Current through Reg. 49, No. 38; September 20, 2024
(a) General requirements. The Texas Health
and Human Services Commission (HHSC) applies the general principles of cost
determination as specified in §
RSA 355.101 of this
title (relating to Introduction).
(b) Cost reporting. Provider agencies must
follow the cost-reporting guidelines as specified in §
RSA
355.105 of this title (relating to General
Reporting and Documentation Requirements, Methods and Procedures).
(1) Number of cost reports to be submitted.
Every legal entity must submit a cost report unless the entity meets one or
more of the conditions in §
RSA
355.105(b)(4)(D) of this
title.
(A) Contracted providers participating
in the attendant compensation rate enhancement.
(i) At the same level of enhancement. If all
the contracts under the legal entity participate in the enhancement at the same
level of enhancement, the contracted provider must submit one cost report for
the legal entity.
(ii) At different
levels of enhancement. If all the contracts under the legal entity participate
in the enhancement but they participate at more than one enhancement level, the
contracted provider must submit one cost report for each level of
enhancement.
(B)
Contracted providers not participating in the attendant compensation rate
enhancement. If all the contracts under the legal entity do not participate in
the enhancement, the contracted provider must submit one cost report for the
legal entity.
(C) Contractors
participating and not participating in attendant compensation rate enhancement.
(i) At the same level of enhancement. If some
of the contracts under the legal entity do not participate in the enhancement
and the rest of the contracts under the legal entity participate at the same
level of enhancement, the contracted provider must submit:
(I) one cost report for the contracts that do
not participate; and
(II) one cost
report for the contracts that do participate.
(ii) At different levels of enhancement. If
some of the contracts under the legal entity do not participate in the
enhancement and the rest of the contracts under the legal entity participate in
the enhancement but they participate at more than one enhancement level, the
contracted provider must submit:
(I) one cost
report for the contracts that do not participate; and
(II) one cost report for each level of
enhancement.
(2) 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 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 which are
necessary for the provision of services and are consistent with federal and
state regulations. 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.
(c) Reimbursement determination.
Reimbursement is determined in the following manner.
(1) Cost determination by cost area.
Allowable costs are combined into three cost areas, after allocating payroll
taxes 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 and
after applying employee benefits directly to the corresponding salary line
item.
(A) Service support cost area. This
includes field supervisors' salaries and wages, benefits, and mileage
reimbursement expenses. This also includes building, building equipment, and
operation and maintenance costs; administration costs; and other service costs.
Administration expenses equal to $0.18 per priority unit of service are
allocated to priority. The administration costs remaining after this allocation
are summed with the other service support costs.
(B) Non-priority attendants cost area. This
includes non-priority attendants' salaries and wages, benefits, and mileage
reimbursement expenses. This cost area is calculated as specified in §
RSA
355.112 of this title (relating to Attendant
Compensation Rate Enhancement).
(C)
Priority attendants cost area. This includes priority attendants' salaries and
wages, benefits, and mileage reimbursement expenses. This cost area is
calculated as specified in §
RSA
355.112 of this title.
(2) Recommended reimbursement by cost area.
For the service support cost area described in paragraph (1)(A) of this
subsection the following is calculated:
(A)
Projected costs. Each contract's total allowable costs, excluding depreciation
and mortgage interest, per unit of service are projected from each contract's
reporting period to the next ensuing reimbursement period, as described in
§
RSA
355.108 of this title (relating to
Determination of Inflation Indices) to calculate the projected expenses.
Reimbursement may be adjusted where new legislation, regulations, or economic
factors affect costs as specified in §
RSA
355.109 of this title (relating to Adjusting
Reimbursement When New Legislation, Regulations, or Economic Factors Affect
Costs).
(B) Projected cost per unit
of service. To determine the projected cost per unit of service for each
contract, the total projected allowable costs for the service support cost area
are divided by total units of service, including non-priority services,
priority services, and STAR+PLUS services, in order to calculate the projected
cost per unit of service.
(C)
Projected cost arrays. Each contract's projected allowable costs per unit of
service are rank ordered from low to high, along with each contract's
corresponding units of service for each cost area.
(D) Recommended reimbursement for the service
support cost area. The total units of service for each contract are summed
until the median hour of service is reached. The corresponding projected
expense is the weighted median cost component. The weighted median cost
component is multiplied by 1.044 to calculate the recommended reimbursement for
the service support cost area. The service support cost area recommended
reimbursement is limited, if necessary, to available appropriations.
(3) Total recommended
reimbursement.
(A) For non-priority clients.
The recommended reimbursement is determined by summing the recommended
reimbursement described in paragraph (2) of this subsection and the cost area
component from paragraph (1)(B) of this subsection.
(B) For priority clients. The recommended
reimbursement is determined by summing the recommended reimbursement described
in paragraph (2) of this subsection and the cost area component from paragraph
(1)(C) of this subsection.
(d) Reimbursement determination authority.
The reimbursement determination authority is specified in §
RSA 355.101 of this
title.
(e) Desk reviews and field
audits of cost reports. Desk reviews or field audits are performed on cost
reports for all 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 an audit
in accordance with §
RSA
355.107 of this title (relating to
Notification of Exclusions and Adjustments). Provider agencies may request an
informal review and, if necessary, an administrative hearing to dispute an
action taken under §
RSA
355.110 of this title (relating to Informal
Reviews and Formal Appeals).
(f)
Factors affecting allowable 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) and §
RSA
355.103 of this title (relating to
Specifications for Allowable and Unallowable Costs).
(g) Reporting revenues. Revenues must be
reported on the cost report in accordance with §
RSA 355.104 of this
title (relating to Revenues).
