TITLE 1.ADMINISTRATION

Part 3. OFFICE OF THE ATTORNEY GENERAL

Chapter 66. FAMILY TRUST FUND DISBURSEMENT PROCEDURES

The Office of the Attorney General (OAG) proposes new Chapter 66, Family Trust Fund Disbursement Procedures, Subchapter A,§§66.1, 66.3, 66.5, 66.7, and 66.9; Subchapter B, §§66.15, 66.17, 66.19, 66.21, and 66.23; Subchapter C, §§66.31, 66.33, 66.35, 66.37, 66.39, 66.41, 66.43, 66.45, and 66.47; Subchapter D, §§66.55, 66.57, and 66.59; Subchapter E, §§66.67, 66.69, 66.71, 66.73, 66.75, 66.77, 66.79, 66.81, 66.83, 66.85, 66.87, 66.89, 66.91, 66.93, 66.95, 66.97, 66.99, 66.101, 66.103, 66.105, 66.107, 66.109, and 66.111; and Subchapter F, §§66.119, 66.121, and 66.123 relating to rules for disbursement of funds and administration of grants and contracts under the Family Trust Fund. This chapter proposes implementation of new rules necessary to carry out the provisions of the Texas Family Code, Chapter 2, The Marriage Relationship, §2.014, Family Trust Fund (West 1999), which provides funds for programs that assist families. Texas Family Code, §2.014 reflects the 76 th Legislature's intent to provide public funds for the following purposes: (1) the development and distribution of a premarital education handbook; (2) grants to institutions of higher learning that conduct research on marriage and divorce to strengthen families and assist children whose parents are divorcing; (3) support for counties to create or administer free or low- cost premarital education courses; (4) programs that intend to reduce the amount of delinquent child support; and (5) other programs the OAG determines will assist families.

Pursuant to Texas Local Government Code §118.013(c) each county clerk shall remit $3 of the fee for a marriage license to the comptroller for deposit in the Family Trust Fund. Pursuant to Texas Family Code §2.014 the OAG shall administer the funds for the statutory beneficiaries; therefore, it is necessary for the OAG to adopt rules outlining the procedure for disbursement of the funds in a fair and accurate manner. The rules will also cover the application process; the manner of awarding funding; the administration of the fund; individual program monitoring; and audits. This proposed chapter establishes procedures by which entities may apply for and receive grants, or contracts as appropriate, and implement programs which meet the statutory requirements of Texas Family Code §2.014. The rules are also intended to advise the public of the independent functions the OAG has regarding administration of the Family Trust Fund.

Proposed Chapter 66 is organized into six subchapters. Proposed Subchapter A (General Provisions and Eligibility, §§66.1, 66.3, 66.5, 66.7, and 66.9) contains general provisions of Chapter 66, including definitions, statutory authority for the trust fund, source of the trust fund, prohibitions related to the use of the trust fund, and eligibility requirements. Proposed §66.1 provides the definitions of terms. Proposed §66.3 states the statutory authority for the creation of the trust fund and recognizes the authority of the OAG to administer the trust fund. Proposed §66.5 relates the purpose of the trust fund. Proposed §66.7 describes eligible projects for which the trust fund may be used. Proposed §66.9 defines the class of persons and entities eligible to apply for the trust fund.

Proposed Subchapter B (Grant Application, Scope of Grant, Approval, and Funding, §§66.15, 66.17, 66.19, 66.21, and 66.23) describes the application process, including the requirement of a timely-filed application, OAG review criteria, discretionary determination of funding by the OAG, and nonstandard funding. This subchapter also declares that the actual funding of approved new and existing grant projects is contingent upon the availability of funds. Proposed §66.15 provides that applicants must complete and submit an application package to the OAG Grant Coordinator. Proposed §66.17 discusses the OAG's approval process in determining how to disburse the trust fund. Proposed §66.19 defines the grant or contract funding period and criteria for awarding second-year funding. Proposed §66.21 provides for approval of nonstandard grant funding outside the annual grant cycle based on the availability of funds. Proposed §66.23 declares that actual funding of approved new and existing grant projects is contingent upon availability of funds.

Proposed Subchapter C (Special Conditions and Required Documents, §§66.31, 66.33, 66.35, 66.37, 66.39, 66.41, 66.43, 66.45, and 66.47) addresses documents that applicants are required to submit to the OAG to demonstrate that they will follow operating procedures consistent with state and federal law. Proposed §66.31 relates to an Equal Employment Opportunity Program Certification. Proposed §66.33 relates to a Certification Regarding Lobbying. Proposed §66.35 relates to a Nonprocurement Debarment Certification. Proposed §66.37 relates to a Drug-Free Workplace Certification. Proposed §66.39 relates to a Uniform Grants Management Standards Certification. Proposed §66.41 relates to a Certified Assurances Certification. Proposed §66.43 discusses that pre-approval of the OAG is required for grantees to use grant funds to purchase equipment with a cost exceeding $25,000 and establishes the process and documentation necessary for such pre-approval. Proposed §66.45 advises that prior to execution of any contract in excess of $25,000, a grantee must submit said contract and required documentation along with the criteria and process the grantee is considering for entering into contracts. Proposed §66.47 requires that governmental entities and nonprofit organizations who designate someone other than the executive officer of the governmental entity in the grant application must obtain a resolution from its governing body that gives the authorized official the power to accept, reject, or amend a grant. The resolution must state that a security bond will be obtained and in the event grant funds are misused, the grant funds will be returned in full. In addition, the resolution must contain non-supplanting language.

Proposed Subchapter D (Award and Grant Acceptance, §§66.55, 66.57, and 66.59) sets forth the process for the award and acceptance of grants. Proposed §66.55 announces the process for notification of an award of grant funds. This section also sets forth the OAG's full discretion in approving project funding and determining grantee compliance with OAG policies. Proposed §66.57 outlines procedures for an applicant's response to deficiencies in a filed application. Proposed §66.59 describes the process an applicant may pursue in the event that the OAG denies all or part of an application and sets forth the final decision-making authority of the OAG.

Proposed Subchapter E (Administering Grants, §§66.67, 66.69, 66.71, 66.73, 66.75, 66.77, 66.79, 66.81, 66.83, 66.85, 66.87, 66.89, 66.91, 66.93, 66.95, 66.97, 66.99, 66.101, 66.103, 66.105, 66.107, 66.109, and 66.111) proposes rules for the administration of the grants. The rules establish duties and responsibilities for grant officials, requirements regarding records, procedures to requests funds, grant adjustments, copyrights, procurement procedures, and rules relating to property management, bonding, and insurance. This proposed subchapter addresses OAG authority to withhold funds or terminate a grant under certain conditions and a grantee's ability to request a reconsideration of a decision to withhold funds or determinate a grant project. This proposed subchapter also contains procedures for grantee self-evaluation of a project, submission of regular progress reports to the OAG, evaluation of third party contracts, if any, and winding up a grant administration.

Proposed §66.67 requires that each grantee designate three grant officials whose duties are described in the section. Proposed §66.69 advises that OAG approval is required if grant funds are obligated prior to the start date or later than the end date of the grant period. Proposed §66.71 sets forth grant records retention requirements and provides for availability of the records in an electronic format for purposes of audit. Proposed §66.73 specifies that the grantee must file financial expenditure reports each calendar quarter on forms promulgated by the OAG and sets forth the consequences for failing to file a timely report. Proposed §66.75 mandates that the grantee maintain an inventory report on file in the principal office of the grantee. Proposed §66.77 establishes time limits for filing a final request for funds and the consequences for failure to submit accurate reports in a timely manner. Proposed §66.79 describes procedures for submitting a request for a grant adjustment. Proposed §66.81 establishes the OAG's claim to a license to use copyrighted material where the purchase of such copyright was funded in any part by OAG funds. Proposed §66.83 governs procurement procedures, including OAG review and approval, to be used by a grantee who purchases equipment or professional or consultant services in excess of $25,000.

Proposed §66.85 establishes the Uniform Grant Management Standards published by the Governor's Office of Budget and Planning as the governing property management standard for a grantee. Proposed §66.87 provides guidance regarding equipment disposition methods where a grantee who has purchased equipment in whole or in part with OAG funds is no longer funded by the OAG. Proposed §66.89 provides guidance regarding the transfer of title to equipment and nonexpendable personal property acquired with grant funds. Proposed §66.91 sets forth a grantee's bonding and insurance requirements.

Proposed §66.93 addresses the OAG's authority and discretion to withhold funds from a specific project or from all projects operated by a grantee if any of the enumerated conditions or situations occur and a describes a grantee's ability to request a reconsideration of an OAG decision to withhold funds. Proposed §66.95 outlines the procedure regarding cancellation or termination of a grant, the consequences of such action, and a grantee's ability to request a reconsideration of an OAG decision to terminate a grant project.

Proposed §66.97 sets forth the requirements for de-obligation of grant funds at the end of the funding period and provides for final expenditure reports to be submitted within a certain time limit. Proposed §66.99 requires the grantee to obligate and expend all outstanding liabilities within certain specified time frames. Proposed §66.101 requires the grantee and its personnel to report immediately to the OAG and the local prosecuting attorney's office upon discovery of any violation of the law pertaining to the use and expenditure of grant funds. Proposed §66.103 contains a prohibition against behavior constituting a conflict of interest on the part of any person affiliated with the grant project. Proposed §66.105 imposes contract monitoring and self-evaluation requirements on a grantee. In this section, the OAG seeks to ensure that a grantee takes a sustained, active role in assessing actual delivery of service to victims of crime through the grant project. Proposed §66.107 imposes the requirement for filing timely complete progress reports. Proposed §66.109 requires that a grantee who uses grant funds to contract with a third party must maintain proper records to ensure that requirements of the contract are met. Proposed §66.111 establishes the requirement for accuracy of grant records and sets forth the consequences for providing false information.

Proposed Subchapter F ( Program Monitoring and Audits, §§66.119, 66.121, and 66.123) contains provisions concerning OAG monitoring activities, compliance reviews, and auditing authority and standards, as well as procedures for appealing OAG decisions relating to audit findings.

Proposed §66.119 explains that OAG monitoring will attempt to ensure that a grantee is achieving grant performance goals and that grant awards are used in accordance with applicable laws, rules, and grant agreements. Proposed §66.121 requires a grantee to file independent annual audits in accordance with Uniform Grant Management Standards and Generally Accepted Auditing Standards. Proposed §66.123 contains guidance as to the substance of OAG reviews and the substance of required annual audits.

Beth Page, Assistant Attorney General, General Counsel Division, has determined that for each year of the first five years that the proposed rules are in effect:

A. the additional estimated cost to the state expected as a result of enforcing or administering the rules will be zero because the rules impose no additional burden on anyone;

B. the estimated reductions in costs to the state and to local governments as a result of enforcing or administering the rules will be zero because the rules impose no additional burden on anyone; and

C. the estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the rules will be zero because the rules impose no additional burden on anyone.

