1 TAC §355.502-§355.505
The Health and Human Services Commission proposes amendments
to §355.502, concerning reimbursement methodology for the Community-based
Alternatives (CBA) Program, §355.503, concerning reimbursement methodology
for the CBA Program for 1997 and subsequent cost reports, §355.504,
concerning reimbursement methodology for the Community Living Assistance
and Support Services (CLASS) Waiver Program, and §355.505, concerning
reimbursement methodology for the CLASS Program for 1997 and subsequent cost
reports.
The purpose of the amendments to the CBA rules is to eliminate the monthly
fee paid to providers to obtain medical supplies and prescriptions for the
recipient. Costs for medical supplies will be included as adaptive aids in
the current CBA requisition fee schedule. Prescriptions currently are covered
through the Medicaid Vendor Drug Program. The proposed amendments also establish
a methodology for determination of a payment rate for reassessment of the
recipient after Medicaid eligibility is established. Such reassessments are
required by federal regulations.
The amendments to the CLASS rules are intended to establish a methodology
for determination of a fee schedule to reimburse CLASS providers for staff
costs in acquisition of adaptive aids and minor home modifications for the
recipient. These costs currently are reimbursed as habilitation units of service.
If approved, the amendments will establish a methodology similar to the CBA
program for these costs. In addition, the amendment would establish a methodology
to determine the payment rate for reassessment of a recipient after Medicaid
eligibility is established. Such reassessments are required by federal regulations.
Gary Bego, Associate Commissioner for Fiscal Affairs, has determined that
for the first five years the rule is in effect no fiscal implications for
state or local government are anticipated from the enforcement or administration
of the rule.
Mr. Bego has also determined that for each year of the first five years
this rule is in effect the public benefit anticipated from the enforcement
of this rule is (1) clarification of the handling of revenue from acquisition
fees by providers for medical supplies, prescriptions, adaptive aids, and
minor home modifications, (2) the determination of an appropriate reimbursement
of reassessment of a CBA or CLASS program participant. There is no anticipated
economic cost to persons required to comply with the proposed rule. This rule
will have no local employment impact. There will be no effect on small businesses.
Questions or comments by members of the public on the proposed rule are
solicited. Information about the proposal may be obtained by contacting Carolyn
Pratt, Texas Department of Human Services, P. O. Box 149030, Austin, Texas
78714-9030, or by phone 512-438-4057. Written comments on the proposal should
be mailed or delivered to Steve Svadlenak, Texas Health and Human Services
Commission, P.O. Box 13247, Austin, Texas 78711, or by facsimile (FAX) to
(512) 424-6641.
The amendments are proposed under Texas Government Code, §531.033,
which authorizes the commissioner of health and human services to adopt rules
necessary to carry out the commission's duties under chapter 531, and under
§531.021, which authorizes the commission to adopt reasonable rules and
standards to govern the establishment of rates fees, and charges for medical
assistance payments under Human Resources Code, Chapter 32.
This amendments implement Texas Government Code, Chapter 531, §531.021
and Human Resources Code, Chapter 32, §32.028.
§355.502.Reimbursement Methodology for the Community-based Alternatives Program - a 1915(c) Medicaid Home and Community-based Waiver for Aged and Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care.
(a)
General requirements. Cost reports pertaining to providers'
fiscal years ending in calendar year 1996, or modeled costs used for reimbursement
determination, will be governed by the information in this section, and the
information in §355.201(b) of this title (relating to General Specifications
and Methodology). In addition, the Texas Department of Human Services (DHS)
applies the general principles of cost determination as specified in §
355.101 of this title (relating to Introduction). Cost reports pertaining
to providers' fiscal years ending in calendar year 1997 and subsequent years
will be governed by the information in §355.503 of this title (relating
to Reimbursement Methodology for Community-based Alternatives Waiver Program,
a 1915(c) Medicaid Home and Community-based Waiver for Aged and Disabled Adults
Who Meet Criteria for Alternatives to Nursing Facility Care: 1997 and Subsequent
Cost Reports).
(b) - (h)
(No change.)
(i)
Waiver reimbursement determination methodology. Recommended
reimbursements are determined in the following manner.
