Part 15.
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355.
REIMBURSEMENT RATES
Subchapter A. COST DETERMINATION PROCESS
1 TAC §355.101, §355.107
The Texas Health and Human Services Commission (HHSC)
proposes amendments to §355.101, concerning Introduction, and §355.107,
concerning Notification of Exclusions and Adjustments.
Background and Justification
HHSC, under its authority and responsibility to administer and
implement rates, proposes to amend these rules to adopt a formal definition
for the term "line item" and eliminate a reference to auditors.
HHSC is implementing a web-based cost-reporting system, the State
of Texas Automated Information and Reporting System (STAIRS), to replace
its existing cost-reporting system. The current cost-reporting system
identifies each data item by an item number, making it clear that
the term "line item" refers to a numbered item on the cost report.
STAIRS does not have item numbers. With the elimination of line item
numbers under the STAIRS system, a definition of "line item" to accommodate
both the current cost-reporting system and the new STAIRS system is
needed to avoid confusion and misinterpretation.
Additionally, HHSC is modifying its cost report audit process to
focus more audit resources on high-risk cost reports identified through
various risk assessment procedures. The rule proposal deletes a reference
to "auditors" since both audit and non-audit HHSC staff will now be
finalizing cost report desk reviews.
Section-by-Section Summary
The proposed amendment to §355.101 adds a definition for "line
item" in new paragraph (5) of subsection (b).
The proposed amendment to §355.107 deletes the term "auditors"
from subsection (a) and makes several minor technical changes.
Fiscal Note
Gordon E. Taylor, Chief Financial Officer for the Department of
Aging and Disability Services, has determined that during the first
five-year period the amendments are in effect there will be no fiscal
impact to state government. The amendments 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 sections.
Small Business and Micro-business Impact Analysis
Pam McDonald, Director of Rate Analysis, has determined that there
will be no economic effect on small businesses and micro-businesses
as a result of enforcing or administering the amendments. The proposed
amendments do not require any changes in practice or any additional
cost to a contracted provider.
HHSC does not anticipate that there will be any economic cost to
persons who are required to comply with these amendments. The amendments
should not affect local employment.
Public Benefit
Pam McDonald has also determined that, for each of the first five
years the amendments are in effect, the expected public benefit is
that the rules will define what is meant by "line item" when the term
is used in the subchapter and will clarify that reviews of cost reports
may be completed by staff other than auditors.
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
Judy Myers in the HHSC Rate Analysis Department by telephone at (512)
491-1179. Written comments on the proposal may be submitted to Ms.
Myers by fax to (512) 491-1998; by e-mail to judy.myers@hhsc.state.tx.us;
or by mail to HHSC Rate Analysis, Mail Code H400, P.O. Box 85200,
Austin, Texas, 78708-5200, within 30 days of publication of this proposal
in the
Texas Register.
Statutory Authority
The amendments are 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 provides HHSC with the authority to propose and adopt rules
governing the determination of Medicaid reimbursements.
The amendments affect Texas Government Code, Chapter 531 and Texas
Human Resources Code, Chapter 32. No other statutes, articles, or
codes are affected by this proposal.
§355.101.Introduction.
(a)
The information in §355.102 of this title
(relating to General Principles of Allowable and Unallowable Costs), §355.103
of this title (relating to Specifications for Allowable and Unallowable
Costs), §355.104 of this title (relating to Revenues), and §355.105
of this title (relating to General Reporting and Documentation Requirements,
Methods, and Procedures) applies to Intermediate Care Facilities for
Persons with Mental Retardation, Home and Community-based Services,
Service Coordination/Targeted Case Management, Rehabilitative Services,
School Health and Related Services, and Texas Home Living programs
cost reports pertaining to providers' fiscal years ending in calendar
year 2004 and subsequent years. For all other programs these sections
apply to cost reports pertaining to the providers' fiscal years ending
in calendar year 1997 and subsequent years.
