TITLE 1.ADMINISTRATION

Part 5. GENERAL SERVICES COMMISSION

Chapter 111. EXECUTIVE ADMINISTRATIVE DIVISION

Subchapter B. HISTORICALLY UNDERUTILIZED BUSINESS PROGRAM

1 TAC §§111.12, 111.16, 111.28

The General Services Commission proposes amendments to Title 1, T.A.C. §§ 111.12, 111.16 and 111.28 regarding the Historically Underutilized Business Program complying with the requirements of the Texas Government Code, Chapter 2161, Subchapter B, §2161.065 concerning the Mentor-Protégé Program; Subchapter C concerning Planning and Reporting Requirements; and Subchapter F concerning Subcontracting (enacted by S.B. 178, 76th Leg. (1999)). The amendments are being proposed to clarify terminology and to implement the HUB Subcontracting Plans, the agency planning responsibilities, and the new Mentor Protégé Program. The commission, according to the revised rules and in accordance with the HUB Program's policies and procedures, will maintain the requirements.

Sal Valdez, Director of Business Services, has determined that for the first five year period the proposed sections are in effect, there will be no effect to state or local government as a result of implementing these sections.

Sal Valdez, Director of Business Services, has also determined that for each year of the first five year period that the sections are in effect the public benefit anticipated as a result of implementing these rules is a streamlined method for securing more goods and services from HUB vendors. These rules provide a benefit to all small businesses implementing the legislature's policy of providing opportunities to HUBs to do business with the state. There will be no negative or unfair regulatory impact on small businesses. There is no anticipated economic cost to persons who are required to comply with the rules as proposed.

Comments on the proposals may be submitted to Ann Dillion, General Counsel, General Services Commission, P. O. Box 13047, Austin, TX 78711-3047. Comments must be received no later than 30 days from the date of publication of the proposal to the Texas Register .

The sections are proposed under the Texas Government Code, Title 10, Subtitle D, Chapter 2161, Section 2161.002, which provides the General Services Commission with the authority to promulgate rules under this Code.

The following statute is affected by these rules: Government Code, Title 10, Subtitle D, Chapter 2161.

§111.12.Definitions.

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1)

Applicant--A corporation, sole-proprietorship, partnership, joint venture, limited liability company, or supplier that applies to the commission as an historically underutilized business.

(2)

Application--A written request for certification as an historically underutilized business in the required format submitted to the commission.

(3)

Commodities--Materials, supplies, or equipment.

(4)

Comptroller--Comptroller of Public Accounts.

(5)

Contractor/Vendor --A supplier of commodities or services to a state agency under a purchase order contract or other contract.

(6)

Directory--The Texas Certified Historically Underutilized Business Directory.

(7)

Disparity Study--The State of Texas Disparity Study, performed by the National Economic Research Associates, Inc. (NERA).

(8)

Economically Disadvantaged Person--An eligible HUB applicant whose business has not exceeded the graduation size standards according to the commission's graduation procedures in §111.23 of this title (relating to Graduation Procedures).

(9)

Forum--A collaborative effort between agencies and potential contractors/vendors to provide information and training regarding an agency's procurement opportunities.

(10)

Graduation--When a business exceeds the commission's size standard for certification.

(11)

Historically Underutilized Business--A business outlined in subparagraphs (C)-(H) with its principal place of business in Texas (as defined in paragraph (19) of this section) in which the owner(s):

(A)

have a proportionate interest and demonstrate active participation in the control, operation, and management of the entities' affairs; and

(B)

are economically disadvantaged because of their identification as members of the following groups:

(i)

Black Americans--which includes persons having origins in any of the Black racial groups of Africa;

(ii)

Hispanic Americans--which includes persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish or Portuguese culture or origin, regardless of race;

(iii)

American Women--which includes all women of any ethnicity except those specified in clauses (i), (ii), (iv), and (v) of this subparagraph;

(iv)

Asian Pacific Americans--which includes persons whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific, the Northern Marianas, and Subcontinent Asian Americans which includes persons whose origins are from India, Pakistan, Bangladesh, Sri Lanka, Bhutan or Nepal; and

(v)

Native Americans--which includes persons who are American Indians, Eskimos, Aleuts, or Native Hawaiians; and

(C)

a corporation formed for the purpose of making a profit in which at least 51% of all classes of the shares of stock or other equitable securities are owned by one or more persons described by subparagraphs (A) and (B); or

(D)

a sole proprietorship created for the purpose of making a profit that is 100% owned, operated, and controlled by a person described by subparagraphs (A) and (B) of this section; or

(E)

a partnership formed for the purpose of making a profit in which 51% of the assets and interest in the partnership is owned by one or more persons who are described by subparagraphs (A) and (B) of this section; or

(F)

a joint venture in which each entity in the joint venture is an historically underutilized business under this subdivision; or

(G)

a supplier contract between a historically underutilized business under this subdivision and a prime contractor/vendor under which the historically underutilized business is directly involved in the manufacture or distribution of the supplies or materials or otherwise warehouses and ships the supplies;

(H)

a business other than described in subparagraphs (D), (F), and (G) of this section, which is formed for the purpose of making a profit and is otherwise a legally recognized business organization under the laws of the State of Texas, provided that at least 51% of the assets and 51% of any classes of stock and equitable securities are owned by one or more persons described by subparagraphs (A) and (B) of this section.

(12)

Historically Underutilized Business (HUB) Coordinator--An agency employee who holds a position equivalent to the procurement director or is the procurement director. The employee reports to the agency's executive director on HUB activities including, but are not limited to, the agency's good faith effort criteria, HUB reporting, contract administration, and marketing and outreach efforts for HUB participation.

(13)

HUB Report--A fiscal year semi-annual and annual report of the state's total expenditures, contract awards and payments made to certified HUBs.

(14)

Mentor Protégé Program--A program designed by the commission to assist agencies in identifying prime contractors/vendors and HUBs for potential long-term contractual relationships.

(15)

NERA--National Economic Research Associates, Inc.

(16)

Non-Treasury Funds--Funds paid by a state agency that are not treasury funds.

