Part XII.
Advisory Commission on State Emergency Communications
Chapter 255.
Finance
1 TAC §255.4
The Advisory Commission on State Emergency Communications
(ACSEC) proposes an amendment to §255.4, concerning the Definition of
a Local Exchange Access Line and an Equivalent Local Exchange Access Line.
The section is being amended to implement Senate Bill 484 as passed by
the Texas Legislature. In Senate Bill 484, the 76th Texas Legislature gave
the ACSEC the responsibility and charge through rulemaking to determine what
constitutes a local exchange access line and an equivalent local exchange
access line for all 9-1-1 emergency service fees imposed statewide. The amendment
specifically provides that the definition of a local exchange access line
and an equivalent local exchange access line does not include "a line from
a telecommunications service provider to an Internet service provider for
the Internet service provider's data modem lines used only to provide its
Internet access service and that are not capable of transmitting voice messages."
The proposed amendment does not affect the authority of an emergency communication
district to charge different rates for 9-1-1 emergency service fees depending
on whether the line is a residential line, a business line, or a trunk line,
except that the emergency communication district may not impose a 9-1-1 emergency
service fee on any line that is excluded from the ACSEC definition in §255.4.
James D. Goerke, executive director, has determined that for the first
five-year period the rule is in effect there will be no fiscal implications
for state or local government as a result of enforcing or administering the
rule.
Mr. Goerke, 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
the section will be greater clarity in the administration of 9-1-1 emergency
service fees. While no historical data is available, there appears to be no
direct impact on small or large businesses. There is no anticipated economic
cost to persons who are required to comply with the section as proposed.
Comments on the amendment must be submitted in writing within 30 days after
publication of the proposal in the
Texas Register
to: James D. Goerke, Executive Director, Advisory Commission on State
Emergency Communications, 333 Guadalupe Street, Suite 2-212, Austin, Texas
78701-3942.
The amendment is proposed pursuant to the Health and Safety Code,
Chapter 771, §§771.051, 771.063, 771.071, and 771.0711.
Other statutes, articles or codes are affected by the proposed amendment
are Health and Safety Code, Chapter 772, §§772.114, 772.214, 772.314,
and 772.403.
§255.4.Definition of a Local Exchange Access Line or an Equivalent Local Exchange Access Line.
The term
"local exchange access line" or
"equivalent local
exchange access line" means any telephone line or service for which a federal
subscriber line charge is assessed by a local exchange service provider on
the customer's bill or any cellular telephone, communication channel, personal
communication system, commercial mobile radio service, cable/broadband services,
or any other wire or wireless means that connects the customer to the public
switched telecommunications network and provides the customer with ability
to reach a public safety answering point by dialing the digits 9-1-1. The
term does not include coin-operated public telephone equipment, public telephone
equipment operated by card reader, commercial mobile radio service that provides
access to a paging or other one-way signaling service, a communication channel
suitable only for data transmission
, a line from a telecommunications
service provider to an Internet service provider for the Internet service
provider's data modem lines used only to provide its Internet access service
and that are not capable of transmitting voice messages
, a wireless
roaming service or other nonvocal commercial mobile radio service, a private
telecommunications system, or a wireless telecommunications connection subject
to Texas Health and Safety Code, §771.0711.
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
August 16, 1999.
TRD-9905152
James D. Goerke
Executive Director
Advisory Commission on State Emergency Communications
Earliest possible date of adoption: Sepember 26, 1999
For further information, please call: (512) 305-6933
Chapter 355.
Medicaid Reimbursement Rates
Subchapter M. Miscellaneous Medicaid Programs
The Health and Human Services Commission (HHSC) proposes a new Division
1, under Chapter 355, Subchapter M, concerning Early Childhood Intervention:
Case Management Services for Infants and Toddlers with Developmental Disabilities,
a program administered by the Texas Interagency Council on Early Childhood
Intervention (ECI). The Health and Human Services Commission proposes the
repeal and replacement of §§355.9001-355.9010 and §§355.9012-355.9014.
The new Division title name will be "Early Childhood Intervention: Reimbursement
Methodology for Case Management Services for Infants and Toddlers with Developmental
Disabilities".