(b)
The following terms, when used in this subchapter,
have the following meanings:
(1)
HHSC--The Texas Health and Human Services Commission.
(2)
DHS--The Texas Department of Human Services or
its successor agency.
(3)
TDMHMR--The Texas Department of Mental Health and
Mental Retardation or its successor agency.
(4)
TEA--The Texas Education Agency or its successor
agency.
(5)
Line item--A specific informational,
statistical, revenue or expense data element in a cost report.
(c)
HHSC reimburses providers for contracted client
services through reimbursement amounts determined as described in
this chapter and in reimbursement methodologies for each program.
Statewide, uniform reimbursements and reimbursement ceilings are approved
by HHSC. Where reimbursements are contractor-specific, HHSC approves
the reimbursement parameter dollar amounts, e.g., ceilings, floors,
or program reimbursement formula limits. In approving reimbursement
amounts HHSC takes into consideration staff recommendations based
on the application of formulas and procedures described in this chapter
and in reimbursement methodologies for each program. However, HHSC
may adjust staff recommendations when HHSC deems such adjustments
are warranted by particular circumstances likely to affect achievement
of program objectives, including economic conditions and budgetary
considerations. Methodology rules are developed and recommended for
approval to HHSC. HHSC has oversight authority with respect to the
state's reimbursement methodology and cost determination rules.
(1)
Reimbursement amounts will be determined coincident
with the state's biennium.
(2)
Objective of cost determination process. The objective
of the cost determination process is to define direct and indirect
costs that are allowable and, therefore, may be considered for use
in the overall reimbursement determination process. The cost determination
process seeks to collect accurate financial and other statistical
data that constitutes the foundation upon which reimbursements are
determined.
(A)
Cost-reporting. In order to ensure adequate financial
and statistical information upon which to base reimbursement, HHSC
requires that each contracted provider submit a periodic cost report
or supplemental report. It is the responsibility of the provider to
submit accurate and complete information, in accordance with all pertinent
HHSC cost reporting rules and cost report instructions, on the cost
report and any supplemental reports required by HHSC.
(B)
Pro forma costing. When historical costs are unavailable,
such as in the case of a new program, reimbursement may be based on
a pro forma approach. This approach involves using historical costs
of delivering similar services, where appropriate data are available,
and estimating the basic types and costs of products and services
necessary to deliver services meeting federal and state requirements.
(3)
Relationship between cost determination and reimbursement
determination processes. The cost determination process seeks to evaluate
individual cost items of providers to determine their allowability
and to determine whether individual cost reports are of reasonable
accuracy for potential use in reimbursement determination. The reimbursement
determination process takes the evaluation of allowable costs one
step further by comparing allowable costs across providers to identify
those levels of cost, either for individual cost items or groups of
cost items, which must be incurred by efficient and economic providers
of services meeting all state and federal standards. Thus, all costs
allowed in the cost determination process may not necessarily be used
in the reimbursement determination process. The basic objective of
the reimbursement methodologies employed by HHSC is to facilitate
and balance the broader objectives of the programs administered by
the agencies by:
(A)
promoting reasonable access for eligible clients
to services that meet federal and state quality standards via contracting
with an adequate number of qualified providers; and
(B)
expending taxpayer dollars in a reasonable and
prudent manner such that eligible clients are served at the lowest
cost to taxpayers consistent with state and federal laws, standards
and regulations, and with program objectives.
§355.107.Notification of Exclusions and Adjustments.
(a)
The Texas Health and Human Services Commission
(HHSC) notifies providers of exclusions and adjustments to reported
expenses made during HHSC's desk reviews and field audits of cost
reports. HHSC mails notices of desk-review exclusions and adjustments
within 15 working days after finalization of the
desk review
[
(1)
the
line items
[
(2)
the amount of each adjustment or exclusion; and
(3)
the principal reason for each adjustment or exclusion.