(17)

Other services--All services other than construction and professional services, including consulting services subject to Texas Government Code, Chapter 2254, Subchapter B.

(18)

Person--U.S. citizen, born or naturalized.

(19)

Principal place of business--A permanent business office located in Texas where the majority HUB owner(s) makes the decisions, controls the daily operations of the organization, and participates in the business. The qualifying owners must be residents of the State of Texas.

(20)

Professional services--Services of accountants, architects, engineers, land surveyors, and physicians that must be purchased by state agencies under Texas Government Code, Chapter 2254, Subchapter A.

(21)

Subcontractor--A supplier of commodities or services to a contractor/vendor.

(22)

Subcontractor Funds--Payments made to certified historically underutilized businesses by a contractor/vendor or supplier under contract with the state.

(23)

Size Standards--Graduation thresholds established by the HUB program consistent with the commission's rules which are extracted from the U.S. Small Business Administration's size standards, and based on the gross receipts and gross number of employees according to the Standard Industrial Classification codes.

(24)

Term Contract--A contract establishing a source or sources of supply for a specified period of time as defined in § 113.2 of this title (relating to Definitions).

(25)

Treasury Funds--Funds maintained in the state treasury and paid through the comptroller's office for each state agency.

(26)

USAS--Uniform Statewide Accounting System for the State of Texas.

(27)

Vendor Identification Number (VID)--A 13-digit identification number used in state government to identify the bidder or business for payment or award of contracts, certification as a HUB, and registration on the bidders list.

(28)

HUB Subcontracting Plan-Written documentation regarding the use of HUB subcontractors, which is required by a state agency in procurements with an expected value of $100,000 or more which a potential contractor/vendor must prepare and return with their bid, proposal, offer, or other applicable expression of interest. The HUB subcontracting plan subsequently becomes a provision of the contract awarded as a result of the procurement process.

§111.16.State Agency Reporting Requirements.

(a)

The comptroller will report to the commission not later than March 15 of each year regarding the previous six-month period, and on September 15 of each year regarding the preceding fiscal year, the payments made for the purchase of goods, services and public works awarded and actually paid from treasury funds by each state agency. Subject to the capabilities of the comptroller's USAS system, the comptroller shall identify state agencies' purchases from state term contracts which are paid from treasury funds so that those purchases awarded and actually paid under term contracts may be included in the commission's report of its own purchases.

(b)

State agencies will report to the commission, not later than March 15 of each year regarding the previous six-month period and on September 15 of each year regarding the preceding fiscal year, the payments made for the purchase of goods and services awarded and actually paid from non-treasury funds by the state agency. The report shall include information requested by the commission and shall be in a form prescribed by the commission. State agencies' purchases from state term contracts which are paid from non-treasury funds must be identified on the report as such so that they may be reflected on the commission's report of its own purchases.

(c)

State agencies shall maintain, and compile monthly, information relating to the agency's and each of its operating division's use of historically underutilized businesses, including information regarding subcontractors and suppliers. This information shall include but is not limited to the information required in subsections (a) and (b) of this section. On a monthly basis state agencies shall require a contractor/vendor to whom a state agency has awarded a contract to report to the agency the identity and amount paid to each historically underutilized business to whom the contractor/vendor has awarded a subcontract for the purchase of supplies, materials and equipment, provided that payment was made to a historically underutilized business in the month to be reported. Contractors/Vendors shall report to a state agency progress payments made to subcontractors, professionals, consultants and suppliers certified as historically underutilized businesses each month in which such payment is made.

(d)

State agencies will report to the commission, not later than March 15 of each year regarding the previous six-month period and on September 15 of each year regarding the preceding fiscal year, the total dollar amount of historically underutilized business subcontracting participation in all of the agencies' contracts for the purchase of goods, services and public works payments. State agencies must include subcontracting participation paid from Treasury and Non-Treasury funds.

(e)

State agencies that participate in a group purchasing program under Texas Government Code § 2155.134 shall include a separate report to the commission, not later than March 15 of each year regarding the previous six-month period and September 15 of each year regarding the preceding fiscal year, of purchases that are made through the group purchasing program and shall report the dollar amount of each purchase that is allocated to the reporting agency.

(f)

The commission shall prepare a consolidated report based on a compilation and analysis of the reports submitted by each state agency and information provided by the comptroller in the format specified by the commission. These reports of historically underutilized business purchasing and contracts shall form a record of each agency's purchases in which the agency selected the contractor/vendor. If the contractor/vendor was selected by the commission as part of its state term contract program, the purchase will be reflected on the commission's report of its own purchases. The commission report will contain the following information:

(1)

the total dollar amount of payments made by each state agency;

(2)

the total number of HUBs actually paid by each state agency;

(3)

the total number of contracts awarded to HUBs by each state agency;

(4)

the number of bids received from HUBs by each state agency; and

(5)

the graduation rates of HUBs as defined in §111.23 of this title (relating to Graduation Procedures) for the following groups as defined in § 111.12 of this title (relating to Definitions) and certified by the commission:

(A)

Black Americans;

(B)

Hispanic Americans;

(C)

American Women;

(D)

Asian Pacific Americans; and

(E)

Native Americans.

(g)

On April 15 of each year, the commission shall submit the consolidated report regarding the previous six-month period and on October 15 of each year regarding the preceding fiscal year to the presiding officer of each house of the legislature, the members of the legislature and the joint select committee.

(h)

State agencies will receive HUB credit for the total value of contracts awarded directly to certified HUBs under the Vendor Identification Number in the commission's HUB Directory. When the prime contractor/vendor is a HUB, it must perform at least 25% of the total value of the contract with its own or leased employees, as defined by the Internal Revenue Service, in order for the agency to receive 100% HUB credit for the entire contract. The prime HUB contractor/vendor may subcontract up to 75% of the contract with HUBs or non-HUB subcontractors. If a prime HUB contractor's/vendor's HUB subcontracting plan identifies that it is planning to perform less than 25% of the total value of contract with its employees, the agency will receive HUB credit for the value of the contract that was actually performed by the prime HUB contractor/vendor and its HUB subcontractors. To obtain HUB credit, the agency must report its HUB subcontracting expenditures to the commission in accordance with subsection (d) of this section.