Ms. Page has determined that for the first five-year period in which the proposed rules are in effect, the anticipated public benefit will be the administration of the Family Trust Fund program by the OAG, as mandated by the Texas Legislature, without increased costs to the state. The proposed rules will enable direct service providers of programs that assist families to apply for and receive trust fund monies to provide those services.

Ms. Page has also determined there will be no direct adverse effect on small businesses or micro-businesses because these rules apply neither to single businesses nor to micro-businesses.

Ms. Page further determined there will be no economic cost to persons required to comply with the rule.

Comments may be submitted, in writing, no later than 30 days from the date of this publication to Beth Page, Assistant Attorney General, General Counsel Division, OAG, (512) 463-0286, P.O. Box 12548, Austin, Texas 78711-2548 or by e-mail to beth.page@oag.state.tx.us.

Subchapter A. GENERAL PROVISIONS AND ELIGIBILITY

1 TAC §§66.1, 66.3, 66.5, 66.7, 66.9

Chapter 66 is proposed under the Texas Family Code §2.014, which the OAG interprets as authorizing the OAG to adopt rules reasonable and necessary to implement §2.014, in order to provide funds for grants or contracts that support services that assist families.

The proposed new chapter affects Texas Family Code §2.014.

§66.1.Definitions.

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

(1)

GAAS--Generally Accepted Auditing Standards;

(2)

OAG--Office of the Attorney General;

(3)

UGMS--Uniform Grant Management Standards published by the Governor's Office of Budget and Planning;

(4)

FTFG--Family Trust Fund Grant;

(5)

RFP--Request for Proposal;

(6)

IFB--Invitation for Bid;

(7)

HUB--Historically Underutilized Businesses.

§66.3.Source of Funds.

The Family Trust Fund was created by Texas Family Code §2.014 as a trust fund with the state comptroller to be administered by the OAG for the beneficiaries of the fund. Each county clerk of Texas is required to collect $30 of each marriage license issued and to remit $3 of that fee to the comptroller for deposit in the Family Trust Fund. The funds shall be deposited with the State Comptroller's Office in the Family Trust Fund.

§66.5.Purpose of Funds.

The purpose of the Family Trust Fund is to provide funds for programs that provide premarital education, strengthen families, reduce the amount of delinquent child support, and assist families.

§66.7.Eligible Projects.

Grants or contracts awarded under this chapter may be used to fund:

(1)

projects that will assist in the development and distribution of a premarital education handbook;

(2)

projects in institutions of higher education that will assist in developing programs, courses, and policies to help strengthen families and assist children whose parents are divorcing;

(3)

projects in counties that will administer free or low-cost premarital education courses;

(4)

programs that are intended to reduce the amount of delinquent child support; and

(5)

any other program that the OAG determines will assist families in this state.

§66.9.Eligible Applicants.

The entities that are eligible to apply for Family Trust Fund monies are :

(1)

institutions of higher education having academic departments that are capable of research on marriage and divorce that will assist in determining programs, courses, and policies to help strengthen families and assist children whose parents are divorcing;

(2)

counties that are creating and administering free or low cost premarital education courses;

(3)

programs that are intended to reduce the amount of delinquent child support; and

(4)

any other programs that the OAG determines will assist families in this state.

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 April 12, 2001.

TRD-200102109

Susan D. Gusky

Assistant Attorney General

Office of the Attorney General

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 463-2110


Subchapter B. GRANT APPLICATION, SCOPE OF GRANT, APPROVAL AND FUNDING

1 TAC §§66.15, 66.17, 66.19, 66.21, 66.23

Chapter 66 is proposed under the Texas Family Code §2.014, which the OAG interprets as authorizing the OAG to adopt rules reasonable and necessary to implement §2.014, in order to provide funds for grants or contracts that support services that assist families.

The proposed new chapter affects Texas Family Code §2.014.

§66.15.Grant or Contract Application.

(a)

An applicant for a grant under this chapter must complete and submit a grant application package to the OAG Grant Coordinator, 300 West 15th Street, 15th Floor, P.O. Box 12548, Austin, Texas 78711-2548. An applicant may contact the OAG by telephone (512-463-0192) or in writing for information about application requirements and for application packages.

(b)

The original and one copy of the application package must be received by the OAG by the first business day in May of each year. Applications received after the deadline for submission will not be considered. This deadline does not apply to applications received in the FY 2001.

(c)

An applicant for a contract under this chapter must submit a request in writing to the OAG Grant Coordinator, 300 West 15th Street, 15th Floor, P.O. Box 12548, Austin, Texas 78711-2548. An applicant may contact the OAG by telephone (512-463-0192) or in writing for information about the application process.

§66.17.Approval of Grants or Contracts.

The OAG will review and evaluate each timely application. The OAG has full discretion in making all funding decisions. The OAG will base award decisions on an applicant's eligibility, cost effectiveness of the proposed grant or contract, and the service needs within the geographic area of an applicant. Award decisions by the OAG are final and not subject to judicial review.

§66.19.Grant or Contract Period.

(a)

A project will be funded for a 12-month period, beginning no earlier than September 1 of each year, and ending August 31 of each year. This funding period does not apply to applications received for projects in the FY 2001.

(b)

The maximum number of years that a project may be funded is two years.

(c)

An applicant may submit a single application for funding for a two year period. If the application is approved, the project will be funded for the first year and will receive automatic consideration for second year funding. No additional application will be required for the second year, but the OAG may require a grantee to submit updated attachments, contracts, bonds, resolutions, and other information as necessary. The OAG will base its final decision on second year funding on first year performance, including the timeliness and thoroughness of reporting, the success of the project in meeting its goals, and the outcome of OAG on-site visits.

§66.21.Nonstandard Funding.

The OAG may fund projects, upon application, outside of the annual grant or contract cycle or at amounts higher or lower than provided for in this chapter based on availability of funds and a particularized need, consistent with the Texas Family Code, §2.014.

§66.23.Continuation of Funding.

There is no commitment by the OAG that a grant, once funded, will receive subsequent funding, or that a contract, once funded, will receive subsequent renewal. To qualify for continuation of funding for existing projects, applicants must meet all requirements of this chapter and have a history of timely submission of progress and financial reports. Continuation of funding of new and existing projects is also contingent upon the availability of funds.

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 April 12, 2001.

TRD-200102110

Susan D. Gusky

Assistant Attorney General

Office of the Attorney General

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 463-2110


Subchapter C. SPECIAL CONDITIONS AND REQUIRED DOCUMENTS

1 TAC §§66.31, 66.33, 66.35, 66.37, 66.39, 66.41, 66.43, 66.45, 66.47

Chapter 66 is proposed under the Texas Family Code §2.014, which the OAG interprets as authorizing the OAG to adopt rules reasonable and necessary to implement §2.014, in order to provide funds for grants or contracts that support services that assist families.

The proposed new chapter affects Texas Family Code §2.014.

§66.31.Equal Employment Opportunity Program Certification.

An application for funds in excess of $25,000 must include a signed copy of an Equal Employment Opportunity Program certification. Such certification verifies that an agency employing 50 or more people that has applied to the OAG Grants Coordinator for funds in excess of $25,000 has implemented an equal employment opportunity program in accordance with 28 CFR 42.301, et seq., Subpart E.

§66.33.Certification Regarding Lobbying.

(a)

An application must include a signed copy of a Certification Regarding Lobbying in which the applicant certifies that "No Family Trust Fund funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of an agency, a member of the Texas Legislature, and officer or employee of the Texas Legislature, or an employee of a member of the Texas Legislature in connection with this grant." The applicant shall complete and submit the standard form, "Disclosure Form to Report Lobbying," in accordance with its instructions.

(b)

A grantee must file the most current edition of this certification and disclosure form, if applicable, with each submission that initiates agency consideration for an award of a contract or grant.

(c)

The certification required by this section is a material representation of fact upon which reliance is placed when a transaction is made or entered into.

§66.35.Nonprocurement Debarment Certification.

An application must include a signed copy of the Nonprocurement Debarment Certification. It certifies that neither the applicant nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by a federal or state department or agency.

§66.37.Drug-free Workplace Certification.

An application must include a signed copy of the Drug-free Workplace Certification.

§66.39.Uniform Grants Management Standards Certification.

(a)

An application must include a signed copy of the Uniform Grants Management Standards Certification.

(b)

A grantee shall, within 60 days following the date of the grant award, furnish the following information to the OAG:

(1)

identity of the organization conducting the audit;

(2)

approximate time the audit will be conducted; and

(3)

audit coverage to be provided.

§66.41.Certified Assurances.

An application must include a signed copy of the Certified Assurances Certification.

§66.43.Equipment Review and Approval.

(a)

Prior to obligating or expending grant funds for equipment purchases in excess of $25,000, a grantee shall submit the following documentation to the OAG for review and approval:

(1)

a brief narrative description of the procurement procedures used;

(2)

an unequivocal statement of the low compliant bid that was selected;

(3)

a list of vendors requested to bid or respond;

(4)

a copy of the public advertisement;

(5)

a copy of the RFP or the IFB with bid specifications;

(6)

a copy of the awarded bid;

(7)

a bid tabulation sheet;

(8)

a description of the selection process used to select the successful bidder when a grantee does not accept the apparent low bid, along with a copy of the evaluation of all proposals and a transmittal letter stating the reasons why such bid was selected;

(9)

a copy of the sales or purchase contract, if applicable; and

(10)

a letter signed by the authorized person named in the grant or by the person designated in the "Grantee Acceptance Notice" to initiate grant adjustments.

(b)

A grantee must, at a minimum, comply with its own procurement procedures and the Local Government Code, if applicable.

(c)

Grantees must provide notice in their RFPs or IFBs to prospective bidders that contractors who develop or draft specifications, requirements, statements of work and/or RFPs for a proposed procurement shall be excluded from bidding or submitting a proposal to compete for the award of such procurement in order to avoid an OAG organizational conflict of interest.

(d)

State agencies using the purchasing services of the General Services Commission are exempt from the requirement of submitting bidding documentation to the OAG for review and approval prior to purchasing equipment.

§66.45.Contract Review and Approval.