(b)
HHSC also furnishes providers with written reports
of the results of field audits. HHSC mails each field audit report
within 30 days after the final exit interview with the provider. An
exit interview is final when HHSC audit staff have received, reviewed,
and analyzed all documentation from the provider pertinent to the
scope of the audit. The field audit report consists of a professional
report prepared by HHSC audit staff to enumerate the results of a
field audit. Each field audit report includes a specification of:
(1)
cost report
line items
[
(2)
the amount of each adjustment or exclusion; and
(3)
the principal reason for each adjustment or exclusion.
(c)
A provider may also submit a written request for
HHSC to provide additional information about exceptions and adjustments
to the provider's cost report, including citations of the laws or
regulations that constitute the grounds for the exceptions and adjustments.
HHSC must comply with such requests in writing within 30 calendar
days.
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 January 23, 2012.
TRD-201200282
Steve Aragon
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: March 4, 2012
For further information, please call: (512) 424-6576
The Texas Health and Human Services Commission (HHSC) proposes
amendments to §372.107, concerning persons excluded from a Temporary
Assistance for Needy Families (TANF) certified group, and §372.1402,
concerning changes a Supplemental Nutrition Assistance Program (SNAP)
household must report.
Background and Justification
The amendments are proposed to correct outdated rule references
and to reflect current federal regulations and HHSC policy.
The proposed amendment to §372.107 corrects two cross-references
to §372.501, concerning disqualifications due to criminal activity.
An amendment to §372.501, effective April 24, 2011, affected
two cross-references in §372.107. The proposed amendment will
update the cross-references.
Federal rule (Title 7, Code of Federal Regulations (CFR) §273.12)
requires a household receiving SNAP food benefits to promptly report
a change in residence and any change in the household's shelter costs
resulting from the change in residence, if the household does not
have simplified reporting status. Shelter costs include expenses such
as rent, house payments, taxes, insurance, and utilities. "Simplified
reporting status" means a household meets the criteria for reporting
certain changes less frequently than a household that does not meet
the criteria.
The U.S. Department of Agriculture, Food and Nutrition Service
(FNS), previously had given HHSC waivers from two reporting requirements
in 7 CFR §273.12: (1) HHSC could require all households, even
those with simplified reporting status, to promptly report a change
in residence; and (2) HHSC could exempt all households, even those
without simplified reporting status, from reporting shelter cost changes
when they move. HHSC's current rule at §372.1402 reflects these
FNS waivers.
FNS recently approved HHSC's request to continue requiring all
households, even those with simplified reporting status, to promptly
report a change in residence. However, FNS declined to renew HHSC's
request to exempt all households, even those without simplified reporting
status, from reporting shelter cost changes when they move. Therefore,
to be in compliance with federal regulations, HHSC must amend §372.1402
to remove the exemption for SNAP households without simplified reporting
status from reporting shelter cost changes.
Section-by-Section Summary
The proposed amendment to §372.107(3) changes rule cross-references
in subparagraph (G) from §372.501(1) to §372.501(a)(1),
and in subparagraph (H) from §372.501(2) to §372.501(a)(2).
The proposed amendment to §372.1402 deletes the provision
in subsection (a)(1) that households are not required to report changes
in shelter costs and states that the only exception to federal change
reporting requirements in 7 CFR §273.12 is that SNAP households
with simplified reporting status must report changes in their resident
address.
Fiscal Note
Greta Rymal, Deputy Executive Commissioner for Financial Services,
has determined that, for the first five years the proposed amendments
are in effect, enforcing or administering the amendments does not
have foreseeable implications relating to costs or revenues of state
or local governments.
There might be an economic cost to persons who are required to
comply with the proposed rules. A household that does not comply with
the proposed amendment to §372.1402 and does not report new shelter
costs related to a change in residence might see a reduction in the
amount of their SNAP food benefits, because the household's budget
would be recalculated without using the shelter deduction.