(i)

Any prime HUB contractor/vendor that seeks to satisfy the good faith effort requirement shall report to the agency the identity and amount paid to each historically underutilized business each month in which such payment is made. The report will include the volume of work performed under the contract, the portion of the work that was performed with its employees, non-HUB contractors/vendors and other HUB contractors/vendors. The agency may request payment documentation in accordance with subsection (c) of this section and the HUB subcontracting plan that confirms the performance of the contractor/vendor. The agency shall discuss the performance of the contractor/vendor and document the contractor/vendor's performance in the contract file. Any deficiencies will be identified by the agency and must be rectified prior to the next reporting period by the contractor/vendor.

§111.28.Mentor Protégé Program.

(a)

In accordance with the Texas Government Code, Section 2161.065, the commission shall design a Mentor Protégé Program to foster long-term relationships between contractors/vendors and Historically Underutilized Businesses (HUBs) and to increase the ability of HUBs to contract with the state or to receive subcontracts under a state contract. The objective of the Mentor Protégé Program is to provide professional guidance and support to the protégé to facilitate their development and growth. All participation is voluntary and program features should remain flexible so as to maximize participation. Each state agency with a biennial appropriation that exceeds $10 million shall implement a Mentor Protégé Program.

(b)

In efforts to design a Mentor Protégé Program, each agency, because of its unique mission and resources, is encouraged to implement a Mentor Protégé Program that considers;

(1)

the needs of protégé businesses requesting to be mentored;

(2)

the availability of mentors who possess unique skills, talents, and experience related to the mission of the agency's Program; and

(3)

the agency's staff and resources.

(c)

Agencies may elect to implement Mentor Protégé Programs individually or cooperatively with other agencies, and/or other public entities and private organizations, with skills, resources and experience in Mentor Protégé Programs. Agencies are encouraged to implement a Mentor Protégé Program to address the needs of its protégé businesses in the following critical areas of the state's procurements:

(1)

construction,

(2)

commodities, and/or

(3)

services.

(d)

State agencies may consider, but are not limited to, the following factors in developing their Mentor Protégé Program:

(1)

Develop and implement internal procedures, including an application process, regarding the Mentor Protégé Program which identifies the eligibility criteria and the selection criteria for mentors and potential HUB protégé businesses;

(2)

Recruit contractor/vendor mentors and protégés to voluntarily participate in the Program;

(3)

Establish a Mentor Protégé Program objective identifying both the roles and expectations of the agency, mentor and the protégé;

(4)

Monitor the progress of the mentor protégé relationship;

(5)

Identify key agency resources including senior managers and procurement personnel to assist with the implementation of the Program; and

(6)

Encourage partnerships with local governmental and nonprofit entities to implement a community based Mentor Protégé Program.

(e)

An agency's Mentor Protégé Program must include mentor eligibility and selection criteria. In determining the eligibility and selection of a mentor, state agencies may consider the following criteria:

(1)

Whether the mentor is a registered bidder on the commission's Centralized Master Bidders List (CMBL);

(2)

Whether the mentor has extensive work experience and can provide developmental guidance in areas that meet the needs of the protégé, including but not limited to, business, financial, and personnel management; technical matters such as production, inventory control and quality assurance; marketing; insurance; equipment and facilities; and/or other related resources.

(3)

Whether the mentor is in "good standing" with the State of Texas and is not in violation of any state statutes, rules or governing policies;

(4)

Whether the mentor has mentoring experience; and

(5)

Whether the mentor has a successful past work history with the agency.

(f)

An agency's Mentor Protégé Program must include protégé eligibility and selection criteria. In determining the eligibility and selection of HUB protégés, state agencies may use the following criteria:

(1)

Whether the protégé is eligible and willing to become certified as a HUB;

(2)

Whether the protégé's business has been operational for at least one year;

(3)

Whether the protégé is willing to participate with a mentoring firm and will identify the type of guidance that is needed for its development;

(4)

Whether the protégé is in "good standing" with the State of Texas and is not in violation of any state statutes, rules or governing policies; and

(5)

Whether the protégé is involved in a mentoring relationship with another contractor/vendor.

(g)

The mentor and the protégé should agree on the nature of their involvement under the agency's mentor/protégé initiative. Each agency will monitor the process of the relationship. The mentor and protégé relationship should be reduced to writing and that agreement may include, but is not limited to, the following:

(1)

Identification of the developmental areas in which the protégé needs guidance ;

(2)

The time period which the developmental guidance will be provided by the mentor;

(3)

Name, address, phone and fax numbers, and the points of contact that will oversee the agreement of the mentor and protégé;

(4)

Procedure for a mentor firm to notify the protégé in advance if it intends to voluntarily withdraw from the program or terminate the mentor protégé relationship;

(5)

Procedure for a protégé firm to notify the mentor in advance if it intends to terminate the mentor protégé relationship;

(6)

A mutually agreed upon timeline to report the progress of the mentor protégé relationship to the state agency.

(h)

Each agency must notify its mentors and protégés that participation is voluntary. The notice must include written documentation that participation in the agency's Mentor Protégé Program is neither a guarantee for a contract opportunity nor a promise of business; but the Program's intent is to foster positive long-term business relationships.

(i)

State agencies may demonstrate their good faith under this section by submitting a supplemental letter with documentation to the commission with their HUB Report or legislative appropriations request identifying the progress and testimonials of mentors and protégés that participate in the agency's Program. In accordance with §111.26 of this title (relating to HUB Coordinator Responsibilities) the agency's HUB Coordinator shall facilitate compliance by its agency.

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 30, 2000.