The purpose of the new chapter is to establish the methodology by which
the rate for case management services will be calculated.
In conjunction with the repeal and replacement of §§355.9001-355.9010
and §§355.9012-355.9014, the Interagency Council on Early Childhood
Intervention is simultaneously proposing the repeal and replacement of §§621.121-621.128,
concerning Case Management Services for Infants and Toddlers with Developmental
Disabilities elsewhere in this issue of the
Texas
Register
.
Don Green, Chief Financial Officer, HHSC, has determined for the first
five-year period the proposed sections are in effect, the fiscal impact will
be an increase in federal funds to ECI providers of approximately $1,500,000.
The effect on state expenditures will be to reduce the need for general revenue
to be used to provide these services.
Mr. Green also has determined that for each of the first five years the
proposed sections are in effect the public benefit anticipated as a result
of enforcing the sections will be that increased funding will allow families
of children with disabilities to receive increased services from ECI programs.
The Reimbursement Methodology for Case Management Services for Infants and
Toddlers with Developmental Disabilities rules will have no adverse economic
impact on small businesses or on persons complying with the rules as proposed.
There will be no impact on local employment.
Questions about the content of this proposal may be directed to Glenn Hart
at the Texas Interagency Council on Early Childhood Intervention, Division
of Provider Funding, at (512) 424-6830. Written comments on the proposal may
be submitted to Glenn Hart, Division of Provider Funding, Texas Interagency
Council on Early Childhood Intervention, 4900 North Lamar, Austin, Texas 78751-2399,
within 30 days of publication in the
Texas Register
.
1.
Early Childhood Intervention: Case Management Services for Infants and Toddlers with Developmental Disabilities
1 TAC §§§355.9001-355.9010, 355.9012-355.9014
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Health and Human Services Commission or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under Texas Government Code
§531.033, which provides the commissioner of HHSC with broad rulemaking
authority; Texas Human Resources Code §32.021 and Texas Government Code
§531.021(a).
The repeals affect Texas Government Code §531.021(b), which authorizes
HHSC to propose rules covering Medicaid reimbursement.
§355.9001. Reimbursable Services.
§355.9002. General Reimbursement Information.
§355.9003. Methodology.
§355.9004. Cost Reporting Procedures.
§355.9005. Basic Objectives and Criteria for Desk Review of Cost Reports.
§355.9006. Notification.
§355.9007. Reimbursement Rate Determination.
§355.9008. Determination of Inflation Indices.
§355.9009. Adjusting Rates When New Legislation, Regulations, or Economic Factors Affect Costs.
§355.9010. Allowable Cost Information.
§355.9012. List of Allowable Costs.
§355.9013. List of Unallowable Costs.
§355.9014. Reviews and Administrative Hearings.
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
August 16, 1999.
TRD-9905169
Marina S. Henderson
Executive Deputy Commissioner
Health and Human Services Commission
Earliest possible date of adoption: September 26, 1999
For further information, please call: (512) 424-6756
1 TAC §§355.9001-355.9010, 355.9012-355.9014
The new sections are proposed under Texas Government Code
§531.033, which provides the commissioner of HHSC with broad rulemaking
authority; Texas Human Resources Code §32.021 and Texas Government Code
§531.021(a).
The new sections affect Texas Government Code §531.021(b), which authorizes
HHSC to propose rules covering Medicaid reimbursement.
§355.9001. Reimbursable Services.
(a)
Case management services are reimbursable to Medicaid
providers who meet the conditions for provider participation as specified
in 25 TAC §621.125 (relating to Conditions for Medicaid Case Management
Provider Participation). Reimbursable case management services include face-to-face
and telephone contacts with the child's caregiver on behalf of the child,
or with other service providers or professionals on behalf of the child, for
the purpose of assisting that child in gaining access to needed medical, social,
educational, developmental, and other appropriate services. Case management
providers are paid one flat monthly rate each month in which at least one
reimbursable case management contact occurred.
(b)
Case management services are not reimbursable as Medicaid
services when another payor is liable for payment or if case management services
are associated with the proper and efficient administration of the state plan.