There is no anticipated negative impact on local employment.
Small Business and Micro-business Impact Analysis
Ms. Rymal has also determined that there will be no effect on small
businesses or micro-businesses to comply with the proposal, because
the amendments apply only to households receiving TANF or SNAP food
benefits and not to businesses.
Public Benefit
Stephanie Muth, Deputy Executive Commissioner for Social Services,
has determined that, for each year of the first five years the amendments
are in effect, the anticipated public benefit expected as a result
of enforcing the amendments is that the rules will provide correct
cross-references for the public and will reflect the current federal
regulation and HHSC's current waiver from the regulation on change
reporting for SNAP households.
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 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 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 Texas Government Code.
Public Comment
Written comments on the proposal may be submitted to Lisa Bartels,
Health and Human Services Commission, Office of Family Services, MC-2039,
909 West 45th Street, Austin, Texas 78751, or by e-mail to lisa.bartels@hhsc.state.tx.us,
within 30 days after publication of this proposal in the
Texas Register.
Subchapter B. ELIGIBILITY
1.
TANF CERTIFIED GROUPS
1 TAC §372.107
Statutory Authority
The amendment is proposed under Texas Government Code §531.0055,
which provides the Executive Commissioner of HHSC with rulemaking
authority; and Texas Human Resources Code §31.001, which authorizes
HHSC to administer financial assistance programs (TANF).
The amendment affects Texas Government Code, Chapter 531 and Texas
Human Resources Code, Chapter 31. No other statutes, articles, or
codes are affected by this proposal.
§372.107.Excluded TANF Certified Group Members.
The Texas Health and Human Services Commission (HHSC) excludes
from the TANF certified group:
(1)
an authorized representative, payee, or protective
payee;
(2)
a recipient of Supplemental Security Income (SSI),
foster care, or adoption subsidy payments; and
(3)
a person disqualified from receiving TANF benefits
or ineligible to receive TANF benefits, because HHSC determines the
person:
(A)
does not meet an eligibility requirement relating
to the person's:
(i)
age (because, for example, the person does not
meet the definition of a child);
(ii)
citizenship as explained in Division 3 of this
subchapter (relating to Citizenship);
(iii)
residency as explained in Division 4 of this
subchapter (relating to Residency);
(iv)
domicile as explained in Division 5 of this subchapter
(relating to Domicile); or
(v)
relationship status (because, for example, the
person is not within the degree of relationship required by §372.108
of this division (relating to Relationship Requirement));
(B)
committed an intentional TANF program violation
as described in §357.562(b) of this title (relating to Determination
and Disposition of Intentional Program Violations);
(C)
failed to comply with §372.1101 of this chapter
(relating to Social Security Number Requirements);
(D)
failed to comply with Subchapter E, Division 5
of this chapter (relating to Third-party Resources);
(E)
has exhausted the time limits for receiving TANF
benefits under Division 8 of this subchapter (relating to Time Limits);
(F)
failed to comply with §372.1401 of this chapter
(relating to Changes a TANF Household Must Report);
(G)
is a fugitive as explained in
§372.501(a)(1)
[
(H)
has been convicted of a felony drug offense as
explained in
§372.501(a)(2)
[
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 January 23, 2012.
TRD-201200281
Steve Aragon
General Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: March 4, 2012
For further information, please call: (512) 424-6576
desk-review
] by HHSC [
auditors
]. The notice consists
of a letter to the provider and desk-review adjustment sheet(s), or
an e-mail notification to the provider and online access to view the
cost report adjustments, that specifies:
line-items
]
on the cost report that have been adjusted or excluded;
line-items
]
that have been adjusted or excluded;
Chapter 372.
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES AND SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAMS
§372.501(1)
] of this subchapter (relating
to Disqualifications Due to Criminal Activity); or
§372.501(2)
]
of this subchapter.
Subchapter E. PARTICIPATION REQUIREMENTS