(a)

All contracts or groups of contracts with a single vendor that total more than $25,000 must be submitted to and approved by the OAG prior to a grantee obligating or expending any grant funds for contractual services. Each contract must be transmitted by a letter signed by the authorized person named in the grant or by the person designated to initiate grant adjustments and be accompanied by the following:

(1)

a brief narrative description of the procurement procedures used and an unequivocal statement describing the low compliant bid that was selected;

(2)

a list of vendors requested to bid or respond;. An RFP or IFB issued by a grantee to implement the grant project must provide notice to prospective bidders that the OAG organizational conflict of interest provision is applicable in that contractors who develop or draft specification, requirements, statements of work, and/or RFPs for proposed procurement shall be excluded from bidding or submitting a proposal to compete for the award of such contract or order;

(3)

a copy of the public advertisement;

(4)

a copy of the RFP or the IFB, with specifications;

(5)

a copy of the awarded response;

(6)

a description of the selection process used to select the successful bidder, with a copy of the evaluation of all proposals;

(7)

an explanation of why only one response was received, if applicable; and

(8)

an explanation justifying the selection of the sole source contractor if sole source procurement is necessary (i.e., contract is awarded to any organization without conducting a formal advertising and competitive bidding process or without soliciting proposals from potentially qualified contractors, or if only one bid was received.) The explanation must be presented in a format prescribed by the OAG in the application package.

(b)

State agencies using the purchasing service of the State Purchasing and General Services Commission are not exempt from the requirements of this paragraph.

§66.47.Resolutions.

(a)

Governmental entities whose authorized official designated in the grant application is not the executive officer of the governmental entity must submit a resolution from their governing body that gives the authorized official the power to accept, reject or amend a grant. The resolution must state that the governing body will secure a fidelity bond covering the full amount of the OAG funds upon acceptance of any grant award as provided in §66.91 of this title and that in the event of loss or misuse of OAG funds, the governing body assures that the grant funds will be returned to the OAG in full. The resolution from the governing body shall contain a statement that the governing body of the governmental entity may not use the existence of a grant award to offset or decrease total salaries, expenses, and allowances that the applicant receives from the governing body at or after the time the grant is awarded.

(b)

A nonprofit organization whose authorized official designated in the grant application is not the executive officer of the organization must submit a resolution from its governing body that gives the authorized official the power to accept, reject or amend a grant. The resolution must state that the governing body will secure a fidelity bond covering the full amount of the OAG funds upon acceptance of any grant award as provided in §66.91 of this title and that in the event of loss or misuse of OAG funds, the governing body assures that the grant funds will be returned to the OAG in full. The resolution from the governing body shall contain a statement that the governing body of the organization may not use the existence of a grant award to offset or decrease total salaries, expenses, and allowances that the applicant receives from the governing body at or after the time the grant is awarded.

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 April 12, 2001.

TRD-200102111

Susan D. Gusky

Assistant Attorney General

Office of the Attorney General

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 463-2110


Subchapter D. AWARD AND GRANT ACCEPTANCE

1 TAC §§66.55, 66.57, 66.59

Chapter 66 is proposed under the Texas Family Code §2.014, which the OAG interprets as authorizing the OAG to adopt rules reasonable and necessary to implement §2.014, in order to provide funds for grants or contracts that support services that assist families.

The proposed new chapter affects Texas Family Code §2.014.

§66.55.Application Deficiencies and Application Process.

(a)

If the OAG finds deficiencies in an application upon initial review, the OAG will send a deficiency report to the applicant. The applicant may file a response with a correction in the application. Deficiency reports are preliminary assessments only and do not represent a final action or determination by the OAG. A deficiency report is not a commitment by the OAG to fund any portion of the project. Additional deficiencies may be identified after the date of a deficiency report.

(b)

An application for funding will go through many reviews and at any point during the review a process a decision to approve or deny project funding may be made by the OAG, and such decision is within the sole discretion of the OAG. Once an award is made, the OAG has discretion to determine whether or not a grantee is complying with OAG policies and may, upon a negative determination, deobligate the grant and require reimbursement to the OAG of grant funds already disbursed.

(c)

The OAG will inform the applicant of its decision regarding a grant award through either a Statement of Grant Award or a denial letter signed by the Attorney General or his designee.

(d)

Applicants may not contact staff members of the OAG to seek support of an application. Additionally, under no circumstances may a grantee use grant-funded equipment, supplies, personnel, or indirect costs to influence or encourage others to influence the outcome of a grant funding decision by the OAG except as allowed under the OAG review process provided in §66.59 of this title. A decision to award a grant or not will be based only on the application package and OAG records.

§66.57.Notification of Award.

An applicant must accept or reject a grant award in writing and forward the notice to the OAG so that the notice is received by the OAG within 45 days of the grant award. Failure by the applicant to execute the grantee acceptance notice within this time period and promptly forward that notice to the OAG shall be construed as a rejection of the grant award, and the funds will be deobligated. In addition, each applicant who accepts a grant award must implement the grant within 60 days of the designated start date indicated on the statement of grant award. Failure to do so will be construed by the OAG as relinquishment by the applicant of the grant award. Any exception to this paragraph will require the review and written approval of the OAG Grants Coordinator.

§66.59.Review of Denial.

(a)

If the OAG denies an application or any part of an application, an applicant may request a review of the decision by writing to the OAG, Grants Coordinator within 10 days from the date of denial notification. Review requests must be based on a verifiable error made during the review process, and the applicant must be able to show that the error actually caused the application or portion of the application not to be funded. The applicant may submit written documentation in support of the review request.

(b)

Letters and phone calls of support will not be considered as part of the review. The Attorney General or his designee will consider only documentation submitted by the applicant that meets the criteria as outlined in this section. The decision concerning a review is final and not subject to judicial review.

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 April 12, 2001.

TRD-200102112

Susan D. Gusky

Assistant Attorney Genera

Office of the Attorney General

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 463-2110


Subchapter E. ADMINISTERING GRANTS

1 TAC §§66.67, 66.69, 66.71, 66.73, 66.75, 66.77, 66.79, 66.81, 66.83, 66.85, 66.87, 66.89, 66.91, 66.93, 66.95, 66.97, 66.99, 66.101, 66.103, 66.105, 66.107, 66.109, 66.111

Chapter 66 is proposed under the Texas Family Code §2.014, which the OAG interprets as authorizing the OAG to adopt rules reasonable and necessary to implement §2.014, in order to provide funds for grants or contracts that support services that assist families.

The proposed new chapter affects Texas Family Code §2.014.

§66.67.Grant Officials.

A grantee must have three persons designated to serve as grant officials as follows:

(1)

The project director must be an employee of the grantee who will be responsible for operation or monitoring of the project and be able to readily answer questions about its day-to-day operations.

(2)

The financial officer must be the chief financial officer of the grantee. Such officer might be, for example, the county auditor, city treasurer, comptroller, or treasurer of a nonprofit corporation's board. The financial officer may not serve as the project director or the authorized official.

(3)

The authorized person is the person authorized to apply for, accept, decline, or cancel the grant for the applicant agency. This person may be, for example, the executive director of the state agency, county judge, mayor, city manager, assistant city manager, or designee if authorized by the governing body. The name must be consistent with the signature on application page FTFG-1.

§66.69.Obligating Funds.

Grant funds may not, without advance written approval by the OAG Grants Coordinator, be obligated prior to the start date or after the ending date of the grant period. Obligated funds must relate only to approved budget items and purposes. Grant-funded personnel may use grant funds only for project activities stated in the approved FTFG application.

§66.71.Retention of Report Records.

(a)

Except as provided in subsections (b) and (c) of this section, a grantee must maintain all financial records, supporting documents, statistical records and all other records relating to the grant for at least five years following the closure of the most recent audit report. Retention is required for the purposes of federal and state examination and audit. Records may be retained in an electronic format. All of the retained records are subject to audit or monitoring during the entire retention period.

(b)

Records for equipment purchased, non-expendable personal property, and real property shall be retained for a period of three years from the date of the disposition or replacement or transfer at the discretion of the OAG.

(c)

If any litigation, claim, or audit is initiated before the expiration of the three-year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. All of these records are subject to audit or monitoring during the entire retention period.

§66.73.Financial Reports.

A grantee must submit financial expenditure reports each calendar quarter. The OAG will provide the appropriate forms and instructions to each grantee along with deadlines for submission. The financial officer designated for the grant must sign and submit such reports. Failure to submit such reports on a timely basis will result in the OAG placing a grantee on financial hold and may affect future funding requests.

§66.75.Inventory Reports.

A grantee must maintain an inventory report on file at its principal office of all equipment purchased as part of the grant project. This report must be consistent with the final financial expenditure report. The grantee must submit the report to the OAG with the final progress report. The grantee must complete and submit to the OAG an inventory of grant property at least once every two years.

§66.77.Requests for Funds.

A grantee must ensure that its final Request for Funds is postmarked no later than the 90th calendar day (liquidation date as defined in the application package) after the end of the grant period. If this date falls on a weekend or federal holiday, then the OAG will honor a postmark on the next business day. On the liquidation date, if grant funds are on hold for any reason, the funds will lapse and cannot be recovered by the grantee. Under no circumstances will the OAG make payments to a grantee who submits its Request for Funds with a postmark after the above deadlines.

§66.79.Grant Adjustments.

(a)

When it becomes necessary to change any significant program or budget element of a grant, a grantee may request a grant adjustment. This adjustment, if approved by the OAG in writing, will allow the grantee to move funds between budget categories, change officials, revise the scope or target of the program, or alter project activities. The person designated in the grantee acceptance notice to request grant adjustments or the authorized official must sign all requests. The OAG must approve an adjustment in advance through a grant adjustment notice mailed to the project director and the financial officer for the grant.

(b)

The OAG will not consider more than four grant adjustments each grant year where the request is to alter the approved or previously amended budget. This allotment does not include changes in the names of officials, addresses, or phone numbers. The OAG will consider additional budget adjustments only if the OAG expressly requests the budget amendment for reasons other than to resolve deficiencies found during monitoring visits or other examinations of grantee records.

(c)

Personnel funds not expended because of a vacancy may not be reallocated to other budget line items, either within the personnel category or to another budget category.

(d)

The OAG will record grant adjustments that request changes other than those to the budget or the activities of the program. Such changes of basic information will not be acknowledged in writing by the OAG.

(e)

A grantee shall notify the OAG in writing of any change of the designated project director, financial officer, or authorized official within five business days following the change. When such notification records a change of the financial officer, the letter must include a sample signature of the new official.

(f)

A grantee is responsible for initiating a grant adjustment. The request for adjustment must be made in writing, and may include any information that clarifies the request. A grantee must secure OAG approval, through a grant adjustment notice, in advance and each request must include a detailed justification for:

(1)

out-of-state travel that was not included by individual trip in the approved budget;

(2)

changes in the need, objectives, methodology, scope, or geographic location of the grant;

(3)

transfers of funds among direct cost categories exceeding five percent of the total grant budget over the grant year;

(4)

changes in the number or job descriptions of personnel specified in the grant;

(5)

changes in equipment amounts, types, or methods of acquisition;

(6)

changes in the grant period or in the period for liquidating all encumbered funds;

(7)

new line items to be included in the budget or changes to existing line items; and

(8)

cost-of-living and merit increases for a budgeted salary (include documentation of approval by the governing body and effective date of the increases).

(g)

A grantee must submit a request for a grant extension in writing. The OAG Grants Coordinator may approve such requests in extraordinary circumstances. The OAG will not extend a grant for more than 12 months.

