Part 4. OFFICE OF THE SECRETARY OF STATE
Chapter 73. STATUTORY DOCUMENTS
Subchapter A. LABOR ORGANIZERS
The Office of the Secretary of State proposes an amendment to 1 TAC §73.3, concerning labor organizer's card. The amendment is proposed in response to a public comment which noted an inaccurate reference to the state seal under paragraph (5) of the section.
The paragraph now reads: "the signature of the secretary of state, dated and attested by his seal of office." As pointed out by the commenter during a formal review of Secretary of State rules, the "seal" is not the seal of office for the secretary of state. It is the State Seal of Texas as defined by the Texas Constitution, Article IV, Section 19.d. The amendment is proposed to correct this error.
Linda Stout, Director of the Statutory Documents Section, has determined that for each year of the first five years that the section is in effect there will be no fiscal implications to state or local governments as a result of enforcing or administering the amendment as proposed.
Ms. Stout also has determined that for each year of the first five years the section is in effect the public benefit anticipated as a result of enforcing or administering the section as proposed will be to correct the reference to the state seal in the Secretary of State rule. There will be no effect on small or micro businesses. There is no anticipated economic cost to persons who are required to comply with the proposed rule.
Comments on the proposed amendment may be submitted in writing to: Linda Stout, Office of the Secretary of State, Statutory Documents Section, 1019 Brazos Street, Room 214, Austin, Texas 78701. Comments must be received not later than 12 noon, Monday, June 16, 2008.
Statutory Authority: §2001.004(1) of the Government Code.
The rule implements §101.110 of the Labor Code.
§73.3.Organizer's Card.
Upon receipt of a complete and signed application, the secretary of state shall issue an organizer's card to the applicant. The card shall bear the following information:
(1) - (4) (No change.)
(5) the signature of the secretary of state, dated
and attested by the state seal [his seal of office].
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 May 1, 2008.
TRD-200802333
Lorna Wassdorf
Director of Business and Public Filings Division
Office of the Secretary of State
Earliest possible date of adoption: June 15, 2008
For further information, please call: (512) 463-5705
Chapter 355. REIMBURSEMENT RATES
Subchapter A. COST DETERMINATION PROCESS
The Texas Health and Human Services Commission (HHSC) proposes to amend §355.114, concerning Consumer Directed Services Payment Option.
Background and Justification
The proposed amendment to §355.114 describes the reimbursement methodology for Support Consultation services. This rule does not apply to Department of Aging and Disability Services' (DADS) program rules.
The DADS implemented the Consumer Directed Services (CDS) option in September 2001, in response to Senate Bill 1586, 76th Legislature, Regular Session, 1999. The CDS option allows consumers or their legal guardians to be employers of record for the service providers. Thus, as participants in CDS, consumers have greater control and responsibility for their care and are able to self-direct their services. Consumers who participate in CDS choose a CDS Agency (CDSA) to provide financial management services such as payroll processing, assistance with developing a budget, and guidance to the consumer acting as an employer.
The CDS option is available in the following programs:
* Community Based Alternatives (CBA);
* Community Living Assistance and Support Services (CLASS);
* Deaf-Blind-Multiple Disability Waiver (DBMD);
* Primary Home Care (PHC);
* Consumer Managed Personal Assistance Services (CMPAS);
* Medically-Dependent Children's Program (MDCP);
* Home and Community Based Services (HCS); and
* Texas Home Living (TxHmL).
The DADS is adding Support Consultation services to the CDS option. Support Consultation services help a consumer meet the required employer responsibilities associated with CDS participation. Support Consultation services provide a higher level of assistance and training to the consumer than the CDSA, including skills training, assistance with completing required documents, and coaching on various employer tasks. A Support Advisor provides the Support Consultation services.
Support Consultation services became available in the HCS and TxHmL waivers effective February 1, 2008. It is scheduled to be implemented in PHC and the other waiver programs over the next year, pending CMS approval.
