6100, Reimbursement, Data Collection and Reports

Revision 22-3; Effective Nov. 8, 2022

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 expenditure, 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 clients (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 access their organization’s personalized MRP from the SharePoint Contractor Portal.

When the MRP is accessed at the start of the contract year, contractors should download and save the invoice and MRP by double 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 and submitted monthly no later than 30 days after the last day of the preceding month to the contact(s) identified in the MRP instructions.

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 following the end of each quarter except the final quarter, which is due 45 days after the end of the contract period (Oct 15th). When October 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 the submission of their August billing. Any additional invoices must be received by 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.

Reimbursement requests submitted more than 45 days following 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 for epilepsy services provided. Invoices  should be submitted for the total monthly reimbursement amount only.