(h)

The OAG will not honor facsimile copies of grant adjustment requests and will not give verbal approvals.

(i)

No budgetary grant adjustment requests will be honored within 30 days prior to the end of the grant period.

(j)

Over the course of the funding year, a grantee may transfer funds between direct cost line items in different budget categories not to exceed a cumulative total of five percent of the grant budget during that year. All such budget transfers must comply with all relevant policies in this chapter. Adjustments must occur before funds are expended or were scheduled to be expended in the approved budget. Total transfers during a grant year that exceed five percent of the OAG portion of the grant budget also require a grant adjustment.

§66.81.Copyrights.

If a grantee uses any OAG funds to purchase or receive a copyright or for a subcontractor to purchase or receive a copyright, the OAG reserves a royalty-free and irrevocable license to reproduce, publish, use, or authorize others to use the copyrighted material.

§66.83.Procurement Procedures.

(a)

Prior to obligating grant funds for equipment purchases or professional or consultant services in excess of $25,000, a grantee must submit all documents to the OAG for review and approval, except as provided by subsection (d) of this section. A grantee is not exempt from this policy if the actual amount is lower than $25,000 because of a trade-in allowance. A grantee must submit documents with a letter signed by the authorized person named in the grant or by the person designated to initiate grant adjustments. The documents must contain:

(1)

a brief narrative description of the procurement procedures used and a statement of which low compliant bid was selected;

(2)

a list of vendors requested to bid or respond. State agencies using the purchasing service of the General Services Commission of Texas are not exempt. RFPs or IFBs issued by a grantee to implement the grant project must provide notice to prospective bidders that the OAG organizational conflict-of-interest provision is applicable. This provision states that contractors that develop or draft specifications, requirements, statements of work, and RFPs for proposed procurement shall be excluded from bidding or submitting a proposal to compete for the award of such a contract;

(3)

a copy of the public advertisement;

(4)

a copy of the RFP or the IFB, with specifications;

(5)

a copy of the acknowledgment of contract receipt;

(6)

a description of the selection process used to select the successful bidder, with a copy of the evaluation of all proposals;

(7)

if sole-source procurement is necessary or if only one response is received, a justification for selecting the sole source or an explanation of why only one response was received a long with a description of the program, what is being contracted for, and why it is necessary to contract non-competitively, such as expertise of the contractor, responsiveness and knowledge of the program, time constraints, and uniqueness; and

(8)

a copy of the proposed contract.

(b)

Each state agency grantee must comply with the Government Code, Chapter 2254, when securing consultant services.

(c)

Cities and counties must comply with the requirements governing advertising for bids, in the Local Government Code, chapters 252 and 262, for cities and counties respectively.

(d)

State agencies contracting for professional or consultant services in excess of $15,000 are not required to submit to the OAG a copy of the contract for approval, but shall provide the OAG a copy for its records. State law requires that state agencies must submit such contracts to the General Services Commission for approval.

(e)

A grantee must make a good-faith effort to encourage HUBs to bid on services for grant-funded projects and report the amount of grant dollars contractually awarded to HUBs. A HUB is defined as a corporation formed for profit in which at least 51% of the equity is owned by one or more Black, Hispanic, Asian, Pacific Islander, Native American, or female person; a sole proprietorship 100% owned, operated, and controlled by such a person; a partnership in which such person(s) owns at least 51% of assets and interest and has proportionate control of partnership affairs; a joint venture of HUBs; or a supplier contract between a HUB and a prime contractor under which the HUB manufactures, distributes, or warehouses and ships the supplies. A grantee must report this information on the Historically Underutilized Business Progress Assessment Report (HUB-PAR) form with the quarterly financial expenditure report. A copy of the (HUB-PAR) is in the application package.

(f)

Any lease-purchase in excess of $15,000 must be the result of competitive procurement. The OAG will not approve lease-purchase agreements or leasing of computer systems (computer hardware and software) unless the applicant demonstrates that the lease-purchase is cost effective. An applicant requesting a lease-purchase must reflect the items in budget schedule D of the grant application form and must attach justification for requesting the lease-purchase method. Any interest charges resulting from such a purchase are not allowable as expenditures under the grant. If approved, lease-purchase is subject to the same requirements for grantee contributions as equipment purchases.

(g)

A grantee must retain ultimate control of and responsibility for the grant project, and any contractor shall be bound by grant agreements, grant conditions, and any other requirements applicable to a grantee.

(h)

A grantee may make purchases of up to $2,000 on a spot purchase basis, without comparative pricing.

(i)

Purchases between $2,000.01 and $5,000 will require a minimum of three verbal bids based on identical specifications. A grantee is required to maintain records for audit that show the name, telephone number, date, and bid amount of each source contacted. A grantee must select the lowest compliant bid.

(j)

Purchases between $5,000.01 and $15,000 require a grantee to issue written invitations for bids, using identical specifications, to a minimum of three prospective suppliers. Such invitations must clearly state the deadline for receipt of written bids. A grantee is required to maintain records for audit that include copies of all invitations and all written responses, including original signatures. A grantee must select the lowest compliant bid.

(k)

Purchases above $15,000 require formal newspaper advertising soliciting bids. A grantee must maintain records for audit that include copies of the advertisement(s) and all written responses, including original signatures. A grantee must select the lowest compliant bid.

(l)

When the required services, supplies, or skills are so unique that the purchaser cannot identify a minimum of three prospective sources and the cost exceeds $2,000, a grantee must request guidance from the OAG. In such cases, a grantee must provide to the OAG a letter containing all relevant facts and a proposed course of action.

(m)

Audit organizations and individual independent auditors typically will not respond to an invitation for bid, without precise specifications stipulated by the purchaser. In such cases, the purchaser must extend an invitation for proposal that permits the prospective supplier to develop specifications and to quote a relevant cost. A grantee must select the most responsive proposal that meets its needs.

(n)

In all instances, prior to the delivery of services, a written contract must be executed to secure professional or consultant services.

§66.85.Property Management Standards.

A grantee shall use the property management standards set forth in the UGMS . The UGMS are incorporated in this chapter for all appropriate purposes. A grantee must comply with the UGMS and all applicable state and local laws and regulations.

§66.87.Disposition of Property.

(a)

If a grantee no longer funded by the OAG purchases equipment in whole or in part with OAG funds, a grantee must write to the OAG for instructions on the disposition of any piece of equipment with a current per-unit fair market value of $1,000 or more. A grantee may use equipment with a current per-unit fair market value of less than $1,000 for other activities without reimbursement to the OAG, or sell the equipment and retain the proceeds, without OAG approval.

(b)

The request for disposition of property must include an explanation of a grantee's preferred disposition. Disposition is subject to OAG approval as follows:

(1)

If a grantee wishes to continue to use the equipment for the project or for activities similar to those of the original project, the OAG may approve such action and transfer title of the equipment to the grantee.

(2)

If a grantee wishes to use the equipment for activities that are not a part of the project or for activities not similar to those of the original project, the OAG may approve transfer of the equipment, provided that the grantee makes compensation to the OAG. The compensation to the OAG is the percentage of the current per-unit fair market value of the equipment equal to the percentage of the OAG share of the original purchase price.

(3)

If a grantee no longer needs the equipment, the OAG may approve sale of the property. If a grantee sells the property, it must then reimburse the OAG for a percentage of the sale in an amount equal to the percentage of the OAG share in the original purchase price. The sale of the property shall be a bona fide, arms-length sale. The grantee shall reimburse the OAG its pro rata share upon receipt of the purchase monies.

(4)

The OAG may instruct a grantee to transfer the equipment to another agency needing the property. If so instructed, the benefitting agency shall reimburse the grantee for the percentage of the current per unit fair market value equal to the percentage of the grantee's share in the original purchase price.

(5)

If the OAG instructs a grantee to dispose of the property in a manner other than that stipulated in paragraphs (1) - (4) of this subsection, the OAG will reimburse the grantee for costs incurred in the disposition.

§66.89.Transfer of Title of Equipment and Nonexpendable Personal Property.

(a)

The OAG may transfer title of grant-acquired property having a unit cost of $1,000 or more to the federal government or to an eligible third party as provided by law.

(b)

Property to be transferred pursuant to subsection (a) of this section must be identified in the grant or otherwise made known to the grantee in writing.

(c)

The OAG will issue disposition instructions within 120 calendar days after the end of grant.

(d)

When title to property is transferred, the grantee will be paid an amount calculated by applying the percentage of participation in the purchase to the current fair market value of the property.

§66.91.Bonding and Insurance.

Each nonprofit organization receiving funds from the OAG must obtain and submit with the grant application a fidelity bond on any employee administering Grant funds. The bond must indemnify the OAG against the loss and theft of the entire amount of Grant funds. The cost of such a bond is an eligible expense of the grant. Two-year funding projects must submit a copy of the bond on or before September 1 of the second year of the grant. If a grantee is self-insured, it must submit documentation of self-insurance with the grant application. An applicant, other than a nonprofit organization, must include in the resolution from its governing body a statement that in the event of loss or misuse of OAG funds, the governing body assures that funds will be returned to the OAG in full.

§66.93.Withholding Funds.

(a)

The OAG may withhold funds from a grantee if a grantee fails to comply with established guidelines, grant conditions, or contractual agreements, or when funds are depleted or insufficient to fund allocations. The OAG may withhold funds from a specific project for reasons that include, but are not limited to:

(1)

failure to comply with any applicable federal or state law, rule, regulation, policy, or guideline, or with the terms of any grant agreements;

(2)

failure to submit reports of expenditures and status of funds, grantee progress reports, or special required reports at the time and in the form established for such reporting;

(3)

failure to maintain proper records as required by these rules;

(4)

failure to conduct the grant project according to the terms of the application for a grant, the statement of grant award, the grantee acceptance notice, or a grant adjustment notice;

(5)

failure to comply with any condition that has been made a part of the statement of grant award by reference or inclusion therein or through the issuance of a grant adjustment notice;

(6)

failure to commence project operations within 60 days of the project start date;

(7)

failure to submit audit reports, including management letters and responses to audit findings;

(8)

failure to provide timely and adequate responses to audit or monitoring report findings; or

(9)

failure to provide accurate information in a grant application, in grantee records, or in reports to the OAG.

(b)

The OAG may withhold funds from all projects operated by a grantee for reasons that include, but are not limited to:

(1)

failure to respond to any deficiency listed in this section;

(2)

failure to return to the OAG within the required time unused grant funds remaining in the expired grant; or

(3)

refusal to return to the OAG any grant funds improperly accounted for or expended for ineligible purposes under a grant that has expired.

(c)

The OAG will not give advance notice that a grantee may be placed on financial hold. It is the responsibility of a grantee to submit all reports and other required information in a timely fashion and to comply with OAG grant guidelines.