Section-by-Section Summary
The amendment creates a new subsection (c), which explains that the hourly payment rate for Support Consultation services is determined by modeling the estimated costs to carry out these responsibilities. The hourly payment rate for Support Consultation services is determined by modeling the cost of providing this service, as defined by the DADS, using staff costs and other statistics from the most recently audited cost reports from providers for staff whose required qualifications are similar to the qualifications required for individuals delivering Support Consultation services.
Fiscal Note
Gordon E. Taylor, Chief Financial Officer for the DADS, has determined that, for the first five-year period the proposed amendment is in effect, there is no fiscal implication for state government as a result of enforcing or administering the section. There are no fiscal implications for local governments as a result of enforcing or administering the section.
Small Business and Micro-business Impact Analysis
Mr. Taylor has also determined that there will be no adverse economic effect on small or micro-businesses as a result of enforcing or administering the proposed section. There is no anticipated economic cost to persons who are required to comply with the proposed section. There is no anticipated effect on local employment in geographic areas affected by this section.
Public Benefit and Costs
Carolyn Pratt, Director of Rate Analysis, has determined that, during the first five years the proposed amendment is in effect, the public benefit anticipated as a result of enforcing §355.114 is that it will allow the state to determine an appropriate rate for Support Consultation services based on the modeled cost of providing services with employees whose required qualifications are similar to those of the Support Advisor.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule" as defined by §2001.0225 of the Texas Government Code. A "major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk 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 a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under §2007.043 of the Government Code.
Public Comment
Written comments on the proposal may be submitted to Sarah Hambrick in the Rate Analysis Division, Texas Health and Human Services Commission, P.O. Box 85200, Austin, Texas 78708-5200; by fax (512) 491-1998 or by e-mail at sarah.hambrick@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas Register.
Statutory Authority
The amendment is proposed under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and the Human Resources Code, §32.021, and the Texas Government Code, §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas.
The proposed amendments to the current rules affect the Human Resources Code Chapter 32, and the Texas Government Code Chapter 531. No other statutes, articles, or codes are affected by this proposal.
§355.114.Consumer Directed Services Payment Option.
(a) For all programs providing consumer directed services (CDS) except the Home and Community-based Services (HCS) program:
(1) The monthly payment to the contracted CDS agency is determined by modeling the estimated cost to carry out the responsibilities of the CDS agency.
(2) The rates for CDS that provide the funds available to the consumers participating in CDS are modeled and are based on the payment rates paid to contracted agencies for providing services to consumers who do not participate in CDS, and then removing from those rates amounts needed to fund CDS agencies responsibilities.
(3) The sum of the payments to the contracted CDS agencies for a 12-month period and the funds available to the consumers participating in CDS for the same 12-month period will not exceed, in the aggregate, the amount that would have been paid to agencies for the same 12 month period if the consumers were not participating in CDS.
(b) For the HCS program:
(1) The monthly payment to the contracted CDS agency is determined by modeling the estimated cost of carrying out the responsibilities of the CDS agency.
(2) The rates for CDS that provide the funds available to the consumer participating in CDS are modeled and are based on the direct care costs plus a portion of the operating costs included in the HCS rate.
(3) The monthly payment to the contracted CDS agency for a 12-month period and the funds available to the consumer participating in CDS for that same 12-month period will not exceed the amount that would have been paid to an agency for the same 12 month period if the consumer was not participating in CDS.
(c) Support Consultation services. The hourly payment rate for Support Consultation services is determined by modeling the cost of providing this service, as defined by the Department of Aging and Disability Services, using staff costs and other statistics from the most recently audited cost reports from providers for staff whose required qualifications are similar to the qualifications required for individuals delivering Support Consultation services. The requirements for a Support Advisor are found at 40 TAC §41.603 (relating to Support Advisor Qualifications).
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 May 1, 2008.
TRD-200802306
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: June 15, 2008
For further information, please call: (512) 424-6576
The Texas Health and Human Services Commission (HHSC) proposes to amend §355.503, Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs.