Case management services associated with the following are not payable as
optional targeted case management services under Medicaid:
(1)
Medicaid eligibility determinations and redeterminations;
(2)
Medicaid eligibility intake processing;
(3)
Medicaid preadmission screening;
(4)
Prior authorization for Medicaid services;
(5)
Required Medicaid utilization review;
(6)
Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT) program administration;
(7)
Medicaid "lock-in" provided for under the Social
Security Act;
(8)
Services that are an integral or inseparable part
of another Medicaid service;
(9)
Outreach activities that are designed to locate individuals
who are potentially eligible for Medicaid; and
(10)
Any medical evaluation, examination, or treatment
billable as a distinct Medicaid-covered benefit. However, referral arrangements
and staff consultation for such services are reimbursable as case management
services.
§355.9002. General Reimbursement Information.
The Commission determines prospective uniform reimbursement rates for
the Texas Early Childhood Intervention Program (ECI) Medicaid programs. ECI
reimburses ECI program providers according to the reimbursement methodology
in §355.9003 of this title (relating to Methodology). The commission
determines the case management rate based on costs contained in the ECI providers'
Time and Financial Information (TAFI) reports, which are reported on a quarterly
basis.
§355.9003. Methodology.
(a)
Except when otherwise specified under this title, the
Commission follows the requirements set forth in subsections (b)-(k) of this
section to determine rates for reimbursing contracted providers for Texas
Early Childhood Intervention Program (ECI) Medicaid programs.
(b)
Amended Time and Financial Information (TAFI) Report Due
Dates. All contracted providers must submit TAFI reports to ECI or its designee
in a manner prescribed by ECI. ECI accepts amended TAFI reports submitted
on the request of the provider until 180 days after the due date of the TAFI
report or 15 working days prior to the public hearing on proposed rates, whichever
occurs first. Since this is a prospective reimbursement system without a provision
for reconciliation, amended TAFI reports filed after this date have no effect
on the rate and are not accepted. Amended TAFI report information that cannot
be verified by 10 working days prior to the hearing will not be used in rate
determination.
(c)
Audits. As specified in §355.9005 of this title (relating
to Basic Objectives and Criteria for Desk Review of TAFI reports), ECI or
its designee conducts desk reviews of all the TAFI reports that it receives.
ECI or its designee also conducts on-site audits of provider records and TAFI
reports. Although the number of on-site audits performed each year may vary,
ECI seeks to maximize the number of on-site audited TAFI reports available
for use in its cost projections. Whenever possible, the records necessary
to verify information submitted to ECI on Medicaid TAFI reports, including
related-party transactions and other business activities engaged in by the
provider, must be accessible to ECI audit staff, or its designee in the state
of Texas.
(d)
In addition to the exclusions and adjustments made during
desk reviews and on-site audits, ECI may exclude or adjust certain expenses
in the TAFI data base in order to base rates on the reasonable and necessary
costs that an economical and efficient provider must incur.
(e)
ECI may project expenses in the TAFI report data base
to account for cost inflation between the reporting period and the prospective
rate period. ECI's procedures for determining inflation indices to account
for cost inflation between the reporting period and the prospective rate period
are specified in §355.9008 of this title (relating to Determination of
Inflation Indices).
(f)
ECI also adjusts rates when new legislation, regulations,
or economic factors affect costs, as specified in §355.9009 of this title
(relating to Adjusting Rates When New Legislation, Regulations, or Economic
Factors Affect Costs).
(g)
After making appropriate exclusions and adjustments, ECI
uses the adjusted TAFI report data to project the cost per unit of service
during the prospective rate period.
(h)
The Commission must hold a public hearing before setting
the reimbursement rate. The purpose of the hearing is to give interested persons
an opportunity to comment on the Commission's proposed rate. The Commission
must provide notice of the hearing to the public; and at least ten working
days before the hearing takes place, the Commission must make material pertinent
to the proposed rates available to the public. At a minimum, this material
must include the Commission's proposed rates and any inflation rates used
to determine them. The Commission must furnish this material to anyone who
requests it. After the hearing, ECI staff must provide the Commission with
a written summary of the comments made during the public hearing.
