Current through Reg. 49, No. 38; September 20, 2024
(a) Day Activity and Health Care Services.
Day activity and health care facilities provide noninstitutional care to
clients residing in the community through rehabilitative nursing and social
services. The Texas Department of Aging and Disability Services (DADS)
reimburses Day Activity and Health Services (DAHS) provider agencies for the
services they provide to clients.
(b) General requirements. For the completion
and submittal of cost reports pertaining to providers' fiscal years ending in
calendar year 1997 and subsequent years, providers must apply the information
in this section. 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).
(c) Cost-reporting guidelines. Providers 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).
(d) Exclusion of cost reports.
(1) Providers 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 providers. 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.
(2) 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.
(e) Review of cost reports. HHSC
may perform desk reviews or field audits on cost reports for all contracted
providers. HHSC determines the frequency and nature of the desk reviews and
field audits 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
providers 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). Providers 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).
(f)
Reimbursement determination. HHSC determines reimbursement in the following
manner.
(1) A contracted provider must submit
a cost report unless the provider meets one or more of the conditions in §
RSA
355.105(b)(4)(D) of this
title.
(2) HHSC staff allocate
payroll taxes and employee benefits 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. The employee benefits for administrative staff are
allocated directly to the corresponding salaries for those positions. The
allocated payroll taxes are Federal Insurance Contributions Act (FICA) or
Social Security, Workers' Compensation Insurance (WCI), Federal Unemployment
Tax Act (FUTA), and the Texas Unemployment Compensation Act (TUCA).
(3) HHSC staff project all allowable
expenses, excluding depreciation and mortgage interest, for the period from
each provider's reporting period to the next ensuing reimbursement period. HHSC
staff determine reasonable and appropriate economic adjusters as described in
§
RSA
355.108 of this title (relating to
Determination of Inflation Indices) to calculate the projected expenses. HHSC
staff also adjust reimbursement if 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).
(4) HHSC staff combine
allowable reported costs into the following four cost areas:
(A) Attendant cost area. This cost area is
calculated as specified in §
RSA
355.112 of this title (relating to Attendant
Compensation Rate Enhancement).
(B)
Other direct care costs. This cost area includes other direct care staff; food
and food service costs; activity costs; and other direct service
costs.
(C) Facility cost area. This
cost area includes building, maintenance staff, and utility costs.
(D) Administration and transportation cost
area. This cost area includes transportation, administrative staff, and other
administrative costs.
(5)
For the cost areas described in paragraph (4)(B) - (D) of this subsection,
allowable costs are totaled by cost area and then divided by the total units of
service for the reporting period to determine the cost per unit of service.
HHSC staff rank from low to high all provider agencies' projected costs per
unit of service in each cost area. The median projected unit of service cost
from each cost area is then determined. Those median projected unit of service
costs from each cost area are totaled. That resulting total is multiplied by
1.07 and becomes the recommended reimbursement.
(6) The reimbursement determination authority
is specified in §
RSA 355.101 of this
title (relating to Introduction).
(g) Allowable and unallowable costs.
Providers must follow the guidelines specified in §
RSA
355.102 of this title (relating to General
Principles of Allowable and Unallowable Costs) in determining whether a cost is
allowable or unallowable. Providers must follow the guidelines for allowable
and unallowable costs specified in §
RSA
355.103 of this title (relating to
Specifications for Allowable and Unallowable Costs).
(h) DAHS-specific allowable costs. Allowable
costs specific to the DAHS program are:
(1)
certain medical equipment and supplies, if they are related to the services for
which DADS has contracted. This may include, but is not limited to, supplies
and equipment considered necessary to perform client assessments, medication
administration, and nursing treatment.
(2) transportation costs if they are related
to the services for which DADS has contracted. This includes the costs of
garaging a vehicle that is primarily used to transport clients to and from the
DAHS center. The vehicle may be garaged off-site of the center for security
reasons or for route efficiency management. In these cases of off-site vehicle
garaging, a mileage log is not required if the vehicle is not used for personal
use and is used solely (100%) for the delivery of DAHS services.
(i) DAHS-specific unallowable
costs. Unallowable costs specific to the DAHS program are:
(1) physician's fees for completion of
physician orders; and
(2) costs for
which the provider received federal funds which should have been offset as
specified in §
RSA
355.103(b)(18)(B) of this
title (relating to Specification for Allowable and Unallowable
Costs).
(j) Reporting
revenue. Revenue must be reported on the cost report according to §
RSA 355.104 of this
title (relating to Revenue).