Background and Justification
This rule establishes the reimbursement methodology for the Community-Based Alternatives (CBA) waiver program and the Integrated Care Management-Home and Community Support Services (ICM-HCSS) and Assisted Living/Residential Care (AL/RC) programs. The CBA waiver program and the ICM-HCSS program include in their service arrays out-of-home respite care delivered in a nursing facility. HHSC, under its authority and responsibility to administer and implement rates, is updating these rules to replace a reference in subsection (d)(2)(C) to the Texas Index for Level of Effort (TILE) case mix class with a general reference to the Nursing Facility (NF) case mix class. This will allow HHSC to continue to reimburse out-of-home respite care provided in a nursing facility.
The Texas Medicaid nursing facility program currently uses the TILE case mix system to establish nursing facility reimbursement rates. Effective September 1, 2008, HHSC will replace the TILE case mix system with the Resource Utilization Groups (RUG) case mix system for setting nursing facility reimbursement. Reimbursement rates for CBA and ICM-HCSS out-of-home respite currently are based on nursing facility TILE rates. Because of the change to the nursing facility case mix system, the CBA and ICM-HCSS out-of-home respite reimbursement methodology must be revised to remove the reference to TILE. This proposed amendment replaces the reference to TILE with a general reference to the nursing facility case mix system.
Reimbursement for out-of-home respite services may increase or decrease at the individual provider level as a result of this amendment. Increases and decreases will depend on the TILE classifications of each provider's out-of-home respite clients prior to the effective date of the amendment and the RUG classifications of those same clients after the effective date of the amendment. The change to any individual provider's overall average reimbursement will be negligible because out-of-home respite units of service make up such a small percentage of the total units of service provided under these programs. The amendment will not have a fiscal impact overall.
Section-by-Section Summary
The amendment revises subsection (d)(2)(C) to indicate that reimbursement for out-of-home respite care provided in a nursing facility will be based on the nursing facility case mix class in which the CBA or ICM-HCSS participant is classified. Effective September 1, 2008, nursing facilities will use the RUG case mix system to set nursing facility rates.
Fiscal Note
Gordon E. Taylor, Chief Financial Officer for the Department of Aging and Disability Services, has determined that there will not be a fiscal impact to state government during the first five-year period the amended rule is in effect. The proposed rule will not result in any fiscal implications for local health and human services agencies. There are no fiscal implications for local governments as a result of enforcing or administering the section.
Small Business and Micro-business Impact Analysis
HHSC has determined that there is no adverse economic effect on small businesses or micro-businesses as a result of enforcing or administering the amendment. The implementation of the proposed rule amendment does not require any changes in practice or any additional cost to the contracted provider.
HHSC does not anticipate that there will be any economic cost to persons who are required to comply with this amendment. The amendment will not affect local employment.
Public Benefit
Carolyn Pratt, Director of Rate Analysis, has determined that, for each of the first five years the amendment is in effect, the expected public benefit is that CBA and ICM-HCSS out-of-home respite rates will be based on a case mix classification system that reflects more current practice patterns which will, in turn, lead to a more equitable distribution of payments across different types of participants with differing needs.
Takings Impact Assessment
HHSC has determined that this proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.
Regulatory Analysis
HHSC has determined that this proposal is not a "major environmental rule" as defined by §2001.0225 of the Texas Government Code. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk 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 a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.
Public Comment
Questions about the content of this proposal may be directed to Pam McDonald in the HHSC Rate Analysis Department by telephone at (512) 491-1373. Written comments on the proposal may be submitted to Ms. McDonald by facsimile at (512) 491-1998, by e-mail to pam.mcdonald@hhsc.state.tx.us, or by mail to HHSC Rate Analysis, Mail Code H-400, P.O. Box 85200, Austin, Texas 78708-5200, within 30 days of publication of this proposal in the Texas Register.
Statutory Authority
The amendment is proposed under Texas Government Code §531.033, which authorizes the Executive Commissioner of HHSC to adopt rules necessary to carry out the commission's duties; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and Texas Government Code §531.021(b), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for medical assistance payments under the Human Resources Code, Chapter 32.
The amendment affects Texas Government Code Chapter 531 and Texas Human Resources Code Chapter 32. No other statutes, articles, or codes are affected by this proposal.
