Revision 20-0; Effective December 18, 2020
This section provides policy requirements for submitting for reimbursement, data collection and required reports.
6100 Reimbursement, Data Collection and Reports
Revision 20-0; Effective December 18, 2020
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. Contractors may only bill for services provided to clients who have been screened for potential Medicaid eligibility and other benefit programs and been determined eligible for the Epilepsy Program.
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 and travel, as well as 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 to show 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:
- Fringe Benefits;
- Equipment and Supplies;
- Other; and
- Indirect Costs.
Epilepsy funds are disbursed to contractors through a voucher system as expenses are incurred during the contract period. Program income must be expended before categorical funds are requested through the voucher process. Contractors must still submit vouchers monthly even if the contract reimbursement limit has been met. When program expenses exceed program income, the monthly voucher will result in a payment. Program income includes all fees paid by the clients (client co-pay).
Appropriate financial records must be maintained for review by HHSC through the quality assurance review process and/or fiscal monitoring and/or programmatic desk reviews.
Submission of the Monthly Invoice and Reporting Workbook
At the start of each contract year, contractors will receive a personalized invoice and reporting workbook for their organization from their contract manager. The workbook is required to be completed and sent monthly to the contact(s) identified in the instructions in the workbook, no later than 30 days after the end of the preceding month.
When the workbook is received at the start of the contract year, contractors should download and save the invoice and reporting workbook by double clicking on the file to open, clicking on “file” at the top of the workbook 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 in future months.
Each monthly invoice and reporting workbook will cover services provided or expenses incurred in a preceding month as applicable to the contract. The workbook has six tabs:
- Monthly Report Form Instructions
- Monthly Report Form
- Data Instructions and Definitions
- Data Collection
- Form 4116 Reimbursement Request
- Narrative (to be completed quarterly)
Contractors will need to:
- Complete the Monthly Report Form first;
- Complete Section A of the Data Collection Form for clients that were seen using HHSC Epilepsy Program funds; and
- Review Form 4116 Reimbursement for accuracy.
Note: The tabs in the workbook are interconnected and the workbook must remain intact for the formulas to work and for data to be transferred from one tab to another accurately.
For additional instructions on the Monthly Invoice and Reporting Form and PowerPoint training on the Monthly Invoice and Reporting Workbook, contractors can visit the SharePoint Contractor Portal.
Indirect Charges (Costs)
Contractors should note that the indirect charges (or indirect costs) field on the Monthly Report Form in the Monthly Invoice and Reporting Workbook has been formulated for each contractor so that no amount of charges in excess of what is contractually allowed may be entered.
Quarterly Submission Requirements
Contractors are required to provide additional quarterly summary data in the Monthly Invoice and Reporting Workbook by the last day of the month following the end of each quarter (i.e., the last day of December, March, June and September).
In addition to the tabs and fields that are completed monthly, contractors will need to:
- Complete Sections B, C and D of the Data Collection Form for clients that were seen using HHSC Epilepsy Program funds; and
- Complete the Quarterly Narrative.
Reconciling Errors on Previously Submitted Workbooks
If expenses are overstated on one month’s voucher, the following month’s expenses should be reduced accordingly.
Submission and Reporting after Entire Contract Award is Expended
Contractors must continue to submit the Monthly Invoice and Reporting Workbook 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 Invoice and Reporting Workbook
Contractors may have claims after the submission of their August billing. Contractors may claim any additional services by submission of an invoice and reporting workbook prior to October 15th. Mark this as FINAL.
All claims for reimbursement for services delivered must be submitted within 45 days of the end of the contract term as HHSC Epilepsy Program contracts require closure of the contract attachment 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.
Services may be provided to clients whose screening results indicate 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 monthly invoice and reporting forms for ease of processing. None of the billing or the reporting forms may be altered in any manner. The vouchers should not be altered to itemize expenses for epilepsy services provided. Vouchers should be submitted for the total monthly reimbursement amount only.
Financial Status Report
Contractors must submit a signed quarterly Financial Status Report (FSR or Form 269A) no later than the last day of the month following the end of the quarter. After the start of the fiscal year, each contractor will be sent their personalized FSR Workbook prepopulated with pertinent contract and payment information. Read “How to Use this FSR Workbook” and the instructions tab prior to completing the FSR. The FSR must be submitted to the email addresses on the FSR Instructions tab.
A signed Financial Status Report (Form 269A) final report must be submitted by email to the email addresses on the FSR Instructions tab no later than 45 days after the contract term. Form 269A must be marked as FINAL and include all reimbursements and adjustments in payments for the contract term.