112 of this title (relating to Attendant
Compensation Rate Enhancement).
(B) Other direct care costs. This cost area includes
other direct care staff; food and food service costs; activity costs;
and other direct service costs.
(C) Facility cost area. This cost area includes building,
maintenance staff, and utility costs.
(D) Administration and transportation cost area. This
cost area includes transportation, administrative staff, and other
administrative costs.
(5) For the cost areas described in paragraph (4)(B)
- (D) of this subsection, allowable costs are totaled by cost area
and then divided by the total units of service for the reporting period
to determine the cost per unit of service. HHSC staff rank from low
to high all provider agencies' projected costs per unit of service
in each cost area. The median projected unit of service cost from
each cost area is then determined. Those median projected unit of
service costs from each cost area are totaled. That resulting total
is multiplied by 1.07 and becomes the recommended reimbursement.
(6) The reimbursement determination authority is specified
in §355.101 of this title (relating to Introduction).
(g) Allowable and unallowable costs. Providers must
follow the guidelines specified in §355.102 of this title (relating
to General Principles of Allowable and Unallowable Costs) in determining
whether a cost is allowable or unallowable. Providers must follow
the guidelines for allowable and unallowable costs specified in §355.103
of this title (relating to Specifications for Allowable and Unallowable
Costs).
(h) DAHS-specific allowable costs. Allowable costs
specific to the DAHS program are:
(1) certain medical equipment and supplies, if they
are related to the services for which DADS has contracted. This may
include, but is not limited to, supplies and equipment considered
necessary to perform client assessments, medication administration,
and nursing treatment.
(2) transportation costs if they are related to the
services for which DADS has contracted. This includes the costs of
garaging a vehicle that is primarily used to transport clients to
and from the DAHS center. The vehicle may be garaged off-site of the
center for security reasons or for route efficiency management. In
these cases of off-site vehicle garaging, a mileage log is not required
if the vehicle is not used for personal use and is used solely (100%)
for the delivery of DAHS services.
(i) DAHS-specific unallowable costs. Unallowable costs
specific to the DAHS program are:
(1) physician's fees for completion of physician orders;
and
(2) costs for which the provider received federal funds
which should have been offset as specified in §355.103(b)(18)(B)
of this title (relating to Specification for Allowable and Unallowable
Costs).
(j) Reporting revenue. Revenue must be reported on
the cost report according to §355.104 of this title (relating
to Revenue).
|
| Source Note: The provisions of this §355.6907 adopted to be effective September 1, 1996, 21 TexReg 7892; duplicated effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective November 22, 1998, 23 TexReg 11631; amended to be effective June 25, 2000, 25 TexReg 5867; amended to be effective November 25, 2012, 37 TexReg 9086; amended to be effective January 1, 2015, 39 TexReg 9193; amended to be effective September 2, 2019, 44 TexReg 4691 |