(d)

The OAG will notify a grantee when a grant is placed on financial hold. A grantee may, within 10 days of receiving notification, request in writing a reconsideration of the determination to withhold funds. A grantee should send this request to the OAG Grants Coordinator, together with any documentation in support of the reconsideration. The grants coordinator will review the determination to withhold funds based on the documentation submitted. The OAG will send the final determination to the grantee in writing.

(e)

The OAG will release funds if the grantee has provided evidence satisfactory to the OAG that the deficient conditions have been corrected, unless the OAG has terminated the grant as provided in §66.95 of this title.

§66.95.Grant Termination.

(a)

A grantee shall notify the OAG, in writing, of the cancellation of any Grant funded project immediately upon the decision to cancel the project.

(b)

The OAG may terminate a grant for failure to comply with applicable federal or state laws, rules, regulations, policies, or guidelines, or any OAG grant agreement with the grantee.

(c)

The OAG may terminate a grant if:

(1)

deficient conditions make it unlikely that the grant's objectives will be accomplished;

(2)

deficient conditions cannot be corrected within a period of time judged acceptable by the OAG;

(3)

a grantee provided inaccurate information in a grant application, in grantee records, or in reports to the OAG; or

(4)

a grantee has acted in bad faith.

(d)

The OAG will notify a grantee of deficient conditions and grounds for termination. When a grant is terminated all unexpended or unobligated funds awarded to a grantee will revert to the OAG. The OAG may consider a grantee ineligible for any future grant award if the OAG has terminated a grant for cause.

(e)

In lieu of termination a grant project, the OAG may require the transfer of the grant project by moving the administration of the project to a different agency.

(f)

A grantee may ask for a review of the termination of a grant by writing to the First Assistant of the OAG. The request for review must be received by the OAG within ten days from the date of the suspension or termination notification. A grantee may submit written documentation in support of its request. The First Assistant of the OAG will consider any documentation submitted by a grantee in support of an appeal. The decision of the First Assistant of the OAG concerning termination is final and not subject to judicial review.

§66.97.De-Obligation of Grant Funds.

A grantee must liquidate all properly incurred obligations under the award no later than 90 days after the end of the funding period. Final expenditure reports must be submitted at that time or on the following expenditure report if the end of the liquidation period does not fall at the end of a calendar quarter. In addition, a grantee must submit any unexpended funds and cash match shortages with the final expenditure report.

§66.99.Payment of Outstanding Liabilities.

A grantee must properly obligate and expend funds to satisfy all outstanding liabilities no later than 90 days after the end of the grant period. The OAG will not make any reimbursements to a grantee unless the final request for funds is postmarked by the 90th day after the end of the grant period. If the 90th day falls on a weekend or federal holiday, the OAG will honor receipt or a postmark on the next business day. All payments made after the completion of the grant period must relate to obligations encumbered prior to the end of the grant period.

§66.101.Violations of Laws.

A grantee and its personnel must immediately notify in writing the OAG and, if applicable, the local prosecutor's office, upon discovery of any evidence, knowledge or suspicion of a violation of the law encountered by a grantee or discovered during monitoring visits, including, but not limited to, misappropriation of funds, fraud, theft, embezzlement, forgery, or any serious irregularity or noncompliance with the requirements of this chapter.

§66.103.Conflict of Interest.

Failure to comply with this section shall result in termination of the grant award and may affect future funding decisions. No grantee personnel, member of a grantee board or governing body, or other person affiliated with the grant project may participate in any proceeding or action where grant funds personally benefit, directly or indirectly, the individual or any relative. Grant personnel and officials must avoid any action that might result in or create the appearance of using their official positions for private gain; giving preferential treatment to any person; losing complete independence or impartiality; making an official decision outside of official channels; or affecting adversely the confidence of the public in the integrity of the program or the OAG.

§66.105.Evaluating Project Effectiveness.

A grantee must regularly evaluate the effectiveness of its project. This evaluation includes reassessment of individual project activities and services to determine if they remain relevant and effective. A grantee must be able to show that grant activities are well thought out and provide actual services that directly impact an identified problem statement and bring the project closer to accomplishing its goals. The OAG will assess project effectiveness through review of required progress reports, on-site visits, and desk reviews. Information relating to project evaluations must be maintained in the project's files and must be available for review by OAG staff.

§66.107.Progress Reports.

(a)

A grantee must submit progress reports in accordance with the instructions provided by the OAG and as outlined for each specific program area. To remain eligible for funding, a grantee must be able to show not only the number of services provided, but the impact and quality of those services.

(b)

A grantee must submit reports only for those activities supported by OAG grant funds, grantee match, and program income.

(c)

The OAG may prescribe forms for such reports, which a grantee must use.

(d)

The project director must sign all progress reports.

(e)

The OAG will automatically place projects on financial hold for failure to submit complete and correct progress reports by the specified deadline. The OAG will not send reminder notices or make reminder telephone calls prior to placing funds on hold. A history of delinquent reports may affect future funding decisions.

(f)

The OAG will not make a grant award for second-year funding projects unless all progress reports due by the award date are complete, correct, and on file at the OAG.

§66.109.Oversight of Contracts.

A grantee that uses any portion of Grant funds to contract with a third party must maintain records in a grantee project file showing the specific steps taken to ensure that the terms of the contract are met and that the services provided are evaluated by a grantee annually.

§66.111.Accuracy of Grant Records.

Providing false information, knowingly or unknowingly, on a grant application, in grantee records, or in reports to the OAG may cause an application to be denied or a grant to be terminated and the grant funds deobligated. In some circumstances, such action may also be considered tampering with government records, which is a criminal offense.

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 April 12, 2001.

TRD-200102113

Susan D. Gusky

Assistant Attorney General

Office of the Attorney General

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 463-2110


Subchapter F. PROGRAM MONITORING AND AUDITS

1 TAC §§66.119, 66.121, 66.123

Chapter 66 is proposed under the Texas Family Code §2.014, which the OAG interprets as authorizing the OAG to adopt rules reasonable and necessary to implement §2.014, in order to provide funds for grants or contracts that support services that assist families.

The proposed new chapter affects Texas Family Code §2.014.

§66.119.Monitoring.

(a)

The OAG will monitor grants throughout their existence. A grantee must make all grant-related records available to OAG representatives unless the information is sealed by law.

(b)

The OAG will monitor both financial and program aspects of a grant project to evaluate progress and determine compliance. Monitoring will include both on-site and desk reviews and may involve any information that the OAG deems relevant to the project. The purpose of the monitoring is to ensure that a grantee is meeting performance goals and that grant funds are expended in compliance with applicable laws, rules, grant agreements and other contracts. On-site monitoring includes, but is not limited to the review of:

(1)

adequacy of the accounting systems, files, equipment and property management, and administration;

(2)

relationship of actual expenditures and match requirements compared to approved budgets;

(3)

accuracy of financial information, reasonableness of cost allocation plans, and expenditure documentation;

(4)

timeliness of submission of financial expenditure and progress reports;

(5)

need for, reasonableness of, and authorization for costs;

(6)

charges to cost pools used in calculating indirect cost rates;

(7)

adherence to federal, state, and OAG guidelines and program requirements;

(8)

accuracy of statistics on project activities and goal achievement indicators; and

(9)

documentation of and progress toward achieving the project's output and outcome goals.

(c)

A grantee must maintain current files. The OAG may make unannounced visits at any time.

(d)

The OAG reserves the right to conduct its own audit, or contract with another to audit any grant.

(e)

A grantee must provide access to project records to all OAG representatives and properly designated monitors or auditors.

(f)

A grantee must, within 30 business days of the date of an audit monitoring report, submit documentation to the OAG responding to findings and questioned costs contained in an audit or monitoring report. Documentation may be submitted to the OAG, at 300 W. 15th Street, William P. Clements Building, 15th Floor, Austin, Texas 78701 or by mail to the OAG, Grants Coordinator, Post Office Box 12548, Austin, Texas 78711-2548. The OAG will review the documentation for legal, financial, and program acceptability under state, federal and OAG rules.

(g)

A grantee may request a review of a decision by the OAG after submission of responses to OAG findings, by writing to the OAG, Grants Coordinator. A review board will make recommendations to the First Assistant of the OAG for approval, disapproval, or approval with modifications of audit or monitoring exceptions. The OAG will send the written determination by the First Assistant of the OAG to the grantee within 30 calendar days of a decision. A grantee must, within 30 calendar days, refund all funds due after a final determination. Failure to comply with this provision will subject a grantee to the provisions of this plan relating to the conditions for withholding funds from a grantee. The determination of the First Assistant of the OAG is final and not subject to judicial review.

§66.121.Independent Annual Audit.

The OAG will require an audit of a grant, including subgrants passed through from a Grant grantee, based on state audit requirements, as follows:

(1)

A grantee expending a total of $300,000 or more in state funds, regardless of the source, must submit an annual single audit in accordance with the UGMS;

(2)

A grantee expending less than $300,000 but more than $50,000 in state funds, regardless of the source, must submit a program-specific audit.

(3)

A grantee expending less than a total of $50,000 in state funds, regardless of the source, must submit financial statements audited in accordance with GAAS.

§66.123.Audit Standards.

(a)

A grantee must submit to the OAG copies of all audit reports, including audits as required in the Independent Annual Audit and all other audits that a grantee undergoes, regardless of the purpose.

(b)

A grantee must ensure that required audits are completed and submitted to the OAG on or before 30 days after the issuance of an auditor's report.

(c)

A grantee will bear its fair and reasonable share of audit costs required by the OAG in accordance with applicable federal and state cost principles governing allowability and allocation.

(d)

A grantee, regardless of level of funding, is subject to random, periodic on-site reviews and audits by the OAG. These reviews are designed to complement, not duplicate, any single audit performed.

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 April 12, 2001.

TRD-200102114

Susan D. Gusky

Assistant Attorney General

Office of the Attorney General

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 463-2110


Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 371. MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY

Subchapter C. UTILIZATION REVIEW

1 TAC §§371.212 - 371.214

The Health and Human Services Commission (HHSC) proposes to amend Chapter 371, Medicaid Fraud and Abuse Program Integrity, Subchapter C, Utilization Review, §371.212, Case Mix Classification System, §371.213, Utilization Review and Control Activities Performed by Texas Department of Human Services, concerning the authority for on-site utilization review activities, and §371.214, Texas Index for Level of Effort (TILE) Assessments.

Background and Summary of Factual Basis for the Rules

The 75th Legislature, Regular Session, 1997, through Senate Bill 30, directed the transfer of Utilization Assessment and Review and all its powers, duties, functions, and programs from the Texas Department of Human Services (TDHS) to HHSC, effective September 1, 1997. Rules were officially transferred in March 2000, without language change, from Title 40 of this code to Title 1. One of the functions transferred was the case mix review of nursing facilities. "Case mix" refers to a method of classifying recipients based on their resource and service needs and determining a payment rate based on that classification.