§355.9004. TAFI Reporting Procedures.
Provider agencies must submit to the Texas Early Childhood Intervention
Program (ECI) financial and statistical information on a quarterly basis on
Time and Financial Information (TAFI) software provided by ECI. Providers
must complete the TAFI report according to the rules and specifications set
forth in this section. The Commission determines reimbursement rates as specified
in §355.9002 and §335.9003 of this title (relating to General Reimbursement
Information and Methodology).
(1)
TAFI report due date. Provider agencies must submit TAFI
reports to ECI by the due date specified by ECI.
(2)
Extension of due date. ECI may grant extensions of
due dates for good cause. A good cause is defined as one that the provider
agency could not reasonably be expected to control. Provider agencies must
submit requests for extensions in writing to ECI before the TAFI report due
date. ECI will respond to requests within 10 workdays of receipt.
(3)
Reporting period. The provider agency must prepare
the TAFI report to reflect the activities of the provider agency during the
specified fiscal quarter.
(4)
Failure to file an acceptable TAFI report. If a provider
agency fails to file a TAFI report according to all applicable rules and instructions,
ECI may withhold all provider payments until the provider agency submits an
acceptable TAFI report.
(5)
Accounting requirements. The provider agency's treatment
of any financial or statistical item must reflect the application of the generally
accepted accounting principles (GAAP) approved by the American Institute of
Certified Public Accountants.
(6)
Allocation method. If allocation of cost is necessary,
provider agencies must use reasonable methods of allocation. ECI adjusts allocated
costs if ECI considers the allocation method to be unreasonable. The provider
agency must retain work papers supporting allocations.
(7)
TAFI report certification. Provider agencies must
certify the accuracy of TAFI reports submitted to ECI in the format specified
by ECI. Provider agencies may be liable for civil and/or criminal penalties
in the case of misrepresented or falsified information.
(8)
TAFI report supplements. ECI may at times require
additional financial and statistical information other than the information
contained in the TAFI report.
(9)
Review of TAFI reports. ECI staff, or ECI's designee,
review each TAFI report to ensure that all financial and statistical information
submitted conforms to all applicable rules and instructions. The review of
the TAFI report includes a desk review. ECI reviews all TAFI reports according
to the criteria in §355.9005 of this title (relating to Basic Objectives
and Criteria for Desk Review of TAFI reports). If a provider agency fails
to complete TAFI reports according to TAFI report instructions or rules, ECI
or its designee requires the provider to submit corrected reports. ECI may
require information other than that contained in the TAFI report to substantiate
reported information.
(10)
On-site audits. ECI or its designee may perform
on-site audits on all provider agencies that participate in the ECI program.
ECI determines the frequency and nature of audits but ensures that they are
not less than that required by federal regulations related to the administration
of the program.
(11)
Access to records. Each provider agency or its designated
agent(s) must allow access to any and all records necessary to verify information
submitted to ECI on TAFI reports. This requirement includes records pertaining
to related-party transactions and other business activities engaged in by
the provider agency. If a provider agency does not allow inspection of pertinent
records within 30 days following written notice from ECI, ECI may place a
hold on vendor payments until access to the records is allowed. If the provider
agency continues to deny access to records, ECI may cancel the provider agency's
contract.
(12)
Failure to maintain adequate records. If a provider
agency fails to maintain adequate records to support the financial and statistical
information reported in TAFI reports, ECI allows 90 days for the provider
agency to bring record keeping into compliance. If a provider agency fails
to correct deficiencies within 90 days from the date of notification of the
deficiency, ECI may cancel the provider agency's contract for services.
§355.9005. Basic Objectives and Criteria for Desk Review of Time and Financial Information (TAFI) Reports.
(a)
The Texas Early Childhood Intervention Program (ECI) or
its designee conducts desk reviews of all provider TAFI reports to ensure
that the financial and statistical information submitted in the TAFI reports
conforms to all applicable rules and instructions.