(1)
Unit of service reimbursement. Reimbursement for personal
assistance services, nursing, physical therapy, occupational therapy, speech
pathology, and in-home respite care services will be determined on a fee-for-service
basis in the following manner.
(A)
Total allowable costs for each provider will be determined
by analyzing the allowable historical costs reported on the cost report.
(B)
Total allowable costs are reduced by the amount of
the
pre-enrollment expense fee, [
and
] requisition fee,
and reassessment fee
revenues
accrued for the reporting period.
[
received through a voucher payment system
]
(C) - (F)
(No change.)
(2) - (3)
(No change.)
(4)
Requisition fees. Requisition fees are reimbursements
paid to the CBA
home and community support services
contracted
providers for their efforts in acquiring adaptive aids and minor home modifications
for CBA participants. [
Reimbursement for medical supplies and prescriptions
covered under adaptive aids will be determined on a per month per client served
basis.
] Reimbursement for adaptive aids and minor home modifications
will vary based on the actual cost of the adaptive aid and minor home modification.
Reimbursements are determined using a method based on modeled projected expenses
which are developed by using data from surveys; cost report data from [
other
] similar programs; consultation with other service providers and/or
professionals experienced in delivering contracted services; and
/or
other sources.
(5)
Reassessment fees. Reassessment fees
are reimbursements paid to CBA home and community support services contracted
providers for performing annual reassessments. Reimbursements are determined
using a method based on modeled projected expenses which are developed by
using data from surveys; cost report data from similar programs; consultation
with other service providers and/or professionals experienced in delivering
contracted services; and/or other sources.
[
(5)
Pre-enrollment expense fee. Reimbursement
for pre-enrollment assessment is determined using a method based on modeled
projected expenses which are developed by using data from surveys; cost report
data from other similar programs, consultation with other service providers
and/or professionals experienced in delivering contracted services; and other
sources.
]
(6)
Pre-enrollment expense fee. Reimbursement
for pre-enrollment assessment is determined using a method based on modeled
projected expenses which are developed by using data from surveys; cost report
data from other similar programs, consultation with other service providers
and/or professionals experienced in delivering contracted services; and other
sources.
[
(6)
Exceptions to the reimbursement
determination methodology. DHS may adjust reimbursement to compensate for
anticipated future changes in the program requirements in accordance with
§355.109 of this title (relating to Adjusting Reimbursement When New
Legislation, Regulations, or Economic Factors Affect Costs).
]
(7)
Exceptions to the reimbursement determination
methodology. DHS may adjust reimbursement to compensate for anticipated future
changes in the program requirements in accordance with §355.109 of this
title (relating to Adjusting Reimbursement When New Legislation, Regulations,
or Economic Factors Affect Costs).
[
(7)
Authority to determine reimbursement.
The authority to determine reimbursement is specified in §355.101 of
this title (relating to Introduction).
]
(8)
Authority to determine reimbursement.
The authority to determine reimbursement is specified in §355.101 of
this title (relating to Introduction).
§355.503. Reimbursement Methodology for the Community-based Alternatives Waiver Program - a 1915(c) Medicaid Home and Community-based Waiver for Aged and Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care: 1997 and Subsequent Cost Reports.
(a) - (c)
(No change.)
(d)
Waiver reimbursement determination methodology. Recommended
reimbursements are determined in the following manner.
(1)
Unit of service reimbursement. Reimbursement for personal
assistance services, nursing, physical therapy, occupational therapy, speech
pathology, and in-home respite care services will be determined on a fee-for-service
basis in the following manner.
(A)
(No change.)
(B)
Total allowable costs are reduced by the amount of
the
pre-enrollment expense fee, [
and
] requisition fee,
and reassessment fee
revenues
accrued for the reporting period.
[
received through a voucher payment system.
]
(C)- (F)
(No change.)
(2) - (3)
(No change.)
(4)
Requisition fees. Requisition fees are reimbursements
paid to the CBA
home and community support services
contracted
providers for their efforts in acquiring adaptive aids and minor home modifications
for CBA participants. [
Reimbursement for medical supplies and prescriptions
covered under adaptive aids will be determined on a per month per client served
basis.