TRD-200002282

Ann Dillon

General Counsel

General Services Commission

Earliest possible date of adoption: May 14, 2000

For further information, please call: (512) 463-3960


Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 355. MEDICAID REIMBURSEMENT RATES

Subchapter A. COST DETERMINATION PROCESS

1 TAC §§355.102, 355.103, 355.105, 355.106, 355.110, 355.111

The Texas Health and Human Services Commission (HSSC) proposes amendments to §§355.102, 355.103, 355.105, 355.106, 355.110, and 355.111, concerning general principles of allowable and unallowable costs, specifications for allowable and unallowable costs, general reporting and documentation requirements, methods, and procedures, basic objectives and criteria for audit and desk review of cost reports, informal reviews and formal appeals, and administrative contract violations, in its Cost Determination Process chapter. The purpose of the amendments is to define approval processes and cost reporting procedures, clarify allowable and unallowable costs, remove obsolete references, replace an obsolete reference with a new reference, and correct a typographical error. The amendments clarify current allowable and unallowable costs rules regarding where to report different types of benefits on the cost report and the definition of a passenger van. Clarifications are also being made to the process for requesting a waiver of the related party requirements for reporting costs on the cost report, the disclosure and process for requesting approval of an acceptable allocation method, and the contact for sending a request for an informal review of cost report adjustments. The proposal also specifies that the request of a waiver of the related party requirement for reporting costs on the cost report must be submitted within 45 days of the due date of the cost report. Clarifications are also being made to the definition of direct costing of certain costs on the cost report. The proposal clarifies that prior approval must be obtained to use an allocation method that is not in compliance with DHS rules. The proposal explains what is a functional allocation method. The proposal also grants a compliance period of 15 calendar days before a vendor hold can be placed for failure to submit a required cost report, and correct a typographical error regarding how often mandatory cost report training must be attended. The rules requiring completion of cost reports according to instructions and rules that differentiate between 1994, 1995, and 1996 cost reports and cost reports for 1997 and subsequent years have been deleted. The requirement that cost reports must be completed according to instructions and rules has been moved and restated without a differentiation between cost report years. The rule reference to vendor hold for the nursing facility program has been revised to a new rule reference.

Don Green, chief financial officer, has determined that for the first five-year period the sections are in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the sections.

Mr. Green also has determined that for each year of the first five years the sections are in effect the public benefit anticipated as a result of enforcing the sections will be that the rules will provide guidance to contracted providers regarding the completion of required costs reports. There will be no effect on large, small, or micro businesses, because the amendments define approval processes and cost reporting procedures, clarify allowable and unallowable costs, remove obsolete references, replace an obsolete reference, and correct a typographical error. No changes in practice are required of any business. There is no anticipated economic cost to persons who are required to comply with the proposed sections.

Under §2007.003(b) of the Texas Government Code, the department has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, the department is not required to complete a takings impact assessment regarding these rules.

Questions about the content of this proposal may be directed to Carolyn Pratt at (512) 438-4057 in DHS's Rate Analysis Division. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-148, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

The amendments are proposed under the Government Code, §531.033, which authorizes the commissioner of the Health and Human Services Commission to adopt rules necessary to carry out the commission's duties, and §531.021(b), which establishes the commission as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under Chapter 32, Human Resources Code.

The amendments implement the Government Code, §531.033 and §531.021(b).

§355.102. General Principles of Allowable and Unallowable Costs.

(a) - (c)

(No change.)

(d)

Cost report training. DHS is responsible for conducting, at no charge to the provider, comprehensive cost report training for each contracted program. Beginning with the 1997 cost reports, it is the responsibility of the provider to ensure that each preparer signing the Cost Report Methodology Certification has attended cost report training conducted by DHS. Preparers may be employees of the provider or persons who have been contracted by the provider for the purpose of cost report preparation. Preparers must attend cost report training for each program for which a cost report is submitted. Preparers must attend cost report training for two consecutive years, after which they are required to attend training on at least a biennial [ biannual ] basis. A copy of the most recent cost report training certificate for each preparer of the cost report must be submitted with each cost report. Travel costs to attend the state- sponsored cost report training are allowable within the travel limits specified in §355.103(b)(12) of this title (relating to Specifications for Allowable and Unallowable Costs). Contracted preparer's fees to attend state-sponsored cost report training are allowable.

(1) - (2)

(No change.)

(e)

(No change.)

(f)

Allowable costs. Allowable costs are expenses, both direct and indirect, that are reasonable and necessary, as defined in paragraphs (1) and (2) of this subsection, and which meet the requirements as specified in subsections (i), (j), and (k) of this section, in the normal conduct of operations to provide contracted client services meeting all pertinent state and federal requirements. Only allowable costs are included in the reimbursement determination process.

(1) - (3)

(No change.)

(4)

Indirect costs are those [ shared ] costs which benefit, or contribute to, the operation of providing contracted services, other business components, or the overall entity with which DHS has contracted. These costs could include, but are not limited to, administration salaries and nonlabor costs, building costs, insurance expense, and interest expense. Central office and/or home office administrative expenses are considered indirect costs. [ Indirect costs must be allocated, directly or as a pool of costs, across those business components sharing in the benefits of those costs. ]

(g) - (h)

(No change.)

(i)

Related party transactions.

(1) - (4)

(No change.)

(5)

An exception is provided to the general rule applicable to related organizations. The exception applies if the contracted provider demonstrates [ on each cost report ] by convincing evidence to the satisfaction of DHS that certain criteria have been met. If all of the conditions of this exception are met, then the charges by the supplier to the contracted provider for such services, equipment, facilities, leases, or supplies are allowable costs. If Medicare has made a determination that a related party situation does not exist or that an exception to the related party definition was granted, DHS will review the determination made by Medicare to determine if it is applicable to the current situation of the contracted provider and in compliance with this subsection (relating to related party transactions). In order to have the Medicare determination considered for approval by the department, a copy of the applicable Medicare determination must accompany each written exception request [ affected cost report ] submitted to the department, along with evidence supporting the Medicare determination for the current cost-reporting [ cost report ] period. If the exception granted by Medicare no longer is applicable due to changes in circumstances of the contracted provider or because the circumstances do not apply to the contracted provider, DHS may choose not to consider [ accept ] the Medicare determination. Written requests for an exception to the general rule applicable to related organizations must be submitted for approval to the Rate Analysis Department within 45 days of the due date of the cost report in order to be considered for that year's cost report. Each request must include documentation supporting that the contracted provider meets each of the four criteria listed in subparagraphs (A)-(D) of this paragraph. Requests that do not include the required documentation for each criteria will not be considered for that year's cost report. [ The contracted provider must demonstrate that the following criteria have been met. ]

(A) - (D)

(No change.)