(b)
The basic objective of the desk review is to verify that
each provider's TAFI reports:
(1)
display financial and statistical information in the format
required by ECI;
(2)
report expenses in conformity with ECI's lists of
allowable and unallowable costs, and
(3)
follow generally accepted accounting principles except
as otherwise specified in ECI's lists of allowable and unallowable costs.
(c)
ECI or its designee verifies the information specified
in subsection (b) of this section by:
(1)
comparing each provider's reported costs to:
(A)
past patterns of expenditures for similar services,
(B)
the results of previous on-site audits,
(C)
normal operating cost relationships, and
(D)
provider average costs;
(2)
reviewing each provider's reported costs to
search for:
(A)
reported unallowable costs,
(B)
omitted allowable costs, and
(C)
overstated or understated allowable costs;
(3)
checking for completion of required information;
(4)
checking the format for proper cost classification;
(5)
checking for mathematical accuracy; and
(6)
adjusting improperly prepared reports.
(d)
ECI may conduct on-site audits of TAFI reports that show
unusual fluctuations or trends in costs or statistics. ECI may also conduct
on-site audits when desk reviews are insufficient to verify the accuracy of
reported costs.
§355.9006. Notification.
The Texas Early Childhood Intervention Program (ECI) or its designee
furnishes providers with written reports of the results of on-site audits.
ECI mails each on-site audit report within 21 days after the final exit interview
with the provider. An exit interview is final when ECI or other designated
audit staff have received, reviewed, and analyzed all documentation from the
provider pertinent to the scope of the audit. The on-site audit report consists
of a professional report prepared by the audit staff to enumerate the results
of an on-site audit. Each on-site audit report includes a specification of:
(1)
The Time and Financial Information (TAFI) report line-items
that have been adjusted or excluded,
(2)
the amount of each adjustment or exclusion, and
(3)
the principal reason for each adjustment or exclusion.
§355.9007. Reimbursement Rate Determination.
The Commission determines the reimbursement rate as follows:
(1)
Exclusion of certain reported expenses. Provider agencies
must ensure that all unallowable costs are eliminated from the Time and Financial
Information (TAFI) report. The Texas Early Childhood Intervention Program
(ECI) excludes any unallowable costs that are included in the TAFI report.
(2)
Projected case management costs. ECI projects all
allowable expenses from the reporting period to the next ensuing rate period.
ECI determines reasonable and appropriate economic adjusters as described
in §355.9008 of this title (relating to Determination of Inflation Indices)
to calculate the projected expenses. ECI also adjusts rates if new legislation,
regulations, or economic factors affect costs as specified in §355.9009
of this title (relating to Adjusting Rates When New Legislation, Regulations,
or Economic Factors Affect Costs).
(3)
Rate setting methodology. ECI staff develops proposed
reimbursement rates and recommends them to the Commission. The recommended
rate is determined in the following manner:
(A)
Each provider's total reported costs on the TAFI report
are compared with their total reported costs on the ECI financial reports.
(B)
Providers whose variance between reported costs on the
TAFI report and the ECI financial reports exceeds plus or minus two standard
deviations of the mean provider variance are eliminated.
(C)
Total allowable case management costs for each provider
will be determined from the allowable historical costs reported on the TAFI
report.
(D)
Each provider's total allowable case management cost is
projected from the historical cost reporting period to the prospective reimbursement
period using inflation factors according to §355.9008 of this title (relating
to Determination of Inflation Indices).
(E)
Each provider's total allowable case management cost is
divided by their associated number of unduplicated case management contacts
for the period, thus determining the provider's cost per contact.
(F)
The mean provider cost per contact is calculated, and
the statistical outliers (those providers whose cost per contact exceeds plus
or minus two standard deviations of the mean provider cost per contact) are
eliminated. After removal of the statistical outliers, the mean cost per contact
is calculated.
(G)
The mean cost per contact is the proposed reimbursement
rate.
(4)
Rate setting authority. The Commission establishes
the reimbursement rate in an open meeting after consideration of financial
and statistical information and public testimony. The Commission sets rates
which, in its opinion, are within budgetary constraints, adequate to reimburse
the cost of operations for an efficient and economic provider, and justifiable
given current economic conditions.
§355.9008. Determination of Inflation Indices.
