Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter E - COMMUNITY CARE FOR AGED AND DISABLED › Section 355.511 - Reimbursement Methodology for Home-Delivered Meals

Current through Reg. 49, No. 28; July 12, 2024
(a) Reimbursement ceiling determination. When
				  the Texas Health and Human Services Commission (HHSC) does not require a cost
				  report, HHSC may adjust the rate ceiling as appropriate, based on cost data
				  collected through the budget worksheets or other appropriate cost data related
				  to the program in accordance with §
										RSA
				  355.105(h) of this title
				  (relating to General Reporting and Documentation Requirements, Methods, and
				  Procedures). For the purposes of this section, HHSC means the Texas Health and
				  Human Services Commission or its designee.
(b) Reimbursement ceiling determination based
				  on a cost-reporting process. If HHSC deems it appropriate to require cost
				  reporting, cost reports will be governed by the information in this subsection.
				  HHSC applies the general principles of cost determination as specified in
				  §
										RSA 355.101 of this
				  title (relating to Introduction). The cost-reporting process is as follows:
(1) Documentation requirements. Provider
				  agencies must follow the cost-reporting guidelines specified in §
											RSA
				  355.105 of this title.
(2) Excused from submission of cost reports.
				  If required by HHSC, a contracted provider agency must submit a cost report
				  unless the agency meets one or more of the conditions in §
											RSA
				  355.105(b)(4)(D) of this
				  title.
(3) Exclusion of cost
				  reports.
(A) Provider agencies 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
				  provider agencies. The purpose is to ensure that the database reflects costs
				  and other information that are necessary for the provision of services and are
				  consistent with federal and state regulations.
(B) Individual cost reports may not be
				  included in the database used for reimbursement determination if:
(i) there is reasonable doubt as to the
				  accuracy or allowability of a significant part of the information reported;
				  or
(ii) an auditor determines that
				  reported costs are not verifiable.
(4) Allowable and unallowable costs. Provider
				  agencies must follow the guidelines in determining whether a cost is allowable
				  or unallowable as specified in §
											RSA
				  355.102 of this title (relating to General
				  Principles of Allowable and Unallowable Costs). Provider agencies must follow
				  the guidelines for allowable and unallowable costs as specified in §
											RSA
				  355.103 of this title (relating to
				  Specifications for Allowable and Unallowable Costs).
(5) Revenue. Revenue must be reported on the
				  cost report according to §
											RSA 355.104 of this
				  title (relating to Revenues).
(6)
				  Review of cost reports. HHSC staff perform either desk reviews or field audits
				  on all contracted provider agencies. 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 §
											RSA
				  355.106 of this title (relating to Basic
				  Objectives and Criteria for Audit and Desk Review of Cost Reports), and
				  provider agencies will be notified of the results of a desk review or a field
				  audit in accordance with §
											RSA
				  355.107 of this title (relating to
				  Notification of Exclusions and Adjustments). Provider agencies may request an
				  informal and, if necessary, an administrative hearing to dispute an action
				  taken by HHSC under §
											RSA
				  355.110 of this title (relating to Informal
				  Reviews and Formal Appeals).