(a) The Texas Department of Human Services (DHS) conducts desk reviews and field audits of provider cost reports in order to ensure that all financial and statistical information reported in the cost reports conforms to all applicable rules and instructions. Cost reports must be completed according to instructions and rules in accordance with §355.105(b)(4) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures). DHS may require supporting documentation other than that contained in the cost report to substantiate reported information. [(1)] [For cost reports pertaining to providers' fiscal years ending in calendar year 1994, 1995 or 1996, completion must be according to instructions and rules. DHS may require supporting documentation other than that contained in the cost report to substantiate reported information. ] [(A)] [For nursing facilities, failure to complete cost reports according to instructions and rules may result in vendor hod as specified in §355.310 of this title (relating to Vendor Hold). ] [(B)] [For all other programs, failure to complete cost reports according to instructions and rules constitutes an administrative contract violation. In the case of an administrative contract violation, procedural guidelines and informal reconsideration and/or appeal processes are specified in §355.111 of this title (relating to Administrative Contract Violations). ] [(2)] [For cost reports pertaining to providers' fiscal years ending in calendar year 1997 and subsequent years, completion must be according to instructions and rules in accordance with §355.105(b)(4) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures). DHS may require supporting documentation other than that contained in the cost report to substantiate reported information.] (1) [(A)] For nursing facilities, failure to complete cost reports according to instructions and rules in accordance with §355.105(b)(4) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures) may result in vendor hold as specified in 40 TAC §355.403 [of this title] (relating to Vendor Hold). (2) [(B)] For all other programs, failure to complete cost reports according to instructions and rules in accordance with §355.105(b)(4) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures) constitutes an administrative contract violation. In the case of an administrative contract violation, procedural guidelines and informal reconsideration and/or appeal processes are specified in §355.111 of this title (relating to Administrative Contract Violations). (b) - (e) (No change.) [(f) For cost reports pertaining to providers' fiscal years ending in calendar year 1994, 1995 or 1996, each provider entity or its designated agent(s) must allow access to any and all records necessary to verify information submitted to DHS on cost reports. This requirement includes records pertaining to related party transactions or other business activities engaged in by the provider.] [(1) For nursing facilities, failure to allow access to any and all records necessary to verify information submitted to DHS on cost reports may result in vendor hold as specified in §355.310 of this title (relating to Vendor Hold).] [(2) For all other programs, failure to allow access to any and all records necessary to verify information submitted to DHS on cost reports constitutes an administrative contract violation. In the case of an administrative contract violation, procedural guidelines and informal reconsideration and/or appeal processes are specified in §355.111 of this title (relating to Administrative Contract Violations).] (f) [(g)] For cost reports pertaining to providers' fiscal years ending in calendar year 1997 and subsequent years, each provider entity or its designated agent(s) must allow access to any and all records necessary to verify information submitted to DHS on cost reports. This requirement includes records pertaining to related party transactions or other business activities engaged in by the provider. (1) For nursing facilities, failure to allow access to any and all records necessary to verify information submitted to DHS on cost reports may result in vendor hold as specified in §355.403 of this title (relating to Vendor Hold). (2) For all other programs, failure to allow access to any and all records necessary to verify information submitted to DHS on cost reports constitutes an administrative contract violation. In the case of an administrative contract violation, procedural guidelines and informal reconsideration and/or appeal processes are specified in §355.111 of this title (relating to Administrative Contract Violations). (g) [(h)] A contracted provider may request an informal review, and subsequently an appeal, of a desk review or field audit disallowance in accordance with §355.110 of this title (relating to Informal Reviews and Formal Appeals).
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on March 28, 2000
TRD-200002219 Marina Henderson
Executive Deputy Commissioner
Texas Health and Human Services Commission
Earliest possible date of adoption: May 14, 2000
For further information, please call: (512) 438-3108
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