] Reimbursement for adaptive aids and minor home modifications
will vary based on the actual cost of the adaptive aid and minor home modification.
Reimbursements are determined using a method based on modeled projected expenses
which are developed by using data from surveys; cost report data from [
other
] similar programs; consultation with other service providers and/or
professionals experienced in delivering contracted services; and
/or
other sources.
(5)
Reassessment fees. Reassessment fees
are reimbursements paid to CBA home and community support services contracted
providers for performing annual reassessments. Reimbursements are determined
using a method based on modeled projected expenses which are developed by
using data from surveys; cost report data from similar programs; consultation
with other service providers and/or professionals experienced in delivering
contracted services; and/or other sources.
[
(5)
Pre-enrollment expense fee. Reimbursement
for pre-enrollment assessment is determined using a method based on modeled
projected expenses which are developed by using data from surveys; cost report
data from other similar programs, consultation with other service providers
and/or professionals experienced in delivering contracted services; and other
sources.
]
(6)
Pre-enrollment expense fee. Reimbursement
for pre-enrollment assessment is determined using a method based on modeled
projected expenses which are developed by using data from surveys; cost report
data from other similar programs, consultation with other service providers
and/or professionals experienced in delivering contracted services; and other
sources.
[
(6)
Exceptions to the reimbursement determination
methodology. DHS may adjust reimbursement if new legislation, regulations,
or economic factors affect costs, according to §355.109 of this title
(relating to Adjusting Reimbursement When New Legislation, Regulations, or
Economic Factors Affect Costs).]
(7)
Exceptions to the reimbursement
determination methodology. DHS may adjust reimbursement if new legislation,
regulations, or economic factors affect costs, according to §355.109
of this title (relating to Adjusting Reimbursement When New Legislation, Regulations,
or Economic Factors Affect Costs).
(e) - (h)
(No change.)
§355.504. Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program - a 1915(c) Medicaid Home and Community-based Waiver for Persons With Related Conditions.
(a)
General requirements. Cost reports pertaining to providers'
fiscal years ending in calendar year 1994, 1995, or 1996 will be governed
by the information in this section, and the information in §355.201(b)
of this title (relating to General Specifications and Methodology). In addition,
the Texas Department of Human Services (DHS) applies the general principles
of cost determination as specified in § 355.101 of this title (relating
to Introduction). Cost reports pertaining to providers' fiscal years ending
in calendar year 1997 and subsequent years will be governed by the information
in §355.505 of this title (relating to Reimbursement Methodology for
1915(c) of the Social Security Act Medicaid Home and Community Based Waiver
Services for Persons With Related Conditions: 1997 and Subsequent Cost Reports).
(b)-(c)
(No change.)
(d)
Waiver reimbursement determination methodology.
(1) - (3)
(No change.)
(4)
Reimbursement determination process. Recommended
unit of service reimbursements are determined in the following manner.
(A)
Unit or service reimbursement for habilitation, nursing,
physical therapy, occupational therapy, speech pathology, and psychological
services are determined in the following manner:
(i)
(No change.)
(ii)
Total allowable costs are reduced by the amount of
the
administrative expense fee,
requisition fee, and reassessment
fee
revenues
accrued for the reporting period.
[
received
through a voucher payment system.
]
(iii) - (vii)
(No change.)
(B)-(D)
(No change.)
(5)
(No change.)
(e)
(No change.)
(f)
Requisition fees. Requisition fees are
reimbursements paid to the CLASS direct service agency contract-ed providers
for their efforts in acquiring adaptive aids and minor home modifications
for CLASS participants. Reimbursement for adaptive aids and minor home modifications
will vary based on the actual cost of the adaptive aid and minor home modification.
Reimbursements are determined using a method based on modeled projected expenses
which are developed by using data from surveys; cost report data from similar
programs; consultation with other service providers and/or professionals experienced
in delivering contracted services; and/or other sources.
[
(f)
Reporting requirements. The program director's
full salary is to be reported on the line item of the cost report designated
for the director.
