Epilepsy Program Policy Manual

Revision 25-1; Effective Feb. 24, 2025

Epilepsy services contract amounts are ceilings against which contractors may bill for services provided to Epilepsy Program eligible clients. Once this ceiling has been reached, no further funds will be available for reimbursement. Upon award, contractors are not required to screen new clients for program eligibility. However, if a screening is completed, the contractor is required to provide services to eligible clients. No client can be denied services for the inability to pay.

Contractors may only bill for services provided to clients who have been screened for potential Medicaid eligibility and other benefit programs and who have been determined eligible for the Epilepsy Program.

Categorical Reimbursement

Epilepsy categorical funding, cost reimbursement, is used to develop and maintain contractor infrastructure for the provision of epilepsy and related health services. The funding can be used to support clinic facilities, staff salaries, utilities, medical and office supplies, equipment, travel and direct medical services. All services will be reimbursed on a cost reimbursement basis. Payments will be made for costs incurred and will be supported by reporting services provided and limited client-level data. Costs may be assessed against any of the following categories the contractor identifies during their budget development process:

• personnel
• fringe benefits
• travel
• equipment and supplies
• contractual
• other
• indirect costs

Epilepsy funds are disbursed to contractors through an invoicing system as expenses are incurred during the contract period. Program income must be expended before categorical funds are requested through the reimbursement process. Contractors must submit a Monthly Reimbursement Packet (MRP) even if the contract reimbursement limit has been met. When program expenses exceed program income, the invoice will result in a payment. Program income includes all fees paid by Epilepsy Program client co-pay and other non-HHSC funding.

Accurate financial records must be maintained for quality assurance, fiscal monitoring and programmatic evaluation by HHSC.

Monthly Reporting Packet (MRP)

At the start of each contract year, contractors will receive their organization’s personalized MRP. When the MRP is sent at the start of the contract year, contractors should save the invoice and MRP by clicking on the file to open, selecting File at the top of the MRP and selecting Save As. When done this way, the template (xltx) file saves a new file with an .xlsx extension. This process leaves the template intact for later use.

Each MRP will cover services provided or expenses incurred in a preceding month as applicable to the contract. The MRP has five tabs:

1. Monthly Report Form
2. Data Collection
3. Narrative
4. Monthly Report Form Instructions
5. Data Instructions & Definitions

Monthly Submission Requirements

• Monthly Report Form (MRF)
• Data Collection Form – section A

The MRP is required to be completed monthly. It must be submitted to the contact(s) identified in the MRP instructions no later than 30 days after the last day of the preceding month.

Note: The tabs in the MRP are interconnected and must not be moved or altered in any way. These tabs must remain intact for the formulas to work and for data to be accurately transferred from one tab to another.

Contractors should note that indirect charges, or indirect costs, in excess of the contracted amount will not be allowed.

Quarterly Submission Requirements

In addition to the monthly submission requirements, the following are required to be submitted quarterly:

• Data Collection Form – sections B, C and D
• Quarterly Narrative
• Signed Financial Status Report, Form 269A

Quarterly requirements are due by the last business day of the month after the end of each quarter. The final quarter, however, is due 45 days after the end of the contract period, which is Oct 15th. When Oct. 15th falls on a weekend or holiday, the report is due on the previous Friday.

Reconciling Errors on Previously Submitted MRPs

If expenses are overstated on one month’s invoice, the following month’s expenses should be reduced accordingly.

Submission and Reporting after Entire Contract Award is Expended

Contractors must continue to submit the MRP even after contract ceilings have been reached. Any cost over the contract ceiling 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 MRP

Contractors may have claims after they submit their August billing. Any other invoices must be received by Oct. 15th. Mark this as FINAL.

All claims for reimbursement for services delivered must be submitted within 45 days of the end of the contract.

Reimbursement requests submitted more than 45 days after the end of the contract term will not be paid.

Reimbursable Expenditures

Services may be provided to clients whose screening indicates they are potentially Medicaid eligible, but the client has not yet completed the application process. Services provided on the initial day of service may be billed to the Epilepsy Program for reimbursement with proper documentation of client’s eligibility status.

Altering of Forms

Contractors are required to use the most current version of their organization’s personalized MRP for ease of processing. No billing or reporting forms may be altered in any manner. Invoices should not be altered to itemize expenses not approved in their annual budget workbook. Invoices should be submitted for the total monthly reimbursement amount by approved budget category.