These proposed amendments to the case mix rules were developed in conjunction with a work group consisting of representatives from the Texas Health Care Association, the Texas Association of Homes and Services for the Aging, the Texas-New Mexico Hospice Association, and state health and human services agencies. The amendments clarify the language of the rules and reflect the shift in agency authority and a streamlining of HHSC's utilization review process. In addition, the amendments reflect the inclusion in HHSC's routine case mix review process of all hospice recipients residing in nursing facilities.

Section-by-Section Explanation

Proposed §371.212 generally describes the case mix classification system and facility documentation requirements, gives direction on completing the Client Assessment Review and Evaluation (CARE) form, and gives definitions of the various clinical categories necessary to establish a Texas Index for Level of Effort (TILE) assessment. Under the proposed amendment to this section, the hospice nurse assessor, as well as the nursing facility's director or acting director of nurses and the facility nurse assessor, must sign the CARE form, which is an electronic form. Currently, only nursing facility personnel are required to sign the CARE form; hospice providers use Form 3073, a manual claim form. Signatures from both providers now will be required on the CARE form as documentation of the hospice provider's responsibility for the care provided and of both providers' agreement to the coordinated plan of care, required by §19.1926 and §30.100, Title 40, Texas Administrative Code. Use by hospice providers of the electronic CARE form will also facilitate payment to the hospice providers.

Proposed §371.213 clarifies that on-site utilization review is conducted by HHSC. This section also states the requirement that nursing facility staff cooperate with and fully support utilization review.

Proposed §371.214 generally describes and provides direction for the completion of the TILE assessment. Under the proposed amendment to this section, the routine case mix review process will include all hospice recipients residing in nursing facilities, in compliance with the requirement in 42 C.F.R. §456.1 that there be a utilization control program of all Medicaid services. The TILE assessment will be completed jointly by nursing facility and hospice nurse assessors, which will allow electronic transmission of CARE forms, thereby shortening the input and reimbursement timeframes.

Public Benefit

Don Green, Chief Financial Officer, has determined that during the first five years the proposed rules are in effect, the public will benefit from adoption of the rules by clarifying the criteria that govern the routine case mix review process.

Fiscal Note

Don Green, Chief Financial Officer, has determined that, for each year of the first five years the proposed rules are in effect, there will be no significant fiscal impact to state government. No additional costs will be borne by local governments as a result of the rules, nor is there any anticipated negative impact on revenues of state or local government.

Small and Micro-business Impact Analysis

The proposed rules will not result in additional costs to persons required to comply with the rules. The rules do not have any anticipated adverse effect on small or micro-businesses. The rules will not negatively affect local employment.

Regulatory Analysis

The Commission has determined that none of the proposed rules is a "major environmental rule," as defined by §2001.0225, Government Code. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risks to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment, or the public health and safety of the state or a sector of the state. None of the proposed rules is specifically intended to protect the environment or reduce risks to human health from environmental exposure.

Takings Impact Assessment

HHSC has evaluated the takings impact of the proposed rules under §2007.043, Government Code. HHSC has determined that this action does not restrict or limit an owner's right to their property that would otherwise exist in the absence of governmental action and therefore does not constitute a taking. The majority of the proposed rules are administrative and do not impose any new regulatory requirements. The proposed rules are reasonably taken to fulfill requirements of state law.

Public Comment

Comments on the proposed rules may be submitted in writing to Charlotte Dokes, Director, Utilization Review, Texas Health and Human Services Commission, P.O. Box 13247, Austin, Texas 78711-3247, or by e-mail to Charlotte.Dokes@hhsc.state.tx.us. Comments will be accepted for 30 days following publication of this proposal in the Texas Register .

Statutory Authority

These rule amendments are proposed under authority granted to HHSC by §531.033, Government Code, which authorizes the Commissioner of Health and Human Services to adopt rules necessary to implement HHSC's duties, and under section 531.021(a), Government Code, which authorizes HHSC to administer federal medical assistance (Medicaid) program funds.

The proposed amendment affects Chapter 32 of the Human Resources Code.

§371.212.Case Mix Classification System.

The case mix classification system is defined in terms of recipient condition, functional performance in activities of daily living (ADL), and level of staff intervention. The classification system is divided into four clinical categories, which [ categories which ] are further subdivided based on ADL scores that measure functional performance for eating, transferring, and toileting. The combination of clinical categories and ADL measurements yields an array of 11 Texas Index for Level of Effort (TILE) case-mix classifications.

(1)

Assessment period. The information on the [ Completion of the ] Client Assessment Review and Evaluation (CARE) form for assignment of a clinical category or ADL score must be based on the recipient's status in the facility during the four weeks immediately preceding the assessment date, except in any of the following instances:

(A)

If the recipient has experienced what appears to be a permanent change in clinical or functional status within [ during ] the past four weeks [ and the change appears permanent ], the nursing facility or the hospice provider can choose to complete a new assessment. Information in the new assessment shall be based on the recipient's current status. [ the assessment is made on the current (changed) status. ]

(B)

If the recipient has been admitted or readmitted to a facility during the past four weeks, the assessment is based on the status since admission or readmission.

(C)

The condition or event that [ event which ] precipitates the need for rehabilitative therapy/restorative nursing may have occurred no more than six months prior to the assessment period. An admission or transfer into a facility could qualify as an event.

(2)

Documentation. The documentation in the clinical record must be descriptive and quantitative to allow the accurate completion of the CARE form items relating to the recipient's condition(s), treatment(s), and the ADLs of eating, transferring, and toileting.

(A)

In the absence of required facility documentation, the Texas Health and Human Services Commission (Commission) [ Texas Department of Human Services (DHS) ] nurse reviewers will use available data, staff interviews, and nursing observation to assign ADL scores.

(B)

The required documentation must appear in the clinical record during the assessment period to qualify for a clinical category. Lack of documentation will result in a change to an assessment item for a clinical category.

(C)

Lack of, conflicting, or altered documentation could be the basis for an adjustment in TILE.

(D)

Suspected fraudulent documentation, such as falsified or fabricated medical records, may [ will ] result in a referral for investigation to the Medicaid Program Integrity Division [ Medicaid Provider Sanctions Division ] of the [ Health and Human Services ] Commission, as required as part of the state's methods for identification, investigation and referral for fraud under the Texas Administrative Code, Title 40, Part 1, Chapter 79, Subchapter V (relating to Fraud or Abuse Involving Medical Providers) and Code of Federal Regulations, Title 42, [ CFR ], Chapter IV, Part 455 (concerning Program Integrity: Medicaid).

(3)

Clinical categories. Each recipient is assigned to one of the following four clinical categories based on qualifying conditions or treatments.

(A)

The heavy-care group. To qualify for the heavy-care clinical group, a recipient must have at least one of the following conditions or be receiving at least one of the following treatments, with supporting documentation in the clinical record, and the recipient must have a total ADL score of at least six out of a possible nine.

(i)

Coma. Persistent unconsciousness and unresponsiveness from which a resident cannot be aroused must be documented in the assessment period.

(ii)

Quadriplegia. Neurologic disorder causing paralysis of the four extremities, excluding loss of movement caused solely by contractures. Paralysis is defined as loss of power of voluntary movement in a muscle through injury or disease of its nerve supply. A description of the recipient's functional abilities and limitations must be documented in the clinical record in the assessment period.

(iii)

Stage III or IV decubitus with physician-ordered decubitus care and/or wound dressings twice a day. Decubitus covered by eschar is considered Stage IV. Decubitus must be described and care/dressings must be documented in the assessment period.

(iv)

Non-oral administration of 60% or more of the recipient's nourishment. Times, amount, and types of feeding must be documented in the assessment period.

(v)

Daily oral or nasal suctioning, which must be documented daily in the assessment period.

(vi)

Daily tracheotomy care or suctioning, excluding self-care, which must be documented daily in the assessment period.

(B)

The rehabilitation/restorative group. To qualify for the rehabilitation/restorative clinical group, a recipient must receive TILE 202 restorative nursing care as follow-up to rehabilitation therapy. The TILE 202 restorative nursing and rehabilitation therapy must meet the following criteria with supporting documentation in the clinical record. For hospice recipients residing in nursing facilities rehabilitation or restorative nursing care is only applicable for conditions unrelated to the terminal illness.

(i)

The rehabilitation therapy must be:

(I)

physical or occupational therapy, ordered by a physician, and provided by a licensed therapist or by certified or licensed occupational or physical therapy assistants (COTA/LPTA) under the supervision of a licensed therapist. Positioning, splinting, decubitus ulcer care, and training nursing staff (as in a functional maintenance program) are excluded from the TILE 202, even if provided by an occupational therapist or physical therapist;

(II)

initiated due to an identifiable, documented event, i.e., an illness, injury or physical change or an exacerbation of a chronic illness in the past six months with an associated change in ADL functioning. An admission or transfer into a facility could qualify as an event. The functional change must be documented through one of the following:

(-a-)

a description of the event or illness and the recipient's functional status before and after the event must be documented by nursing staff in the individual's clinical record or care plan ; or

(-b-)

completion of a Minimum Data Set 2.0 Significant Change with [ and ] an updated care plan;

(III)

expected to result in the recipient's making significant, measurable, functional progress, which must be documented in the therapy goals;

(IV)

provided on a one-to-one basis three times per therapy week for at least two therapy weeks; and

(V)

reimbursed by Medicare, Medicaid rehabilitative services, or another third party payer.

(ii)

The TILE 202 restorative nursing must:

(I)

be provided as part of a restorative care plan, based upon the therapist's written plan of care and developed by the restorative team, which must include and be signed by the therapist and a registered nurse;

(II)

begin during the assessment period;

(III)

begin within 14 days of the therapist's written restorative plan of care;

(IV)

be provided for a minimum of 24 sessions within eight therapy weeks, and must continue as long as clinically indicated; and

(V)

be supported by a Restorative Nursing Care Program form, or similar form containing the same elements, which must document each restorative session and the recipient's response to the restorative plan through:

(-a-)

a weekly note by the nursing or therapy staff (as appropriate); and

(-b-)

a written monthly review by the licensed nursing staff or, if services were supervised or delivered by a licensed therapist[ , a licensed therapist ].

(iii)

A recipient will be considered to be properly classified in this clinical group if all criteria in subparagraphs (A) and (B) of this paragraph [ clauses (i) and (ii) of this subparagraph ] are met except clause subparagraph (A)(iv) and (v) of this paragraph [ clause (i)(IV) and (V) of this subparagraph ], which must be met within three months of the date of assessment;

[ (iv)

Payment will be recouped on recipients who do not meet TILE 202 restorative nursing criteria.]