]
(g)
Reassessment fees. Reassessment fees are
reimbursements paid to CLASS direct service agency contracted providers for
performing annual reassessments. Reimbursements are determined using a method
based on modeled projected expenses which are developed by using data from
surveys; cost report data from similar programs; consultation with other service
providers and/or professionals experienced in delivering contracted services;
and/or other sources.
[
(g)
Allowable and unallowable costs.
]
(h)
Reporting requirements. The program director's
full salary is to be reported on the line item of the cost report designated
for the director.
(i)
Allowable and unallowable costs.
(1)
General. Allowable and unallowable costs are defined to
identify expenses which are and are not reasonable and necessary to provide
waiver services to clients by a prudent and cost-effective operation. Only
allowable cost information is used to compile the reimbursement determination
data base. Cost reporting by providers should be consistent with generally
accepted accounting principles (GAAP). In cases where DHS cost reporting rules
conflict with GAAP, IRS, or other authorities, DHS rules take precedence for
cost reporting purposes.
(2)
Definitions. The following words and terms, when
used in this section, shall have the following meanings, unless the context
clearly indicates otherwise.
(A)
Allowable costs. Those expenses that are reasonable and
necessary in the normal conduct of operations relating to the provision of
waiver services.
(i)
"Reasonable" refers to the amount expended. The test of
reasonableness is that the amount expended does not exceed the cost which
would be incurred by a prudent business operator seeking to contain costs.
(ii)
"Necessary" refers to the relationship of the cost to
provision of waiver services. To qualify as a necessary expense, a cost must
be one that is usual and customary in the operation of waiver services and
must meet the following requirements.
(I)
The expenditure was not for personal or other activity
not specifically related to the provision of waiver services.
(II)
The cost does not appear on the list of specific unallowable
costs and is not unallowable under other federal, state, or local laws or
regulations.
(III)
The cost bears a significant relationship to the provision
of waiver services. The test of significance is whether elimination of the
expenditure would adversely affect the delivery of waiver services.
(IV)
The expense was incurred in the purchase of materials,
supplies, or services provided directly to the clients or staff of the program
in the conduct of normal business operations.
(iii)
Normal conduct of operations relating to waiver services
and the pre-enrollment assessment process includes, but is not limited to,
the following:
(I)
The administrative expense fee covers reimbursement for
the pre-enrollment assessment and care planning services.
(II)
Only direct contact with the client is considered allowable
when recording pre-enrollment assessment and care planning time for each type
of professional service.
(III)
Only costs associated with the pre-enrollment assessment
and care planning of those clients seeking enrollment into the waiver program
will be allowed.
(IV)
Expenses not used solely for the provision of waiver
services and the pre-enrollment assessment. Whenever allowable costs are attributable
partially to personal or other business interests not related to the provision
of waiver services/pre-enrollment assessment and partially to waiver services/pre-enrollment
assessment, the latter portion may be allowed on a pro rata basis if the proportion
of use by the waiver services/pre-enrollment assessment is well-documented.
(V)
Allowable costs for cost reporting purposes should result
from arms-length transactions involving unrelated parties. However, in related-party
transactions the allowable cost to the waiver services program is limited
to the lesser of the actual cost to the related party (excluding markups and
profit margins) or the cost to the contracted waiver service provider. Such
allowable cost must not exceed the usual and customary charges for comparable
goods or services in an arms-length transaction. A related party is a natural
person or organization related to the provider entity by blood/marriage, or
common ownership, or any association which permits either entity to exert
power or influence, either directly or indirectly, over the other.
(B)
Unallowable costs. Those expenses that are not reasonable
or necessary for the provision of waiver services and the pre-enrollment assessment.
Unallowable costs are not included in the data base used to determine recommended
reimbursements and fees.
(3)
List of Allowable Costs. The following list
of allowable costs is not comprehensive, but rather serves as a general guide
and identifies certain key expense areas. The absence of a particular cost
does not necessarily mean that it is not an allowable cost.
(A)
Compensation of waiver services staff. Compensation will
be given only to those staff who provide waiver services directly to the clients
or in support of staff of the waiver services program in the normal conduct
of operations relating to the provision of waiver services. This includes:
(i)
Wages and salaries.