§355.503.Reimbursement Methodology for the Community-Based Alternatives Waiver Program and the Integrated Care Management-Home and Community Support Services and Assisted Living/Residential Care Programs.
(a) General requirements. The Texas Health and Human Services Commission (HHSC) applies the general principles of cost determination as specified in §355.101 of this title (relating to Introduction).
(b) General. Texas Medicaid contracted providers will be reimbursed for waiver services provided to individuals who meet the criteria for alternatives to nursing facility care. Additionally, Texas Medicaid contracted providers will be reimbursed for a pre-enrollment assessment of potential waiver participants. The pre-enrollment assessment covers care planning for the participant and is reimbursed by a one-time administrative expense fee which is not included in the waiver services but will be paid from Medicaid administrative funds.
(c) Other sources of cost information. If HHSC has determined that there is not sufficient reliable cost report data from which to determine reimbursements and reimbursement ceilings for waiver services, reimbursements and reimbursement ceilings will be developed by using data from surveys; cost report data from other similar programs, consultation with other service providers and/or professionals experienced in delivering contracted services; and other sources.
(d) Waiver reimbursement determination. Recommended reimbursements are determined in the following manner.
(1) Unit of service reimbursement. Reimbursement for personal assistance services, nursing services provided by a registered nurse (RN), nursing services provided by a licensed vocational nurse (LVN), physical therapy, occupational therapy, speech pathology, and in-home respite care services will be determined on a fee-for-service basis in the following manner.
(A) Total allowable costs for each provider will be determined by analyzing the allowable historical costs reported on the cost report.
(B) Total allowable costs are reduced by the amount of the pre-enrollment expense fee and requisition fee revenues accrued for the reporting period.
(C) Each provider's total reported allowable costs, excluding depreciation and mortgage interest, are projected from the historical cost-reporting period to the prospective reimbursement period as described in §355.108 of this title (relating to Determination of Inflation Indices). The prospective reimbursement period is the period of time that the reimbursement is expected to be in effect.
(D) Payroll taxes and employee benefits are allocated to each salary line item on the cost report on a pro rata basis based on the portion of that salary line item to the amount of total salary expense for the appropriate group of staff. Employee benefits will be charged to a specific salary line item if the benefits are reported separately. The allocated payroll taxes are Federal Insurance Contributions Act (FICA) or Social Security, Medicare Contributions, Workers' Compensation Insurance (WCI), the Federal Unemployment Tax Act (FUTA), and the Texas Unemployment Compensation Act (TUCA).
(E) Allowable administrative and facility costs are allocated or spread to each waiver service cost component on a pro rata basis based on the portion of each waiver service's units of service to the amount of total waiver units of service.
(F) For nursing services provided by an RN, nursing services provided by an LVN, physical therapy, occupational therapy, speech pathology, and in-home respite care services, an allowable cost per unit of service is calculated for each contracted provider for each service. The allowable costs per unit of service for each contracted provider are arrayed. The units of service for each contracted provider in the array are summed until the median unit of service is reached. The corresponding expense to the median unit of service is determined and is multiplied by 1.044. The allowable costs per unit of service may be combined into an array with the allowable cost per unit of service of similar services provided by other programs in determining the weighted median cost per unit of service.
(G) For personal assistance services two cost areas are created:
(i) The attendant cost area includes salaries, wages, benefits, and mileage reimbursement calculated as specified in §355.112 of this title (relating to Attendant Compensation Rate Enhancement).
(ii) Another attendant cost area is created which includes the other personal attendant services costs not included in subparagraph (G)(i) of this paragraph as determined in subparagraphs (A) - (E) of this paragraph. An allowable cost per unit of service is determined for each contracted provider for the other attendant cost area. The allowable costs per unit of service for each contracted provider are arrayed. The units of service for each contracted provider in the array are summed until the median unit of service is reached. The corresponding expense to the median unit of service is determined and is multiplied by 1.044.
(iii) The attendant cost area and the other attendant cost area are summed to determine the personal assistance services cost per unit of service.
(2) Per day reimbursement.