The Texas Early Childhood Intervention Program (ECI) uses the Implicit
Price Deflator-Personal Consumption Expenditures (IPD-PCE) as its cost inflation
index. The IPD-PCE is a nationally recognized measure of inflation published
by the Bureau of Economic Analysis of the U.S. Department of Commerce.
§355.9009. Adjusting Rates When New Legislation, Regulations, or Economic Factors Affect Costs.
(a)
The Commission must adjust the reimbursement rate when
federal or state laws, rules, regulations, policies, or guidelines are adopted,
promulgated, judicially interpreted, or otherwise changed in ways that can
reasonably be expected to affect allowable costs or alter the rates of change
in allowable costs. The Commission must propose adjustments to the rate for
these reasons at the earliest feasible opportunity to become effective on
the effective date of the federal or state laws, rules, regulations, policies,
or guidelines or at the beginning of the nearest calendar quarter for which
federal financial participation is available. These adjustments must result
in increases or decreases in the reimbursement rate.
(b)
The Commission may also adjust reimbursement rates when
changes in economic factors significantly affect allowable costs or alter
the rates of change in allowable costs. Such changes in economic factors include,
but are not limited to, substantial changes in the rate of wage and price
inflation that are not discernible in Time and Financial Information (TAFI)
report data, increases in the number of participating providers with significantly
different costs, increases in the number of clients with significantly different
costs, and changes in The Texas Early Childhood Intervention's (ECI's) budgetary
capabilities.
(c)
The Commission must consider all known changes in laws,
rules, regulations, policies, guidelines, or economic factors at the time
of the Commission's regular determination of reimbursement rates.
(d)
The Commission may promulgate downward rate adjustments
for budgetary reasons whenever such adjustments are necessary for ECI to operate
within the limits of appropriated funds.
§355.9010. Allowable Cost Information.
(a)
Factors affecting allowable costs. To be allowable under
the Texas Early Childhood Intervention Program (ECI), costs must be:
(1)
necessary and reasonable for the proper and efficient
administration of the program to deliver services for which ECI has contracted;
(2)
authorized or not prohibited under state or local
laws or regulations;
(3)
consistent with any limitations or exclusions described
in this section, federal or state laws or other governing limitations as to
types or amounts of cost items:
(4)
consistent with policies, regulations, and procedures
that apply uniformly to both the ECI program and other activities of the organization
of which the provider agency is a part;
(5)
treated consistently using generally accepted accounting
principles appropriate to the circumstances;
(6)
not allocable to or included as a cost of any other
program in either the current or a prior period; and
(7)
the net of all applicable credits.
(b)
Reasonableness. A cost is reasonable if, in its nature
and amount, it does not exceed that which would be incurred by an ordinarily
prudent person in the conduct of competitive business. In determining the
reasonableness of a given cost, ECI considers the following:
(1)
whether the cost is of a type generally recognized as
ordinary and necessary for the operation of the business or the performance
under the contract;
(2)
the restraints or requirements imposed by generally
accepted sound business practices, arm's length bargaining, federal and state
laws and regulations, and contract terms and specifications; and
(3)
the action that a prudent person would take in the
circumstances, considering his responsibilities to the public, the government,
his employees, clients, shareholders, or members, and the fulfillment of the
purpose for which the business was organized.
§355.9012. List of Allowable Costs.
The following list of costs allowable on the Texas Early Childhood
Intervention Program (ECI) Time and Financial Information (TAFI) report is
not comprehensive, but rather serves as a general guide and clarifies certain
key expense areas. The absence of a particular cost from this list does not
necessarily mean that it is not an allowable cost.
(1)
Compensation of ECI provider employees, which includes:
(A)
wages and salaries. This can include deferred compensation,
overtime pay, other monies subject to withholding taxes and Federal Insurance
Contributions Act (FICA) deductions.
(B)
payroll taxes and insurance. This includes FICA, unemployment
compensation insurance, and workmen's compensation insurance.
(C)
employee benefits. This includes employer-paid health
and life insurance premiums and employer contributions to employee retirement
accounts.