(6) - (7)

(No change.)

(j)

Cost allocation. Direct costing must be used whenever reasonably possible. Direct costing means that allowable costs, direct or indirect, (as defined in subsection (f)(3)-(4) of this section) incurred for the benefit of, or directly attributable to, a specific business component must be directly charged to that particular business component. [ In the case of direct costs as defined in subsection (f)(3) of this section, direct costing is required. In the case of indirect costs as defined in subsection (f)(4) of this section, it is necessary to allocate these costs either directly or as a pool of costs across those business components sharing in the benefits. ] For example, the payroll costs of a direct care employee who works across cost areas within one DHS-contracted program would be directly charged to each cost area of that program based upon that employee's continuous daily time sheets and the costs of a direct care employee who works across more than one service delivery area would also be directly charged to each service delivery area based upon that employee's continuous daily time sheets.

(1)

If cost allocation is necessary for cost-reporting purposes, contracted providers must use reasonable methods of allocation and must be consistent in their use of allocation methods for cost- reporting purposes across all program areas and business entities.

(A) - (C)

(No change.)

(D)

Providers must use an allocation method approved or required by DHS. Any change in cost-reporting allocation methods from one year to the next must be fully disclosed by the contracted provider on its cost report[ , ] and must be accompanied by a written explanation of the reasons and justification for such change . [ , and must be accompanied by written prior approval from DHS's Rate Analysis Department. ] If the provider wishes to use an allocation method that is not in compliance with the cost-reporting allocation methods in paragraphs (3)-(4) of this subsection, the contracted provider must obtain written prior approval from DHS's Rate Analysis Department.

(i)

Requests for approval to use an allocation method other than those identified in paragraphs (3)-(4) of this subsection or for approval of a provider's change in cost-reporting allocation method other than those identified in paragraphs (3)-(4) of this subsection must be received by DHS's Rate Analysis Department prior to the end of the contracted provider's fiscal year. Requests for approval of allocation methods will not be acceptable as a basis for the extension of the cost report due date.

(ii)

(No change.)

(iii)

Failure to [ Providers must ] use an allocation method approved or required by DHS or to disclose a [ . A ] change in an allocation [ must be disclosed ] to DHS will result in the following .

(I) - (II)

(No change.)

[ (E) ]

[ Any new contracted provider submitting its first cost report must have its cost-reporting allocation methods approved by the DHS's Rate Analysis Department prior to submitting its first cost report. Submittal of a cost report for a new contracted provider without an approved allocation method is considered a failure to file a completed cost report in accordance with §355.105(b)(4)(C) of this title (General Reporting and Documentation Requirements, Methods, and Procedures). ]

[ (i) ]

[ Requests for approval of a new provider's cost report allocation methods must be received by the Rate Analysis Department 60 days prior to the due date of the cost report. Requests for approval of allocation methods will not be acceptable as a basis for the extension of the cost report due date. ]

[ (ii) ]

[ The Rate Analysis Department will forward its written decision to the contracted provider within 45 days of its receipt of the provider's original written request. If sufficient documentation is not provided by the provider to verify the acceptability of the allocation method, then DHS may extend the decision time frame. However, an extension of the due date of the cost report will not be granted. Written decisions made on or after the due date of the cost report will apply to the next year's cost report. A contracted provider may request an informal review, and subsequently an appeal, of a decision concerning its allocation methods in accordance with §355.110 of this title (relating to Informal Reviews and Formal Appeals). ]

(2)

(No change.)

(3)

When a building is shared and the building usage is separate and distinct for each entity using the building, the building costs, identified as building and facility cost categories on the cost report [ such as rent, depreciation, utilities, maintenance, and insurance ], should be allocated based upon square footage and may not be allocated with other indirect costs as a pool of costs. When the same building space is shared by various entities, the shared building costs, identified as building and facility cost categories on the cost report [ such as rent, depreciation, utilities, maintenance, and insurance ], should be allocated using a reasonable method which reflects the actual usage, such as an allocation based on time in shared activity areas or a functional study of shared dietary costs related to [ meals served in ] shared dining and kitchen areas.

(4)

Where costs are shared, are not directly chargeable and are allocated as a pool of costs, the following allocation methods are acceptable for cost-reporting purposes.

(A) - (B)

(No change.)

(C)

If a contracted provider's business components are mixed, with some being labor-intensive and others having a programmatic residential or institutional component, the contracted provider must allocate its indirect costs requiring allocation as a pool of costs either:

(i)

based upon the ratio of each business component's total costs less that business component's facility or building costs, as related to the contracted provider's total business component costs less facility or building costs for all the contracted provider's business components , with "facility or building costs" referring to those cost categories as identified on the cost report ; or

(ii)

(No change.)

(D)

In order to achieve a more accurate and representative reporting of costs than results from allocating shared indirect costs as a pool of costs, a provider may choose to allocate its indirect shared expenses on an appropriate and reasonable [ a ] functional basis. If allocating shared direct client care costs, a provider may use an appropriate and reasonable functional method. For example, costs of a central payroll operation could be allocated to all business components based on the number of checks issued; the costs of a central purchasing function could be allocated based on the number [ dollar amount ] of purchases made or requisitions handled; payroll costs for an administrative employee working across business components could be directly charged [ allocated ] based upon that employee's time sheets and/or allocated based upon a documented time study; food costs could be allocated based upon a functional study of shared dietary costs [ the number of meals served ]; transportation equipment costs could be allocated based upon mileage logs; and shared laundry costs could be allocated based upon a functional study of the number of pounds/loads of laundry processed. Providers choosing to allocate allowable employee-related self-insurance paid claims in accordance with §20.103(b)(10)(B)(ii) of this title relating to General Principles of Allowable and Unallowable Costs) should base the allocation on percentage of salaries of employees benefiting from the coverage for fully self-insured situations or on percentage of premiums of covered employees for partially self-insured situations since purchased premiums must be directly charged.

