1 TAC § 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 by HHSC. 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:

(1) the line items on the cost report that have been adjusted or excluded;

(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 that have been adjusted or excluded;

(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.