(A) The reimbursement for Adult Foster Care (AFC) and out-of-home respite care will be determined as a per day reimbursement using a method based on modeled projected expenses which are developed by using data from surveys; cost report data from other similar programs, consultation with other service providers and/or professionals experienced in delivering contracted services; and other sources. The room and board payments for AFC Services are not covered in these reimbursements and will be paid to providers from the client's Supplemental Security Income, less a personal needs allowance.
(B) The reimbursement for Assisted Living/Residential Care (AL/RC) will be determined as a per day reimbursement in accordance with §355.509(a) - (c)(2)(F)(iii) of this title (relating to Reimbursement Methodology for Residential Care). The per day reimbursement for attendant care will be determined, based upon client need for attendant care into six levels of care. A total reimbursement amount will be calculated and the proposed reimbursement is equal to the total reimbursement less the client's room and board payments. The room and board payment is paid to the provider by the client from the client's Supplemental Security Income (SSI), less a personal needs allowance. When the SSI is increased or decreased by the Federal Social Security Administration, the reimbursement for AL/RC will be adjusted in amounts equal to the increase or decrease in SSI received by clients.
(C) The reimbursement for out-of-home respite care
provided in a Nursing Facility will be based on the amount determined
for the Nursing Facility case mix class into which [
Texas Index of Level of Effort (TILE) for] the CBA participant
is classified.
(D) The reimbursement for Personal Care III will be composed of two rate components, one for the direct care cost center and one for the non-direct care cost center.
(i) Direct care costs. The rate component for the direct care cost center will be determined by modeling the cost of the minimum required staffing for the Personal Care III setting, as specified by the Department of Aging and Disability Services, and using staff costs and other statistics from the most recently audited cost reports from providers delivering similar care.
(ii) Non-direct care costs. The rate component for the non-direct care cost center will be equal to the non-attendant portion of the non-apartment assisted living rate per day for non-participants in the Attendant Compensation Rate Enhancement. Providers receiving the Personal Care III rate are not eligible to participate in the Attendant Compensation Rate Enhancement and receive direct care add-on's to the Personal Care III rates.
(3) Monthly reimbursement ceilings. The reimbursement for Emergency Response Services will be determined as monthly reimbursement ceiling, based on the ceiling amount determined in accordance with 40 TAC §52.504 (relating to Reimbursement Methodology for Emergency Response Services (ERS)). The reimbursement for Home-Delivered Meals will be determined on a per meal basis, based on the ceiling amount determined in accordance with 40 TAC §55.45 (relating to Reimbursement Methodology for Home-Delivered Meals).
(4) Requisition fees. Requisition fees are reimbursements paid to the CBA home and community support services contracted providers for their efforts in acquiring adaptive aids and minor home modifications for CBA participants. Reimbursement for adaptive aids and minor home modifications will vary based on the actual cost of the adaptive aid and minor home modification. Reimbursements are determined using a method based on modeled projected expenses which are developed by using data from surveys; cost report data from similar programs; consultation with other service providers and/or professionals experienced in delivering contracted services; and/or other sources.
(5) Pre-enrollment expense fee. Reimbursement for pre-enrollment assessment is determined using a method based on modeled projected expenses that are developed by using data from surveys; cost report data from other similar programs; consultation with other service providers and/or professionals experienced in delivering contracted services; and other sources.
(6) Specialized nursing reimbursement add-on. A specialized nursing reimbursement add-on will be paid in addition to the unit-of-service reimbursements for skilled nursing services provided by an RN or by an LVN. The specialized nursing reimbursement add-on is paid when a client requires, as determined by a physician, daily skilled nursing to cleanse, dress, and suction a tracheostomy or daily skilled nursing assistance with ventilator or respirator care. The client must be unable to do self-care and require the assistance of a nurse for the ventilator, respirator, or tracheostomy care. This specialized nursing reimbursement add-on will be determined in accordance with subsection (c) of this section.
(7) Exceptions to the reimbursement determination methodology. HHSC may adjust reimbursement if new legislation, regulations, or economic factors affect costs, according to §355.109 of this title (relating to Adjusting Reimbursement When New Legislation, Regulations, or Economic Factors Affect Costs).