(E)

(No change.)

(k)

(No change.)

§355.103. Specifications for Allowable and Unallowable Costs.

(a)

(No change.)

(b)

Allowable and unallowable costs.

(1)

Compensation of employees. Compensation includes both cash and non-cash forms of compensation subject to federal payroll tax regulations. Compensation includes wages and salaries (including bonuses); payroll taxes and insurance; and [ fringe ] benefits. Payroll taxes and insurance include Federal Insurance Contributions Act (old age, survivors, and disability insurance (OASDI) and Medicare hospital insurance); Unemployment Compensation Insurance; and Workers' Compensation Insurance.

(A)

Allowable compensation of employees is compensation paid to employees in arm's-length transactions as nonowners and non-related parties and is subject to the reasonable and necessary costs which must be incurred by providers in the provision of contracted client services. Guidelines for compensation of owners and related parties are specified in paragraph (2) of this subsection.

(i) - (ii)

(No change.)

(iii)

Benefits [ Fringe benefits ] are amounts paid to or on behalf of an employee, in addition to direct salary or wages, and from which the employee, his dependent, or his beneficiary derives a personal benefit before or after the employee's retirement or death.

(I)

Benefits [ Fringe benefits ] paid to employees in arm's length transactions as nonowners and non-related parties are allowable costs, subject to the reasonable and necessary costs which must be incurred by providers in the provision of contracted client care. To be allowable, [ fringe ] benefits paid to owners and/or related parties must not discriminate in favor of certain employees, such as employees who are officers, stockholders, or the highest paid individual(s) of the organization.

(II)

Allowable [ fringe ] benefits are reported on cost reports either as salaries and/or wages, as employee benefits, or as costs applicable to specific cost [ areas ] report line items, as specified in this subclause and in subclause (iii) of this clause . Any [ fringe ] benefit subject to payroll taxes is reported as salaries [ salary ] and wages. Allowable [ fringe ] benefits which are routinely reported as salaries and wages include paid vacations, paid holidays, sick leave, voting leave, court or jury duty leave, and/or all- inclusive paid days, as specified in subclause (III)(-c-) of this clause. Allowable [ fringe ] benefits which are routinely reported as employee benefits include employer contributions to certain deferred compensation plans, as specified in subclause (III)(-a-) of this clause, employer contributions to an employee retirement fund or certain pension plans, as specified in subclause (III)(-b-) of this clause, and costs of certain employer-paid health, life, and disability insurance premiums, as specified in subclause (III)(-f-) of this clause. The contracted provider's unrecovered cost of meals and room and board furnished to direct care employees , uniforms, employee personal vehicle mileage reimbursement in accordance with paragraph (12) of this subsection, job-related training reimbursements in accordance with paragraph (12) of this subsection, and job certification renewal fees in accordance with paragraph (12) of this subsection are not to be reported as [ are fringe ] benefits but [ which ] are to be reported as costs applicable to specific cost report line items, [ areas, as specified in subclause (III)(-e-) of this clause ], unless they are subject to payroll taxes, whereas they are reported as salaries and wages.

(III)

Benefits [ Fringe benefits ] include the following:

(-a-)

Employer contributions to certain deferred compensation plans are reported as employee benefits . Deferred compensation is remuneration currently earned by an employee but which is not received until a subsequent period, usually after retirement. For the cost to be allowable, the deferred compensation plan must be formal, established, and maintained by the contracted provider and communicated to all eligible employees. A formal plan is one that is provided for in a written agreement executed between the contracted provider and the participating employees. The plan must:

(-1-) - (-7-)

(No change.)

(-b-)

Employer contributions to an employee retirement fund or certain pension plans are reported as employee benefits . A pension plan is a type of deferred compensation plan which is established and maintained by the employer to provide systematic payment of definitely determinable benefits to its employees over a period of years, or for life, after retirement. Such a plan may include disability, withdrawal, option for lump-sum payment, or insurance or survivorship benefits incidental and directly related to the pension benefits. A pension plan must meet all the requirements of a deferred compensation plan. All employees' pension fund rights must be nonforfeitable after such time as they vest under the plan. Pension fund rights cannot be contingent on continuance of employment or other factors. Only the amount the contracted provider or employer contributed to the pension fund during the reporting period is allowable and should be reported as an employee benefit. To be allowable, contributions representing the employee's share cannot revert to the contracted provider. However employer-paid contributions can revert to the contracted provider in the event an employee does not vest.

(-c-)

Paid leave is reported as salaries or wages . Paid vacations, paid holidays, sick leave, voting leave, court or jury duty leave, and/or all-inclusive paid days, all are reported as employee salaries and/or wages rather than as employee benefits, as follows:

(-1-) - (-3-)

(No change.)

(-d-)

Provider-paid instructional courses benefiting the employer's [ employee's ] interest are not to be reported as employee benefits, but are to be reported as costs related to specific cost report line items . Costs related to provider-paid instructional courses for the benefit of the employee only are unallowable costs. Refer to paragraph (12)(A) of this subsection, concerning staff training costs.

(-e-)

Contracted provider's unrecovered cost of meals and room and board furnished on-site to direct care employees are not to be reported as employee benefits, but are to be reported as costs related to specific cost report line items . Any reasonable unrecovered cost of meals and/or room and board furnished on-site by a contracted provider to its direct care employees, which are equivalent to the meals and/or room and board provided to clients, are allowable costs since they are related to client care in that such reasonable costs are appropriate and helpful in developing and maintaining the contracted provider's operations to deliver contracted services. Such allowable costs should be reported in the cost area where the costs were incurred, such as meal costs being reported in the cost area associated with food and meal preparation and room and/or board costs being reported in the cost area associated with building costs.

(-f-)

Costs of health, disability and life insurance premiums paid or incurred by the contracted provider if the benefits of the policy are payable to the employee or his beneficiary are reported as employee benefits . Report allowable health, disability, and life insurance premium costs as employee benefits. Refer to paragraph (10) of this subsection, concerning insurance expense.

(B)

(No change.)

