8000, Required Forms and Reports | Texas Health and Human Services

Revision 24-2; Effective Oct. 15, 2024

Description: Includes Form B-13X, Form 4116, and Form Data Management
Submission Date: By the last business day of the month following the month when expenses were incurred or services provided. Final voucher due within 45 calendar days after end of the grant term.
Accepted Method of Submission: Email
Submit Copy to: fcs_finance@hhs.texas.gov
Original Signature Required: No
Number of Copies: One
Instructions: Enter Cost Reimbursement monthly expenses per budget category, co-pays/donations, which is program income, non-HHSC funding and data collection.
Note: The Monthly Voucher Packet templates are sent to grantees by their contract manager. Vouchers must be submitted each month even if there are no expenditures. Vouchers must still be submitted each month for actual expenditures of the program even if the grant limit has been reached.

Description: Quarterly report that includes all expenditures, program income and non-HHSC funding for the defining three months with amounts received from HHSC.
Submission Date: Reports are due as follows: Quarter 1: September through November; Quarter 2: December through February; Quarter 3: March through May; Quarter 4: June through August. Submit 30 calendar days after the end of each quarter. The final quarterly FSR is due 45 days after the end of the grant term. The final quarter report includes all final charges and expenses associated with the program grant. Mark it as "Final."
Accepted Method of Submission: Email
Submit Copy to: fcs_finance@hhs.texas.gov
Original Signature Required: No
Number of Copies: One

Description: Fee-for-Service, file furnished voucher through Texas Medicaid and Healthcare Partnership (TMHP) TexMedConnect/Compass 21
Submission Date: Claims Filing Deadline: Within 95 calendar days from date of service or date of third-party insurance EOB form. Within 45 calendar days after the end of the grant term.
Accepted Method of Submission: TMHP/Compass 21
Submit Copy to: Not applicable
Original Signature Required: No
Number of Copies: Not applicable
Instructions: Claims must continue to be submitted to TMHP TexMedConnect/Compass 21 even if the grant award amount has been reached.
Note: Appeals must be submitted within 120 calendar days of denial during the grant term. All appeals must be submitted and finalized within 45 calendar days after the end of the grant term.

Submission Date: No later than 60 calendar days after the end of the grant term.
Accepted Method of Submission: Email
Submit Copy to: fcs_finance@hhs.texas.gov
Original Signature Required: No
Number of Copies: Not applicable
Instructions: The FRR is required only if the grantee has only a fee-for-service component without a cost reimbursement component.

Description: This plan should outline the grantee’s goals to inform the public of the program’s purpose and available services, enhance community understanding of its objectives, disseminate basic family planning and women’s health care knowledge, enlist community support and recruit potential clients for FPP. Grantees may use the Promotion and Outreach Plan Template, Form 1060, in the Forms section as an optional framework for this internal plan.
Submission Date: The contractor completes the report within 45 calendar days of the start of the grant period and keeps it on file for monitoring purposes.
Accepted Method of Submission: Plans must be kept on file for monitoring requirements, but do not need to be submitted to HHSC.
Submit Copy to: N/A
Original Signature Required: No
Number of copies: Not applicable
Instructions: Complete plan annually by due date outlined.

Description: This survey will be sent via email to designated FPP signature authorities bi-annually. Grantees are required to complete the survey within 30 days.
Submission Date: The report is due within 30 days of receipt.
Original Signature Required: No
Number of Copies: Not applicable

Instructions: Submit completed surveys bi-annually by the due date outlined.