(ii)
Payroll taxes and insurance. Federal Insurance Contributions
Act (FICA or social security), unemployment compensation insurance, workman's
compensation insurance.
(iii)
Employee benefits. Employer-paid health, life, accident,
liability, and disability insurance for employees; contributions to employee
retirement fund; and deferred compensation limited to the dollar amount the
employer contributes. The expense:
(I)
must represent a clearly enumerated liability of the employer
to individual employees;
(II)
must not be incurred as a benefit to employees who do
not provide services directly to the clients or staff of the waiver services
program; and
(III)
must not represent any form of profit sharing.
(B)
Compensation of staff outside of the waiver program who
provide services directly to the clients or in support of staff of the program.
Allowable compensation is limited to the pro rata portion of the actual working
time spent on behalf of the program.
(C)
Compensation of outside consultants providing services
directly to the clients or in support of staff of the program.
(D)
Materials and supplies. Includes office supplies, housekeeping
supplies, medical, and other supplies.
(E)
Utilities. Includes electricity, natural gas, fuel oil,
water, waste water, garbage collection, telephone, and telegraph.
(F)
Buildings, equipment, and capital expenses. Buildings,
equipment, and capital used by the waiver provider or in support of the waiver
services staff, and not for personal business. If these costs are shared with
other program operations, the portion of the costs relating directly to waiver
services may be allowed on a pro rata basis if the proportion of use for waiver
services is documented.
(G)
Depreciation and amortization expense. Property owned
by the provider entity and improvements to owned, leased, or rented property
used by the waiver provider that are valued at more than $500 at the time
of purchase must be depreciated or amortized using the straight line method.
The minimum usable lives to be assigned to common classes of depreciable property
are as follows:
(i)
buildings: 30 years, with a minimum salvage value of 10%;
and
(ii)
transportation equipment used for the transport of clients,
materials and supplies, or staff providing waiver services: a minimum of three
years for passenger automobiles and five years for light trucks and vans,
all with a minimum salvage value of 10%.
(H)
Provider-owned property. Property owned by the provider
entity and improvements to property owned, leased, or rented by the provider
that are valued at less than $500 at the time of purchase may be treated as
ordinary expenses.
(I)
Rental and lease expense. This includes rental and lease
expenses for buildings, building equipment, transportation equipment, other
equipment, related materials, and supplies used by the waiver provider. Rental
or lease expense paid to a related party is limited to the actual allowable
cost incurred by the related party.
(J)
Transportation expense. This includes the cost of public
transportation or mileage claimed at the allowable reimbursement per mile
set by the state legislature for state employees.
(K)
Interest expense. Interest expense is allowable on loans
for the acquisition of allowable items, subject to:
(i)
all of the requirements for allowable costs,
(ii)
written evidence of the loan, and
(iii)
the provider entity being named as maker or comaker
of the note. Allowable interest is limited to the lesser of the cost to the
related party or the prevailing national average prime interest rate for the
year in which the loan contract was executed.
(L)
Tax expense. This includes real and personal property
taxes, motor vehicle registration fees, sales taxes, Texas corporate franchise
taxes, and organization filing fees.
(M)
Insurance expense. This includes facility fire and casualty,
professional liability and malpractice, and transportation insurance.
(N)
Contract waiver services provided by outside vendors to
persons with related conditions.
(O)
Business and professional association dues limited to
associations devoted primarily to the issues of related conditions.
(P)
Outside training costs. Limited to direct costs (transportation,
meals, lodging, and registration fees) for training provided to personnel
rendering services directly to the clients or staff of the waiver provider.
The training must be directly related to issues concerning related conditions
and located within the continental United States.
(4)
List of unallowable costs. Unallowable costs
are those expenses that are not reasonable or necessary for the provision
of waiver services. Unallowable costs are not included in the reimbursement
determination data base used to determine recommended reimbursements. The
following list is not intended to be comprehensive, but rather to serve as
a general guide and identify certain key expense areas that are not allowable.
The absence of a particular cost does not necessarily mean that it is an allowable
cost.