(2)

Compensation of owners and related parties. Compensation includes both cash and non-cash forms of compensation subject to federal payroll tax regulations. Compensation includes withdrawals from an owner's capital account; wages and salaries (including bonuses); payroll taxes and insurance; and [ fringe ] benefits. Payroll taxes and insurance include Federal Insurance Contributions Act (old age, survivors, and disability insurance (OASDI) and Medicare hospital insurance); Unemployment Compensation Insurance; and Workers' Compensation Insurance. Allowable compensation must be reported as salaries and not as management fees.

(A) - (E)

(No change.)

(3) - (6)

(No change.)

(7)

Depreciation and amortization expense. For purchases made after the beginning of the contracted provider's fiscal year 1997, an asset valued at $1,000 or more and with an estimated useful life of more than one year at the time of purchase must be depreciated or amortized, using the straight line method. In determining whether to expense or depreciate a purchased item, a contracted provider may expense any single item costing less than $1,000 or having a useful life of one year or less. Depreciation and amortization expenses for unallowable assets and costs are also unallowable, including amounts in excess of those resulting from the straight line method, capitalized lease expenses in excess of actual lease payments, and goodwill or any excess above the actual value of physical assets at the time of purchase. The minimum useful lives to be assigned to common classes of depreciable property are as follows:

(A) - (B)

(No change.)

(C)

Transportation equipment used for the transport of clients, staff, or materials and supplies utilized by the contracted provider. Cost reporting must reflect a minimum of three years for automobiles (including minivans); five years for light trucks and vans (up to and including 15-passenger vans) ; and seven years for buses and airplanes. Depreciation expenses for transportation equipment not generally suited or not commonly used to transport clients, staff, or provider supplies are unallowable costs. This includes motor homes and recreational vehicles; sports automobiles; motorcycles; heavy trucks, tractors and equipment used in farming, ranching, and construction; and transportation equipment used for other activities unrelated to the provision of contracted client care, unless program-specific reimbursement methodology rules provide otherwise. Refer to §355.105(b)(2)(B)(iii) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures) for requirements for the maintenance of mileage logs and other documentation required to substantiate transportation equipment costs.

(i)

Luxury automobiles are defined for cost-reporting purposes as passenger vehicles, including automobiles, light trucks, and vans (up to and including 15-passenger vans) and excluding buses, with an historical cost at time of purchase or a market value at execution of the lease exceeding $30,000 when purchased or leased before January 1, 1997. For vehicles leased or purchased on or after January 1, 1997, luxury vehicles are defined as a base value of $30,000 with 2.0% being added (using the compound method) to the base value each January 1 beginning on January 1, 1998. Any amount above the definition of a luxury vehicle stated above is an unallowable cost. When a passenger vehicle's cost exceeds the amount determined by the definition of a luxury vehicle stated above, the historical cost is reduced to the amount determined by the definition of a luxury vehicle. When a passenger vehicle's market value at the execution of the lease exceeds the amount determined by the definition of a luxury vehicle stated above, the allowable lease payment is limited to the lease amount for a vehicle with the base value as determined above, with substantiating documentation as specified in §355.105(b)(2)(B)(iv) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures). Luxury vehicles must be depreciated according to depreciation guidelines in this paragraph. Expenses for passenger luxury vehicles will be allowable if the contracted provider maintains adequate mileage logs substantiating the use of the luxury vehicles to transport clients, contracted provider staff or provider supplies. Refer to §355.105(b)(2)(B)(iii) of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures) for requirements for the maintenance of mileage logs. The base value does not include specialized equipment, such as wheelchair lifts, added to assist clients.

(ii) - (iii)

(No change.)

(D) - (F)

(No change.)

(8) - (18)

(No change.)

§355.105. General Reporting and Documentation Requirements, Methods, and Procedures.

(a)

(No change.)

(b)

Cost report requirements. Unless specifically stated in program rules, each provider must submit financial and statistical information on cost report forms provided by DHS, or on facsimiles which are formatted according to DHS specifications and are pre-approved by DHS staff, or electronically in DHS-prescribed format in programs where these systems are operational. The cost reports must be submitted to DHS in a manner prescribed by DHS. The cost reports must be prepared to reflect the activities of the provider while delivering contracted services during the fiscal year specified by the cost report. Cost reports or other special surveys or reports may be required for other periods at the discretion of DHS. Each provider is responsible for accurately completing any cost report or other special survey or report submitted to DHS.

(1)

(No change.)

(2)

Recordkeeping and adequate documentation. There is a distinction between noncompliance in recordkeeping, which equates with unauditability of a cost report and constitutes an administrative contract violation or, for nursing facilities, may result in vendor hold, and a provider's inability to provide adequate documentation, which results in disallowance of relevant costs. Each is discussed in the following paragraphs.

(A)

(No change.)

(B)

Adequate documentation. To be allowable, the relationship between reported costs and contracted services must be clearly and adequately documented. Adequate documentation consists of all materials necessary to demonstrate the relationship of personnel, supplies, and services to the provision of contracted client care or the relationship of the central office to the individual service delivery entity level. These materials may include, but are not limited to, accounting records, invoices, organizational charts, functional job descriptions, other written statements, and direct interviews with staff, as deemed necessary by DHS auditors to perform required tests of reasonableness, necessity, and allowability. For the 1997 cost report only, DHS will accept documentation to retrospectively support expenses which were incurred in the provider's 1997 fiscal year prior to the adoption of these rules and reported on the provider's 1997 cost report.

(i) - (x)

(No change.)

(xi)

Regarding compensation of owners and related parties, providers must maintain the following documentation, at a minimum, for each owner or related party: a detailed written description of actual duties, functions, and responsibilities; documentation substantiating that the services performed are not duplicative of services performed by other employees; time sheets or other documentation verifying the hours and days worked; the amount of total compensation paid for these duties, with a breakdown detailing regular salary, overtime, bonuses, [ fringe ] benefits, and other payments; documentation of regular, periodic payments and/or accruals of the compensation, documentation that the compensation is subject to payroll or self-employment taxes; and a detailed allocation worksheet indicating how the total compensation was allocated across business components receiving the benefit of these duties.