(C)

The clinically unstable group. To qualify for the clinically unstable group, a recipient must have at least one of the following conditions or receive one of the following treatments during the assessment period[ , with the exception of an amputation, which must have occurred in the six months preceding the assessment date, or be receiving at least one of the following treatments during the assessment period ].

(i)

Recent amputation of arms, legs, or parts thereof in the six months preceding the assessment date. Date and site of amputation must be documented in the clinical record.

(ii)

Seizures, which occurred in the facility, in the assessment period. A description of the seizure and nursing interventions must be documented in the clinical record.

(iii)

Dehydration with documented intake/output monitoring (including frequency and amounts of output) on at least two shifts per day. Dehydration that was diagnosed, treated, and resolved outside the facility and is no longer symptomatic is excluded. The signs, symptoms, interventions, and measures taken to prevent recurrence must be documented in the assessment period.

(iv)

Acute, symptomatic urinary tract infection (UTI) with a documented intake and output (including frequency and amounts of output) on three shifts a day. UTIs that were diagnosed, treated and resolved outside the facility and are no longer symptomatic and UTIs identified by urinalysis alone are excluded. The signs, symptoms, interventions and measures taken to prevent recurrence must be documented in the assessment period.

(v)

Incontinence or a Foley catheter, with an individualized bowel or bladder rehabilitation program requiring staff intervention at least three times per day. The program must assess the cause of the incontinence and the rehabilitative potential, and document the interventions and outcomes. The care plan must include the individualized goals and approaches that reflect both the resident and nursing participation in the process. Frequency of staff intervention must be documented.

(vi)

Oxygen [ Daily oxygen ] administration, which must be documented on a daily basis during [ in ] the assessment period. One day of oxygen use is excluded from reimbursement as a daily oxygen charge.

(vii)

Respiratory therapy, ordered by a physician, performed by licensed nursing staff or a respiratory therapist, received at least three times per day, and documented in the assessment period. Respiratory therapy includes nebulizers, percussion, cupping, postural drainage, updrafts, and intermittent positive pressure breathing (IPPB) treatments, but excludes inhalers.

(viii)

Wound dressing applied to an open wound at least two times per day, excluding simple skin tears and closed abrasions. A description of the wound and the treatment, including frequency, must be documented in the assessment period.

(D)

The clinically stable group. This clinical group includes all recipients who do not qualify clinically for the heavy-care, rehabilitation/restorative, or clinically unstable group, and who have an ADL score between 3 and 9. The clinically stable group includes a mental/behavioral condition subgroup. A recipient qualifies for this subgroup if:

(i)

they have an ADL score of exactly three; and

(ii)

they have at least one of the following cognitive or behavioral characteristics:

(I)

incoherent/frequent disorientation requiring daily staff intervention. Orientation problems must be described in the clinical record in the assessment period, including the staff intervention required and its frequency; or

(II)

[ daily ] disruptive or aggressive behavior, requiring immediate staff intervention on a daily basis . The behaviors must be described in the clinical record, in the assessment period, including the frequency and the required staff intervention.

(4)

Computation of the ADL scale. The ADL scale is used to assess recipients' daily functional abilities in eating, transferring and toileting. The facility nurse assessors rate these activities with a value of one to five on the CARE form. The CARE form values are recoded by DHS into a three-point system. The recoding results in points that range from one to three for each item and totals from three to nine for all three items. A recipient's total points for all three ADLs are used to determine case-mix classifications within the clinical categories. The ADLs and their corresponding points on the TILE nine-point scale are:

(A)

Transferring, or the process of moving between positions, such as to or from a bed, a chair, or a standing position, but excluding to and from the toilet.

(i)

One TILE point is given for recipients rated as:

(I)

Independent; no staff assistance required, but recipient may use equipment such as railings, trapeze, etc.

(II)

Pro re nata (PRN); recipient requires PRN assistance for transfers.

(ii)

Two TILE points are given for recipients rated as "one to transfer"; requires one person continuously for physical or verbal assist on 60% or more of the transfers. When assistance is required and for what reason must be documented in the assessment period.

(iii)

Three TILE points are given for recipients rated as:

(I)

Two to transfer; requires assistance of two or more staff during the entire activity on 60% or more of the transfers. When assistance is required and for what reason must be documented in the assessment period.

(II)

Not Transferred; may be transferred to a stretcher or chair once a week or less, excluding transfers to bath or toilet.

(B)

Eating, including the use of an enteral or parenteral tube, but excluding tray set up and food preparation.

(i)

One TILE point is given for recipients rated as:

(I)

Independent or recipient has chosen not to receive nutrition.

(II)

Intermittent assistance; requires verbal or physical assistance less than 60% of the time.

(ii)

Two TILE points are given for recipients rated as:

(I)

Being trained to feed themselves. An assessment of the retraining potential and a description of the training program must be documented in the clinical record in the assessment period. The retraining program must include a minimum of training at two meals per day.

(II)

Requiring assistance to syringe or spoon-feed [ spoon feed ] for 60% or more of the time. The type of assistance, when the assistance is required, and for what reason must be documented in the clinical record.

(iii)

Three TILE points are given for recipients rated as receiving non-oral feedings for 60% or more of the recipient's nutrition using a tube such as a naso-gastric tube, gastrostromy tube, percutaneous endoscopic gastrostromy tube, or administration of total parenteral nutrition via a central line. The frequency, amounts, routes, and times the non-oral feedings were administered must be documented in the clinical record.

(C)

Toileting, or the process of elimination including the use of a bedpan, urinal, bedside commode, or toilet, or ostomy or incontinent care.

(i)

One TILE point is given for recipients rated as:

(I)

Independent, including the use of special equipment or performing of own incontinent care, self-catheterization, ostomy care.

(II)

Requires assistance but can be left alone for privacy. Assistance may include transferring on and off the commode, cleansing after elimination, adjusting clothing, or washing hands.

(ii)

Two TILE points are given for recipients rated as incontinent or having an indwelling catheter, including staff-administered ostomy care, incontinence care using protective padding, incontinence briefs, changing clothes, or a propped urinal. A description of what staff are required to do 60% or more of the time must be documented in the clinical record.

(iii)

Three TILE points will be given for recipients rated as:

(I)

Requiring physical or verbal assist or supervision during entire toileting process, excluding incontinent care, and cannot be left alone. The functional, medical, or behavioral reason the recipient cannot be left alone must be documented in the clinical record in the assessment period.

(II)

Receiving scheduled toileting by the staff every two hours during waking hours, or more often if needed by the resident, as incontinence management. Recipient does not initiate process and stays dry 60% or more of the time as the result of staff-initiated scheduled toileting. A description of staff actions and whether the resident was wet or dry each time he/she was taken to the toilet must be documented in the clinical record in the assessment period. Recipients who receive in and out catheterization by the staff two or more times each day are included in this category.

(5)

Special cases. A recipient who qualifies for more than one of the 11 TILE case-mix groups is classified in the group with the highest case-mix index and associated per diem rate. If a provider incorrectly or incompletely reports data necessary for TILE determination, the recipient is temporarily classified in the Default TILE 212 [ default ] group until the data are corrected as provided by §371.214 of this title .

(6)

Case-mix classifications. Case-mix classifications are determined by the clinical group in combination with the ADL score as follows:

(A)

TILE 201; heavy care and an ADL score of 8-9;

(B)

TILE 203; heavy care and an ADL score of 6-7;

(C)

TILE 202; rehabilitation and an ADL score of at least 3;

(D)

TILE 204; clinically unstable and an ADL score of 7-9;

(E)

TILE 205; clinically stable and an ADL score of 7-9;

(F)

TILE 206; clinically unstable and an ADL score of 4-6;

(G)

TILE 207; clinically stable and an ADL score of 5-6;

(H)

TILE 208; clinically unstable and an ADL score of 3;

(I)

TILE 209; clinically stable and an ADL score of 4;

(J)

TILE 210; clinically stable, an ADL score of exactly 3, and includes a mental/behavioral subcategory;

(K)

TILE 211; clinically stable and an ADL score of 3;

(L)

Default TILE 212 ; provider incorrectly or incompletely reports data necessary for TILE determination or if the facility fails to cooperate fully with nurse reviewers as provided by §371.214 of this title .

(7)

Required signatures. The Texas Nursing Facility CARE [ assessment ] form must be signed by the director of nurses [ or the acting director of nurses ] and the facility nurse assessor, one of whom has received TILE training, as required by §371.214 [ §19.2412 ] of this title (relating to Texas Index for Level of Effort (TILE) Assessments). If the form is completed for a hospice recipient residing in the nursing facility, the form must also be signed by a hospice nurse assessor. These signatures certify the information claimed is accurate and complete and subject to penalties for falsification, as provided in 42 Code of Federal Regulations, Part 1003. A copy of the electronically transmitted form with the required signatures must be maintained by the nursing facility.

§371.213.Utilization Review and Control Activities Performed by Texas Health and Human Services Commission (Commission) [ Texas Department of Human Services (DHS) ] .

(a)

According to state law [ federal regulations ] and the state plan [ State Plan ] requirements, the Texas Health and Human Services Commission (Commission) [ Texas Department of Human Services (DHS) ] staff conducts [ conduct ] required on-site activities related to utilization review [ and utilization control ].

(b)

Facility staff must cooperate with and fully support the Commission [ DHS ] staff during on-site reviews and facilitate [ inspections for the purpose of ] personal contact with and observation of each resident and the review of each resident's clinical records.

§371.214.Texas Index for Level of Effort (TILE) Assessments.

(a)

Nursing facility [ Recipient assessment. Facility ] nurse assessors assess recipients for TILE determination by completing Texas Nursing Facility Client Assessment, Review, and Evaluation (CARE) forms. The nursing facility and hospice nurse assessors jointly assess hospice recipients who are residing in nursing facilities for TILE determination by completing the Texas Nursing Facility CARE forms. Hospice recipients residing in nursing facilities must have all eligibility forms submitted prior to Texas Department of Human Services (DHS) paying nursing facility room and board to the hospice provider. These assessments establish TILE classifications as described in paragraphs (1)-(8) of this subsection. Nursing facility [ Effective April 1, 1995, ] nurse assessors must complete and pass the Texas Health and Human Services Commission (Commission) [ have completed a Texas Department of Human Services (DHS) ] TILE training course with a minimum score of 70%. The nurse's license number will [ and must ] be registered with the National Heritage Insurance Company (NHIC). Hospice nurse assessors may complete the Commission's Texas TILE training course.

(1)

Preadmission assessments do not establish a TILE classification.

(2)

Admissions assessments establish TILE classifications as follows:

(A)

If the nursing facility resident has not previously attained a permanent medical necessity or if an individual is simultaneously admitted to a nursing facility as a hospice recipient , the nurse assessor submits an admission assessment within 20 calendar days of admission, as provided in the Texas Administrative Code (TAC), Title 40, Part 1, Chapter 19, Subchapter Y, §19.2403 (relating to Utilization Review Process). The admission assessment establishes a medical necessity (MN) and a TILE classification for 180 days.

