| (a) The Texas Health and Human Services Commission
(HHSC) notifies providers of exclusions and adjustments to reported
expenses made during HHSC's desk reviews and field audits of cost
reports. HHSC mails notices of desk-review exclusions and adjustments
within 15 working days after finalization of the desk review by HHSC.
The notice consists of a letter to the provider and desk-review adjustment
sheet(s), or an e-mail notification to the provider and online access
to view the cost report adjustments, that specifies:
(1) the line items on the cost report that have been
adjusted or excluded;
(2) the amount of each adjustment or exclusion; and
(3) the principal reason for each adjustment or exclusion.
(b) HHSC also furnishes providers with written reports
of the results of field audits. HHSC mails each field audit report
within 30 days after the final exit interview with the provider. An
exit interview is final when HHSC audit staff have received, reviewed,
and analyzed all documentation from the provider pertinent to the
scope of the audit. The field audit report consists of a professional
report prepared by HHSC audit staff to enumerate the results of a
field audit. Each field audit report includes a specification of:
(1) cost report line items that have been adjusted
or excluded;
(2) the amount of each adjustment or exclusion; and
(3) the principal reason for each adjustment or exclusion.
(c) A provider may also submit a written request for
HHSC to provide additional information about exceptions and adjustments
to the provider's cost report, including citations of the laws or
regulations that constitute the grounds for the exceptions and adjustments.
HHSC must comply with such requests in writing within 30 calendar
days.
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| Source Note: The provisions of this §355.107 adopted to be effective September 1, 1996, 21 TexReg 7866; duplicated effective September 1, 1997, as published in the Texas Register October 17, 1997, 22 TexReg 10311; amended to be effective August 31, 2004, 29 TexReg 8093; amended to be effective September 1, 2011, 36 TexReg 4795; amended to be effective May 8, 2012, 37 TexReg 3394 |