(2)
Employee travel expenses. Expenses based on
mileage are allowable if there is adequate documentation of the mileage and
if the expenses were related to delivery of services for which ECI has contracted.
(3)
Building, equipment, supplies and capital expenses.
(A)
Depreciation and amortization expense. Property owned
by the provider and improvements to owned, leased, or rented property valued
at more than $1,000 at the time of purchase must be depreciated or amortized,
using the straight-line method, with the following restrictions.
(i)
For buildings, allowable depreciation is calculated by
deducting the estimated salvage value from the historical cost and dividing
the result by the asset's remaining years of useful life.
(ii)
For building equipment, allowable depreciation expenses
include air conditioners, furnaces, chairs, tables, and building and grounds
improvements.
(B)
Rental and lease expense. Rental and lease expense paid
to a related party is limited to whichever is lower: the actual cost to the
related party, or the actual cost if rented or purchased elsewhere. This includes
buildings, building equipment, and furniture.
(C)
Tax expense. This includes ad valorem, real and personal
property taxes, motor vehicle registration fees, sales taxes, Texas corporate
franchise taxes, and organization filing fees.
(D)
Insurance expense. This includes facility fire and casualty,
professional liability and transportation equipment liability insurance.
(E)
Utilities expense. This includes electricity and natural
gas, water, waste water, garbage collection, and telephone.
(F)
Materials and supplies. This includes office, reproduction
and printing, and postage supplies.
(G)
Training expenses. These are limited to direct costs for
travel, lodging, food, and registration fees for training directly related
to the provision of ECI services.
(H)
Contract services provided by outside providers. This
includes professional services provided by therapists to ECI clients, other
professional services such as those of accountants and attorneys, and other
services such as building maintenance.
§355.9013. List of Unallowable Costs.
Costs that are unallowable to report on the Texas Early Childhood Intervention
Program (ECI) Time and Financial Information (TAFI) report are those expenses
incurred by a provider agency which are not directly or indirectly related
to the provision of contracted services according to applicable laws, rules,
and standards. A provider agency may expend funds on unallowable cost items,
but those costs must not be included in the TAFI report and are not used in
calculating a rate recommendation. The following list is a general guide to
the various unallowable costs frequently encountered in TAFI reports submitted
by provider agencies and is not intended to be inclusive of all possible unallowable
costs:
(1)
advertising expenses other than those for employee recruitment,
yellow page listings no larger than one column width and one inch length,
and advertising to meet statutory or regulatory requirements;
(2)
allowances for bad debts or other similar accounts;
(3)
expenses not related to the provision of services
for which ECI has contracted;
(4)
contributions to political activities or contributions
to charity;
(5)
headquarters expenses that are not directly involved
in providing services or supplies used by ECI Program staff in normal operations
related to early intervention services;
(6)
depreciation expenses other than those based on straight-line
depreciation;
(7)
discounts for administrative reasons; courtesy, cash,
trade, and quantity discounts; rebates; or other discounts granted;
(8)
dues and membership fees to organizations whose primary
emphasis is not related to the services for which ECI has contracted;
(9)
entertainment expenses, such as the costs of amusements
and social activities;
(10)
fund-raising expenses;
(11)
expenses which are not the legal obligation of the
provider agency;
(12)
fines and other penalties for violation of statutes
or ordinances; penalties for late payment of taxes, utilities, mortgages,
loans, and other similar penalties;
(13)
premiums for life insurance policies in which the
beneficiary is the provider organization, unless life insurance is a requirement
of a loan agreement and the loan is related to client care;
(14)
interest expenses;
(15)
medical equipment and supplies;
(16)
personal compensation not related to the delivery
of services for which ECI has contracted;
(17)
personal expenses not related to the delivery of
services for which ECI has contracted;
(18)
expenses for the purchase of services, facilities,
or supplies from related organizations or parties, if the expenses exceed
whichever is lower: the cost to the related party or organization; or the
price of comparable services, facilities, or supplies purchased in an arm's
length transaction;
(19)
rental or lease expense on any item not related
to the delivery of services for which ECI has contracted;
(20)
tax expense for federal, state, or local income
tax; any tax levied on assets not related to the delivery of services for
which ECI has contracted;
(21)
transportation expenses for vehicles which are not
generally suited to functions related to the provision of services for which
ECI has contracted. Mileage expense may be included at a cost per mile not
to exceed the current reimbursement rate set by the legislature for state
employee travel;
(22)
attorney fees;
(23)
building depreciation expenses based on less than
a 30-year life;
(24)
contributions to self-insurance funds that do not
represent payment on current liabilities;
(25)
expenses that cannot be adequately documented;
(26)
forms of compensation that are not clearly enumerated
to dollar amount or that represent profit distributions;
(27)
insurance premiums pertaining to items of unallowable
cost; and
(28)
values assigned to the services of unpaid workers
or volunteers.