(I)

(No change.)

(II)

Regarding [ fringe ] benefits provided to owners and related parties, the provider must maintain clearly defined benefit policies in its written agreements with employees or in its overall employment policy. At a minimum, the documentation must include the basis for eligibility for each type of [ fringe ] benefit available, who is eligible to receive each type of [ fringe ] benefit, who actually receives each type of [ fringe ] benefit, whether the persons receiving each type of benefit are owners, related parties, or arm's-length employees, and the amount of each [ fringe ] benefit received by each individual.

(xii)

Regarding all forms of compensation, providers must maintain documentation for each employee which clearly identifies each compensation component, including regular pay, overtime pay, incentive pay, mileage reimbursements, bonuses, sick leave, vacation, other paid leave, deferred compensation, retirement contributions, provider-paid instructional courses, health insurance, disability insurance, life insurance, and any other form of compensation. Types of documentation would include insurance policies; provider benefit policies; records showing paid leave accrued and taken; documentation to support hours (regular and overtime) worked and wages paid; and mileage logs or other documentation to support mileage reimbursements and travel allowances. For accrued [ fringe ] benefits, the documentation must clearly identify the period of the accrual. For example, if an employee accrues two weeks of vacation during 19x1 and receives the corresponding vacation pay during 19x3, that employee's compensation documentation for 19x3 should clearly indicate that the vacation pay received had been accrued during 19x1.

(xiii) - (xx)

(No change.)

(3) - (6)

(No change.)

(c) - (h)

(No change.)

§355.106. Basic Objectives and Criteria for Audit and Desk Review of Cost Reports

(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).

§355.110. Informal Reviews and Formal Appeals.

(a)

General provisions.

(1) - (2)

(No change.)

(3)

Subject matter of informal reviews and formal appeals. An interested party may request an informal review or formal appeal [ as follows: ]

[ (A)

For cost reports pertaining to providers' fiscal years 1994, 1995 and 1996, related to a DHS action or determination regarding desk review or field audit exclusions or adjustments, taken specifically in regard to the interested party.]

[ (B) ]

[ For cost reports pertaining to providers' fiscal years ending in calendar year 1997 and subsequent years, ] regarding a DHS action or determination under §355.102 of this title (relating to General Principles of Allowable and Unallowable Costs), §355.103 of this title (relating to Specifications for Allowable and Unallowable Costs), §355.104 of this title (relating to Revenues), and §355.105 (relating to General Reporting and Documentation Requirements, Methods and Procedures), or program-specific allowable or unallowable costs, taken specifically in regard to the interested party.

(b)

(No change.)

(c)

Informal review.

(1)

An interested party who disputes a DHS action or determination under this chapter may request an informal review under this section. The purpose of an informal review is to provide for the informal and efficient resolution of the matters in dispute. An informal review is not a formal administrative hearing, but is a prerequisite to obtaining a formal administrative hearing and is conducted according to the following procedures:

(A)

The interested party must contact the Rate Analysis Department [ commissioner of DHS ] in writing by U.S. mail or special mail delivery within 20 calendar days of the date on DHS's written notification of the exclusions or adjustments to request an informal review.

(B)

(No change.)

(2)

(No change.)

(d)

(No change.)

§355.111. Administrative Contract Violations.

The Texas Department of Human Services (DHS) may take the following actions for administrative contract violations.

(1)

DHS grants the following compliance periods for administrative contract violations:

(A)

For failure to submit a cost report by the due date, DHS grants the provider a compliance period of no more than 15 calendar days.

(B)

For all other administrative contract violations,

[ (1) ]

DHS grants the provider a compliance period of no more than 30 calendar days to correct a contract violation. At the end of the compliance period, if DHS determines that a contract violation is not corrected, but determines that the provider has made substantial progress toward correcting the contract violation, DHS may grant an additional one-time extension period of up to 15 calendar days.

(2) - (3)

( No change.)

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


Subchapter F. GENERAL REIMBURSEMENT METHODOLOGY FOR ALL MEDICAL ASSISTANCE PROGRAMS

1 TAC §355.731, §355.744

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Health and Human Services Commission or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Health and Human Services Commission (THHSC) proposes the repeals of §355.731 and §355.744 of Chapter 355, Medicaid Reimbursement Rates, Subchapter F, governing general reimbursement methodology for all medical assistance programs.

Section 355.731 is proposed for repeal because it conflicts with 25 TAC §419.666 (relating to Provider Reimbursement), which was adopted to be effective March 1, 2000. Section 355.744 (relating to Right to Appeal) is proposed for repeal because provisions regarding fair hearings for Medicaid recipients of service coordination (previously referred to as case management) are described in 25 TAC §412.464.

Don Green, chief financial officer, has determined that for each year of the first five years the proposed repeals are in effect enforcing or administering the rules does not have foreseeable implications relating to cost or revenues of the state or local governments.

Don Green has also determined that for each year of the first five years the proposed repeals are in effect the public benefit expected is the elimination of unnecessary rules. It is anticipated that there would be no additional economic cost to persons required to comply with the proposed rules.

It is anticipated that the proposed repeals will not affect a local economy.

It is anticipated that the proposed repeals will not have an adverse economic effect on small businesses or micro-businesses.

Comments on the proposal may be submitted to Linda Logan, director, Policy Development, Texas Department Mental Health and Mental Retardation, P.O. Box 12668, Austin, TX 78711-2668, within 30 days of publication of this notice.

The repeals are proposed under the Texas Government Code, §531.033, which provides the commissioner of THHSC with broad rulemaking authority; the Texas Human Resources Code, §32.021, and the Texas Government Code, §531.021(a), which provide THHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and the Texas Government Code, §531.021(b), which provides THHSC with the authority to adopt rules governing the determination of Medicaid rates.

The proposal affects the Texas Human Resources Code, §32.021, and the Texas Government Code, §531.021(a), and §531.033.

§355.731.Provider Claims Payment.

§355.744.Right to Appeal.

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 29, 2000.

TRD-200002266

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) 206-5216