(A)
Compensation in the form of salaries, benefits, or any
form of compensation given to individuals who do not provide waiver services
either directly to clients or in support of staff;
(B)
Personal expenses not directly related to the provision
of waiver services;
(C)
Client room and board expenses, except for those related
to respite care;
(D)
management fees paid to a related party that are not derived
from the actual cost of materials, supplies, or services provided directly
to the program;
(E)
Advertising expenses other than those for yellow pages
advertising, advertising for employee recruitment, and advertising to meet
any statutory or regulatory requirement;
(F)
Business expenses not directly related to the provision
of waiver services;
(G)
Political contributions;
(H)
Depreciation and amortization of unallowable costs. This
includes amounts in excess of those resulting from the straight line depreciation
method, capitalized lease expenses in excess of the actual lease payment,
and goodwill or any excess above the actual value of the physical assets at
the time of purchase;
(I)
Trade discounts of all types. This includes returns, allowances,
and refunds;
(J)
Donated facilities, materials, supplies, and services,
including the values assigned to the services of unpaid workers and volunteers;
(K)
Dues to all types of political and social organizations,
and to professional associations not directly and primarily concerned with
the provision of waiver services;
(L)
Entertainment expenses except those incurred for entertainment
provided to the staff of the waiver provider as an employee benefit;
(M)
Boards of directors' fees;
(N)
Fines and penalties for violations of regulations, statutes,
and ordinances of all types;
(O)
Fund raising and promotional expenses;
(P)
Expenses incurred in the purchase of goods and services
with revenues from gifts, donations, endowments, and trusts;
(Q)
Interest expenses on loans pertaining to unallowable items
and on that portion of interest paid which is reduced or offset by interest
income;
(R)
Insurance premiums pertaining to items of unallowable
cost;
(S)
Accrued expenses that are not a legal obligation of the
provider or are not clearly enumerated as to dollar amount. This includes
any form of profit sharing and the accrued liabilities of deferred compensation
plans;
(T)
Planning and evaluation expenses for the purchase of depreciable
assets, except where purchases are actually made and the assets are put into
service in providing waiver services;
(U)
Mileage expense which exceeds the current reimbursement
rate set by the Texas Legislature for state employee travel or expenses exceeding
actual cost of public transportation;
(V)
Costs of purchases from a related party which exceed the
original cost to the related party;
(W)
Out-of-state travel expenses, except for provision of
waiver services that may include training and quality assurance functions;
(X)
Legal and other costs associated with litigation between
a provider and state or federal agencies, unless the litigation is decided
in the provider's favor,
(Y)
Contributions to self-insurance funds which do not represent
payments based on current liabilities;
(Z)
Any expense incurred because of imprudent business practices;
(AA)
Expenses which cannot be adequately documented;
(BB)
Expenses not reported according to the instructions
on the cost report;
(CC)
Expenses not allowable under other pertinent federal,
state, or local laws and regulations; and
(DD)
Federal, state, and local income taxes and any expenses
related to preparing and filing income tax forms.
§355.505. Reimbursement Methodology for the Community Living Assistance and Support Services Waiver Program - a 1915(c) Medicaid Home and Community-based Waiver for Persons With Related Conditions: 1997 and Subsequent Cost Reports.
(a)-(c)
(No change.)
(d)
Waiver reimbursement determination methodology.
(1)-(3)
(No change.)
(4)
Reimbursement determination process. Recommended
unit of service reimbursements are determined in the following manner.
(A)
Unit or service reimbursement for habilitation, nursing,
physical therapy, occupational therapy, speech pathology, and psychological
services are determined in the following manner:
(i)
Total allowable costs for each provider will be determined
by analyzing the allowable historical costs reported on the cost report and
other pertinent cost survey information.
(ii)
Total allowable costs are reduced by the amount of
the
administrative expense fee,
requisition fee, and reassessment
fee
revenues
accrued for the reporting period.
[
received
through a voucher payment system.
]
(iii)-(vii)
(No change.)
(B)-(D)
(No change.)
(e)
(No change.)
(f)
Requisition fees. Requisition fees are
reimbursements paid to the CLASS direct service agency contract-ed providers
for their efforts in acquiring adaptive aids and minor home modifications
for CLASS participants. Reimbursement for adaptive aids and minor home modifications
will vary based on the actual cost of the adaptive aid and minor home modification.