§355.9014. Reviews and Administrative Hearings.
(a)
General requirements. A provider who disagrees with the
Early Childhood Intervention Program (ECI) desk-review or on-site audit exclusions
or adjustments, determination of inflation indices, or rate adjustments in
response to new legislation, regulations, or economic factors under the provisions
of §§621.132, 621.133, 621.135, or 621.136 of this title (relating
to Basic Objectives and Criteria for Desk Review of Cost Reports; Notification;
Determination of Inflation Indices; and Adjusting Rates When New Legislation,
Regulations, or Economic Factors Affect Costs) must follow the procedures
for informal reviews and administrative hearings set forth in this section
to resolve the disagreement. Only contracted providers have standing to file
for informal reviews and administrative hearings.
(b)
Separation of reviews and hearings from the rate-setting
process. The filing of a review or administrative hearing under the provisions
of this section cannot stay the implementation of reimbursement rates adopted
by Health and Human Services Commission (HHSC).
(c)
Informal review. A provider who disagrees with an ECI
decision or action under the criteria specified in subsection (a) of this
section is entitled to an informal review with ECI staff. The review is an
informal meeting, rather than a formal administrative hearing. It is intended
to encourage open discussion between the provider and the staff, and to promote
resolution of the matters in dispute. ECI staff shall conduct the review according
to the following procedures:
(1)
If the provider disagrees with ECI desk-review or on-site
audit exclusions or adjustments, the provider must contact the executive director
of ECI in writing within 30 calendar days of receiving ECI's written notification
of the exclusions or adjustments, and request a review.
(2)
If the provider disagrees with ECI's determination
of inflation indices or with rate adjustments that have resulted from new
legislation, regulations, or economic factors, the provider must contact the
executive director of ECI in writing within 30 calendar days of the setting
of rates by the ECI council, and request a review. Reviews of inflation indices
and rate adjustments may only consider whether ECI staff followed the requirements
of this chapter in developing its rates.
(3)
On receipt of a request for review, the executive
director of ECI or his designee appoints three ECI staff members as the review
panel. The panel members must be knowledgeable in cost-report auditing or
rate-setting issues, as appropriate. The executive director designates one
of the three panel members as the lead reviewer. The lead reviewer arranges
a meeting at the earliest possible date convenient to both the provider and
review staff. At the meeting, the provider may present all the information
he considers pertinent to his position. The review panel considers the provider's
information and all the ECI information it deems necessary to reach a decision.
Within 30 days of the review, the panel must send the provider its written
decision.
(d)
Administrative hearings. If a provider disagrees with
the result of an informal review, the provider may request a formal administrative
hearing. The provider must file a written request for a hearing with ECI,
4900 North Lamar Boulevard, Austin, Texas 78751-2399 within 15 days after
receiving the review panel's decision. A provider may not request an administrative
hearing before receiving ECI's written review decision as specified in subsection
(c) of this section. The administrative hearing is limited to the issues that
were considered in the informal review process.
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
August 16, 1999.
TRD-9905168
Marina S. Henderson
Executive Deputy Commissioner
Health and Human Services Commission
Earliest possible date of adoption: September 26, 1999
For further information, please call: (512) 424-6756
Part XV.
Health and Human Services Commission
1.
Early Childhood Intervention: Reimbursement Methodology for Case Management Services for Infants and Toddlers with Developmental Disabilities
Chapter 361.
Children's Health Insurance Program