| (a) A governmental entity that provides funds for use
as the non-federal share in the Medicaid program must report information
to the Texas Health and Human Services Commission (HHSC) in a form
and format to be determined by HHSC.
(b) The information must be reported at least annually,
no later than October 31st, or upon request by HHSC.
(c) HHSC will open the information reporting system
prior to the end of the federal fiscal year and will review reported
information based on governmental entity funding sources, including:
(1) local provider participation funds (LPPFs) authorized
by the Texas Health and Safety Code Chapter 288 et
seq. or other provider tax structures;
(2) non-LPPF provider taxes;
(3) ad valorem tax revenue;
(4) patient revenue;
(5) other local funding sources; and
(6) donations.
(d) HHSC will use the information from the report to
monitor each governmental entity fund source and determine the likelihood
that the funds are permissible for use in the Medicaid program. The
monitoring will include the following:
(1) Survey. An electronic annual survey that will request:
(A) a list of all health care providers for which the
governmental entity transferred or certified funds as the non-federal
share;
(B) the relationship between the governmental entity
and the health care provider, including a copy of any formal or informal
agreements between the entity and the provider;
(C) the type of health care provider (i.e. ambulance,
dentist, hospital, intermediate care facilities for individuals with
an intellectual disability, nursing facility, physician practice group)
and ownership status;
(D) the source of the funds used as the non-federal
share transferred by the governmental entity;
(E) information on any debt instruments (bonds, loans,
etc.) that a governmental entity utilizes and the relationship of
the instrument to any transferred funds;
(F) to the extent patient revenue is used, a description
of payor mix during the federal fiscal year and any anticipated changes;
(G) any transfer of funds or provision of services
from a health care provider or entity related to a health care provider
to the governmental entity, including in-cash or in-kind donations,
or any other transfer of value;
(H) overview of funds received from all sources available
to the governmental entity in its current fiscal year;
(I) other information as determined necessary and appropriate
to determine compliance with federal or state statutes and regulations,
including attestations of compliance from the local government; and
(J) any publicly available information, such as:
(i) audio recordings of discussions or written minutes
from public meetings to set assessment rates or gather feedback from
providers or their representatives;
(ii) written correspondence describing the entity's
funding dedicated to the Medicaid program;
(iii) URL links to websites that describe the funds
transferred or certified as the non-federal share or any agreement
between the governmental entity and a health care provider or entity
related to a health care provider; and
(iv) copies of any public notices, local orders, announcements,
or other related documentation.
(2) Risk Assessment.
(A) The risk assessment will include:
(i) a risk assessment score based on self-reported
annual survey responses; and
(ii) any adjustments made at HHSC's discretion based
on supplemental documentation and discussion with the impacted governmental
entity and review of additional documentation requests as may be needed,
in HHSC's sole discretion, to confirm, audit, or modify self-reported
data and qualitative descriptions.
(B) Funding sources will be categorized as likely permissible,
further review required, or likely impermissible. HHSC will contact
entities whose funding sources are categorized as further review required
or likely impermissible to obtain additional information. The entity
must furnish the requested information to HHSC within ten (10) business
days of the date of the request.
(i) Likely permissible. Funding source appears to comply
with federal and state statutes and regulations.
(ii) Further review required. Funding source compliance
with federal and state statutes and regulations is unclear.
(iii) Likely impermissible. Funding source does not
appear to comply with federal or state regulations.
(3) In-depth Review. HHSC will select a sample of survey
respondents for an in-depth review in which HHSC may examine supporting
documentation, either on-site or electronically, at HHSC's discretion.
HHSC will select a sample of survey respondents sufficient to result
in a 95 percent confidence level with a 5 percent margin of error.
HHSC will initially select entities that are in the likely impermissible
and further review required categories, and if additional entities
are necessary to complete a sample size, they will be randomly selected
from the likely permissible category. HHSC will notify a governmental
entity if an on-site review will occur at least ten (10) calendar
days prior to the visit.
(4) Determination. Determination of completeness of
reporting and HHSC's assigned risk assessment for each funding source.
(5) Post-Determination Review. Post-determination review
will be conducted as outlined in this subchapter.
(6) Federal Reporting.
(e) If a governmental entity fails to submit the required
information or supplemental documentation as requested by HHSC by
the deadline specified in this section, HHSC will not accept further
transfer of funds for any Medicaid program from the governmental entity
until the reporting requirement is satisfied and may process recoupments
for any payments resulting from funds transferred determined to be
non-compliant.
(f) Prior to the applicable deadline, a governmental
entity may request an extension of up to ten (10) business days for
any deadline contained in this subchapter. HHSC may grant or reject
such request at its sole discretion.
(g) HHSC will notify the governmental entity upon determination
of:
(1) reporting compliance;
(2) permissibility of funds; and
(3) a risk assessment category for each funding source.
(h) After review of any additional information provided,
HHSC may also seek input on the likely permissibility of the funds
from the Centers for Medicare and Medicaid Services (CMS). In the
event HHSC elects to request input from CMS regarding the compliance
of a specific funding source as contemplated by this subchapter, HHSC
will notify the governmental entity prior to requesting such review.
HHSC may, at its discretion, accept or reject local funds from the
governmental entity for such funding source while awaiting CMS input;
however, HHSC will recoup all Medicaid payments generated from a funding
source deemed impermissible by CMS at any time.
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