Reimbursements are determined using a method based on modeled projected expenses
which are developed by using data from surveys; cost report data from similar
programs; consultation with other service providers and/or professionals experienced
in delivering contracted services; and/or other sources.
[
(f)
Allowable and unallowable costs.
[
(1)
Providers must follow the guidelines
in determining whether a cost is allowable or unallowable as specified in
§335.102 and §355.103 of this title (relating to General Principles
of Allowable and Unallowable Costs, and Specifications for Allowable and Unallowable
Costs) as well as the following provisions.
[
(2)
Participant room and board expenses
are not allowable, except for those related to respite care.
[
(3)
The cost of adaptive aids and home
modifications are not allowable. Allowable labor costs associated with acquiring
adaptive aids and home modifications should be reported in the cost report.
Any item purchased for participants in this program and reimbursed through
a voucher payment system is unallowable. Refer to §355.103(17)(K) of
this title (relating to Specifications for Allowable and Unallowable Costs).
]
(g)
Reassessment fees. Reassessment fees are
reimbursements paid to CLASS direct service agency contracted providers for
performing annual reassessments. Reimbursements are determined using a method
based on modeled projected expenses which are developed by using data from
surveys; cost report data from similar programs, consultation with other service
providers and/or professionals experienced in delivering contracted services;
and/or other sources.
[
(g)
Authority to determine reimbursement.
The authority to determine reimbursement is specified in §355.101 of
this title (relating to Introduction).
]
(h)
Allowable and unallowable costs.
(1)
Providers must follow the guidelines in
determining whether a cost is allowable or unallowable as specified in §355.102
and §355.103 of this title (relating to General Principles of Allowable
and Unallowable Costs, and Specifications for Allowable and Unallowable Costs)
as well as the following provisions.
(2)
Participant room and board expenses
are not allowable, except for those related to respite care.
(3)
The cost of adaptive aids and home
modifications is not allowable. Allowable labor costs associated with acquiring
adaptive aids and home modifications should be reported in the cost report.
Any item purchased for participants in this program and reimbursed through
a voucher payment system is unallowable. Refer to §355.103(b)(17)(K)
of this title (relating to Specifications for Allowable and Unallowable Costs).
[
(h)
Reporting revenue. Revenues must be reported
on the cost report in accordance with §355.104 of this title (relating
to Revenues).
]
(i)
Authority to determine reimbursement.
The authority to determine reimbursement is specified in §355.101 of
this title (relating to Introduction).
[
(i)
Reviews and field audits of cost reports.
DHS staff perform desk reviews or field audits on all contracted providers.
The frequency and nature of the field audit are determined by DHS to ensure
the fiscal integrity of the program. Desk reviews and field audits will be
conducted in accordance with 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 §355.107 of this title (relating to Notification of Exclusions and
Adjustments). Providers may request an informal review and, if necessary,
an administrative hearing to dispute an action taken by DHS under §355.110
of this title (relating to Informal Reviews and Formal Appeals).
]
(j)
Reporting revenue. Revenues must be reported
on the cost report in accordance with §355.104 of this title (relating
to Revenues).
[
(j)
Reporting requirements. The program director's
full salary is to be reported on the line item of the cost report designated
for the director.
]
(k)
Reviews and field audits of cost reports.
DHS staff perform desk reviews or field audits on all contracted providers.
The frequency and nature of the field audit are determined by DHS to ensure
the fiscal integrity of the program. Desk reviews and field audits will be
conducted in accordance with §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 §355.107 of this title (relating to Notification of Exclusions and
Adjustments). Providers may request an informal review and, if necessary,
an administrative hearing to dispute an action taken by DHS under §355.110
of this title (relating to Informal Reviews and Formal Appeals).
(l)
Reporting requirements. The program director's
full salary is to be reported on the line item of the cost report designated
for the director.
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
February 9, 1998.
TRD-9801839
Marina Henderson
Executive Deputy Commissioner
Health and Human Services Commission
Earliest possible date of adoption: March 22, 1998
For further information, please call: (512) 424-6576