(B)

If the nursing facility resident has previously attained a permanent MN, the admission assessment is completed on an abbreviated form, which [ form which ] sets TILE only.

(3)

One medical necessity review (MNR) is required 180 days after the effective date of the admission assessment. If the MNR indicates an MN for nursing facility care, DHS will notify the facility of the permanent MN. This notification becomes a part of the resident's permanent medical record. A permanent MN will be lost only if a resident is discharged to home for over 30 days. The MNR may also establish a new TILE classification.

(4)

After the establishment of permanent MN, residents with a 211 TILE require no further assessment unless there is a change in their condition. All other TILE levels require a review every 180 days.

(5)

If a recipient's medical condition changes [ deteriorates ] to the extent that he qualifies for a different TILE, [ the provider may submit ] an off-cycle assessment may be submitted. If a nursing facility resident becomes a hospice recipient, an off-cycle assessment must be submitted. Only two off-cycle assessments for any one nursing facility resident or hospice recipient residing in a nursing facility [ recipient ] are permitted per calendar year, one from January through June and one from July through December. The off-cycle assessment for a nursing facility resident that becomes a hospice recipient is not included in the two allowable off-cycle assessments. The assessment sets a new schedule for submission of forms if permanent MN has been achieved. Before [ Prior to ] permanent MN, the assessment will not set a new schedule for submission of forms.

(6)

A new CARE form may be submitted for the purpose of correcting [ allowing a provider to correct ] errors previously made in the assessment portion of the form (Items 30, 31, and 50-99). The submission of the correction does not change the schedule for submission of forms or necessarily change the TILE group. Corrections must be submitted within 60 days from the date of assessment on the incorrect form. The Commission [ DHS ] will not accept requests for changes submitted:

(A)

over 60 days from the date of assessment on the incorrect form; or

(B)

after notification of an on-site review date.

(7)

If a recipient experiences a significant change related to mental illness, mental retardation, and/or a related condition that [ which ] indicates that the recipient might benefit from specialized services, a [ an off-cycle ] request for a recipient Preadmission Screening and Resident Review (PASARR) must be submitted to the local DHS' [ DHS ] PASARR office using a CARE form.

(8)

A facility may submit a request for retroactive payment in the following instances:

(A)

when a facility provides care for a recipient for a period of time not covered by an effective MN determination at admission or by assessment CARE forms as provided in TAC, Title 40, Part 1, Chapter 19, Subchapter Y, §19.2413 (relating to Reconsideration of Medical Necessity Determination and Effective Dates) [ between reviews (see §19.2413 of this title (relating to Reconsideration of Medical Necessity Determination and Effective Dates)) ]; or

(B)

if a recipient is found to be otherwise eligible for Medicaid for the three months prior to the month of his date of application for Medicaid assistance as provided in TAC, Title 40, Part 1, Chapter 19, Subchapter Y, §19.2408 (relating to Retroactive Medical Necessity Determinations) [ (see §19.2408 of this title (relating to Retroactive Medical Necessity Determinations)) ].

(C)

The effective date for a retroactive payment for a hospice recipient may not be prior to June 1, 2001.

(b)

Nursing facilities with new directors of nurses, nurse managers and nurse assessors may request a one time 60-day waiver to complete the TILE assessments. At the end of the 60-day waiver period, the nursing facility director of nurses, nurse manager and nurse assessor must complete and pass the Commission TILE training course with a minimum score of 70%. The Commission assumes cost for the initial TILE training course. The facility or individual shall assume the cost of any additional required training and testing for the same individual.

(c)

[ (b) ] Review and appeal of case-mix assessments. Commission [ DHS ] nurse reviewers conduct desk reviews and in-depth, on-site reviews of Texas Nursing Facility CARE forms completed by nursing facility and hospice staff [ providers ] to verify TILE and medical necessity information. The assessment forms and the entire medical record of a minimum of ten Medicaid recipients, excluding TILE 211, will be reviewed[ , unless the low census of a nursing facility precludes the review of ten forms ]. Forms expired over 12 months will not be reviewed.

(1)

Commission [ DHS ] nurse reviewers will notify nursing facilities and hospice providers a minimum of two working days prior to [ facilities in advance of ] routine on-site visits . They will be given information regarding the recipients whose medical records will be reviewed, the time period covered by the review[ , the parts of the record to be reviewed, ] and the accommodations necessary for the review. No [ Facilities receive a minimum of two working days' notice prior to a routine visit. Less than two days ] notice is required for [ may be given to ] facilities whose last two on-site visits resulted in corrective action; [ monitoring, compliance, or vendor hold. No notice is required for ] visits for investigation of TILE issues, including suspected fraud ; [ , ] or [ for ] visits requested by another state agency. For routine onsite visits, nurse reviewers must be given prompt access to all information and resources necessary to conduct the TILE review. Failure to do so may result in the nursing facility being classified in the Default TILE 212 until the visit can be conducted. This is not applicable in the event of unforeseen environmental conditions. [ If nurse reviewers are prevented from conducting a review based on a facility's actions, TILE rates on the recipients chosen for review will be lowered to the default TILE rate until the review can be accomplished. ]

(2)

When a Commission [ DHS ] nurse reviewer determines that the TILE classification [ or permanent MN determination ] is not substantiated and/or does not accurately reflect the recipient's status, the reviewer will discuss the error and give the provider an opportunity to submit additional documentation to support the item claimed. [ propose corrections with facility staff and make appropriate corrections during the review. ] An exit conference is held with the nursing facility staff following the review. Hospice staff may attend if hospice recipients are reviewed. Additional documentation to support nursing facility resident and hospice recipient [ the facility's ] assessments may be presented at any time during the review process or the exit conference, and adjustments may be made. The nursing facility administrator and hospice provider are [ is ] given formal notification of all TILE changes within 15 working days of the exit conference.

(A)

At the direction of the Commission, DHS recoups funds previously paid to the nursing facility and hospice provider under incorrect TILE classification. At the direction of the Commission, DHS pays the nursing facility and the hospice provider any increase due to a change in TILE classification.

(B)

The change in TILE classification and per diem rate is effective retroactively to the "effective date" of the assessment reviewed.

[(C)

The change in MN determination is effective on the date of the review. If discharge results, the procedures in §19.502 of this title (relating to Transfer and Discharge) must be followed.]

(3)

If a Commission [ DHS ] nurse reviewer and a facility or hospice nurse assessor are unable to agree about an assessment, either provider [ the provider ] may submit a reconsideration request to the Commission's state office nurse specialist. [ request a reconsideration by a DHS nurse supervisor. ]

(A)

The request for the reconsideration and all documentation supporting the requested changes must be received by the state office nurse specialist [ regional nurse supervisor ] within 15 days of receipt of formal notification of TILE changes.

(B)

The [ regional nurse supervisor or a ] state office nurse will review all material submitted by the provider and all information collected during the Utilization Review. [ and Assessment Review (UAR) review. ]

(C)

The TILE classification and associated per diem rate specified by the Commission [ DHS ] nurse reviewer remain in effect during the reconsideration period.

(D)

If the reconsideration establishes that the Commission [ DHS ] has changed a TILE classification in error, the Commission will direct DHS to correct [ corrects ] the error retroactively.

(4)

If the provider disagrees with the findings of the state office nurse specialist [ regional nurse supervisor ], the provider may initiate a formal appeal, as stated in Chapter 79, Subchapter Q of this title (relating to Contract Appeals Process) by submitting a request to the Director, Hearings Department, Mail Code W-613, Texas Department of Human Services, P.O. Box 149030, Austin, Texas 78714-9030 within 15 days of receipt of notification of the results of the reconsideration.

(A)

The TILE classification and associated per diem rate specified by the state office nurse specialist [ regional nurse supervisor ] remain in effect during the formal contract appeal.

(B)

If the contract appeal process establishes that the Commission [ DHS ] has changed a TILE classification in error, the Commission will direct DHS to correct [ corrects ] the error retroactively.

(d)

[ (c) Monitoring. ] TILE error rates on the assessment forms reviewed which exceed 20% may result in a facility's undergoing a monitoring period. [ Decisions to institute monitoring will be made by the Utilization and Assessment Review (UAR) staff in state office. ]

(1)

During the monitoring period, nursing facilities may not [ must ] submit Texas Nursing Facility CARE forms to NHIC either electronically or by mail. All [ all ] Texas Nursing Facility CARE forms , which include both nursing facility residents and hospice recipients residing in nursing facilities, must be submitted to the Commission [ to DHS ] nurse reviewers. [ Forms may not be submitted to NHIC either electronically or by mail. ]

(2)

The length of the monitoring period is 60 days. If accuracy of forms is still at an unacceptable level at the end of 60 days, the Commission [ DHS ] may give a one-time, 30-day extension, if the facility has shown an attempt to improve their accuracy. If forms are not accurate at the end of 90 days, the Commission [ DHS ] places the facility on compliance.

(e)

[ (d) Compliance. ]

[ (1)

A decision to place a facility on compliance will be made by UAR staff in state office. ] Compliance may result when a facility has a 20% or greater error rate on the current assessment forms reviewed and one of the following:

[ (A) ]

a 20% or greater error rate by the end of a monitoring period;

[ (B) ]

lack of documentation regarding key assessment items;

[ (C) ]

a history of noncompliance;

[ (D) ]

or medical records that [ which ] contain alterations in areas designed to lower the TILE level and increase the payment.

(1)

[ (2) ] Within a 30 to 45-day [ 30-day ] compliance period, facilities must complete new Texas Nursing Facility CARE [ assessment ] forms on all recipients not in the original review. [ Facilities may not submit forms to NHIC electronically or by mail. ]

(2)

During the compliance period, facilities may not submit Texas Nursing Facility CARE forms to NHIC either electronically or by mail. All Texas Nursing Facility CARE forms, which include both nursing facility residents and hospice recipients residing in nursing facilities, must be submitted to Commission nurse reviewers.

(f)

[ (3) ] If a facility has a 20% or greater error rate by the end of the compliance period, the Commission will direct DHS to hold vendor payments to the facility [ will be held ] until the facility has less than a 20% error rate. A decision to place a facility on vendor hold will be made by UR staff in state office.

(g)

[ (4) ] The nursing facility nurse assessor and the director of nurses must complete and pass the Commission [ attend a DHS ] TILE training course with a minimum score of 70% within 60 days of the beginning of the compliance period or vendor hold . If a score of 70% or higher is not achieved by the director of nurses or facility nurse assessor, the nursing facility will remain on corrective action until such time as the acceptable score of 70% is achieved.

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 April 16, 2001.

TRD-200102131

Marina S. Henderson

Executive Deputy Commissioner

Texas Health and Human Services Commission

Earliest possible date of adoption: May 27, 2001

For further information, please call: (512) 424-6576