(e) Authority to determine reimbursement. The authority to determine reimbursement is specified in §355.101 of this title (relating to Introduction).
(f) Reporting of cost.
(1) Cost reporting guidelines. If HHSC requires a cost report for any waiver service in this program, providers must follow the cost-reporting guidelines as specified in §355.105 of this title (relating to General Reporting and Documentation Requirements, Methods, and Procedures).
(2) Excused from submission of cost reports. If required by HHSC, all contracted providers must submit a cost report unless the number of days between the date the first Texas Department of Aging and Disability Services (DADS) client received services and the provider's fiscal year end is 30 days or fewer. The provider may be excused from submitting a cost report if circumstances beyond the control of the provider make cost-report completion impossible, such as the loss of records due to natural disasters or removal of records from the provider's custody by any regulatory agency. An AL/RC provider may also be excused from submitting a cost report if the total number of days serving AL/RC or Residential Care residents is 366 or fewer during its fiscal year. Requests to be excused from submitting a cost report must be received by HHSC before the due date of the cost report.
(3) Number of cost reports to be submitted. Contracted providers are required to submit one cost report per legal entity if all contracts under the legal entity participate in the attendant compensation rate enhancement in accordance with §355.112 of this title (relating to Attendant Compensation Rate Enhancement). Contracted providers who operate both contracts that are participating in the attendant compensation rate enhancement program and contracts that are not participating in the attendant compensation rate enhancement program must file two separate cost reports per legal entity, one report for the contracts that are participating in the attendant compensation rate enhancement program and one cost report for the contracts that are not participating in the attendant compensation rate enhancement.
(4) Reporting and verification of allowable cost.
(A) Providers are responsible for reporting only allowable costs on the cost report, except where cost report instructions indicate that other costs are to be reported in specific lines or sections. Only allowable cost information is used to determine recommended reimbursements. HHSC excludes from reimbursement determination any unallowable expenses included in the cost report and makes the appropriate adjustments to expenses and other information reported by providers; the purpose is to ensure that the database reflects costs and other information which are necessary for the provision of services, and are consistent with federal and state regulations.
(B) Individual cost reports may not be included in the database used for reimbursement determination if:
(i) there is reasonable doubt as to the accuracy or allowability of a significant part of the information reported; or
(ii) an auditor determines that reported costs are not verifiable.
(C) When material pertinent to proposed reimbursements is made available to the public, the material will include the number of cost reports eliminated from reimbursement determination for the reason stated in subparagraph (B)(i) of this paragraph.
(5) Allowable and unallowable costs. Providers must follow the guidelines in determining whether a cost is allowable or unallowable as specified in §355.102 and §355.103 of this title (relating to General Principles of Allowable and Unallowable Costs, and Specifications for Allowable and Unallowable Costs), in addition to the following.
(A) Client room and board expenses are not allowable, except for those related to respite care.
(B) The actual cost of adaptive aids and home modifications are not allowable for cost reporting purposes. Allowable labor costs associated with acquiring adaptive aids and home modifications should be reported in the cost report. Any item purchased for participants in this program and reimbursed through a voucher payment system is unallowable for cost reporting purposes. Refer to §355.103(17)(K) of this title (relating to Specifications for Allowable and Unallowable Costs).
(g) Reporting revenue. Revenues must be reported on the cost report in accordance with §355.104 of this title (relating to Revenues).
(h) Reviews and field audits of cost reports. Desk reviews or field audits are performed on cost reports for all contracted providers. The frequency and nature of the field audits are determined by HHSC to ensure the fiscal integrity of the program. Desk reviews and field audits will be conducted in accordance with §355.106 of this title (relating to Basic Objectives and Criteria for Audit and Desk Review of Cost Reports), and providers will be notified of the results of a desk review or a field audit in accordance with §355.107 of this title (relating to Notification of Exclusions and Adjustments). Providers may request an informal review and, if necessary, an administrative hearing to dispute an action taken under §355.110 of this title (relating to Informal Reviews and Formal Appeals).
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 May 1, 2008.
TRD-200802307
Steve Aragón
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: June 15, 2008
For further information, please call: (512) 424-6576