Revision 23-2; Effective Sept. 8, 2023

This section provides policy requirements for submitting for reimbursement, data collection and required reports.

6100 Reimbursement, Data Collection and Reports

Revision 23-2; Effective Sept. 8, 2023

Grantees shall bill for allowable services provided to eligible clients and receive reimbursement up to their grant award amount. Child Health and Dental Reimbursement request for the month of September must be submitted and reimbursed by Dec. 31 . Submissions that do not meet the above requirement will not be processed.

Prenatal Medical and Dental Reimbursement request for the month of September, must be submitted and reimbursed by Nov. 30. Submissions that do not meet the above requirement will not be processed. Once all award funds have been expended, no other funds will be available for reimbursement.   

Continuation of Services

Grantees who have exhausted their awarded funds must continue to serve their existing clients. 

Submission of the Monthly Invoice and Monthly Reporting Packet (MRP)

The MRP for both programs are available for grantees to download from the Grantee Portal. The MRP will be available to download at the start of each state fiscal year. Each MRP submission should only include services provided in the preceding month as applicable to the grant. Late or absent submissions can impact HHSC midyear utilization determination, which is decided during the second quarter of the state fiscal year. Monthly submission should be sent to HDS.ADS@hhs.texas.gov.

Grantees will need to:

• complete the date and contact information on the Monthly Reimbursement Request (MRR);
• complete the service quantities on the 185 and 186 tabs; and
• complete demographic data for the Monthly Activity tab.

Additional instructions are included in a separate tab at the end of the MRP.

An important note about the Monthly Activity tab is that this report counts the unduplicated number of clients receiving billable services by age, race and ethnicity on their first visit. A client’s first visit during a state fiscal year will be counted as an unduplicated client for each Title V program they participate in. All subsequent visits within a program should not be counted again in the unduplicated client count. The four Title V programs are Prenatal Medical, Prenatal Dental, Child Health and Child Dental.  

Reconciling Discrepancies on Previously Submitted Monthly Reporting Packets (MRP)

Incorrect or missing information that requires clarification or follow-up by HHSC staff may delay payment. A response is required within five business days of the initial outreach to the grantee. Discrepancies can occur that result in a grantee receiving payment for services not billed appropriately during a service month. This can be corrected by subtracting the amount from the next month, adjusting all information. 

Grantees must maintain records that document the necessary information for services provided and billed for reimbursement. Documentation will be audited during HHSC on-site quality assurance reviews and fiscal monitoring reviews.

Supplemental Invoices

Instances can occur that result in missed reporting of a prior month’s services that have not yet been billed to Title V MCH FFS. Any services performed prior to the current service month must be submitted as a supplemental invoice, with a separate invoice for each service month applicable. Please use your MRP to submit the supplemental invoice to HDS.ADS@hhs.texas.gov and included “supplemental” in the message’s subject line. 

Submission and Reporting After Entire Contract Award is Expended

Grantees must continue to submit the MRP even after the contract award has been expended. A MRP must be submitted even if the reimbursement requested amount is zero. Any cost over the contract award after deducting program income should be reflected under Non-HHSC Funding. This submission is required to continue reporting expenditures on any program income collected monthly and to provide HHSC with statistical information about the use of services.

Submission of Final Invoice and MRP

Grantees may have claims after the submission of their August billing. You may claim any additional services by submission of a MRP prior to Oct. 15. Please mark this as FINAL. 

Submit all claims for reimbursement for services delivered within 45 days of the end of the contract term. 

Reimbursement requests submitted more than 45 days following the end of the contract term will not be paid. If the 45-day deadline falls on a weekend, the final invoice and MRP must be submitted prior to this date.

Submission of Financial Reconciliation Report (FRR)

The FRR must include all reimbursements and adjustments in payment for the contract term and be submitted within 60 days of the completion of the contract year, i.e., Oct. 31, to HDS.ADS@hhs.texas.gov

Altering of Forms

Grantees must use the most current version of their organization’s MRP for ease of processing. No billing or reporting forms may be altered in any manner. 

The tabs on the MRP are locked to ensure they remain in the original order. Alteration of order can create an error in the reported reimbursement amount and thus the invoice will have to be corrected causing delay in payment.  

Maintaining Appropriate Supporting Documentation

Grantees must maintain a monthly billing log, also known as billing strips, (automated or manual) to support their Monthly Reporting Packet (MRP) submissions. The log should contain a unique client number, patient’s age at time of service, date of service, and procedure code for each service billed. These logs will be audited during HHSC quality assurance reviews and fiscal compliance monitoring reviews.