V. Settlement Process 

V1. How can we obtain cost report details?

Cost reports can be viewed and printed from STAIRS.

V2. When is the Settlement period and how will we know?

HHSC sends out a SHARS Cost Report Settlement notice on or before August 31. Notices are distributed via Fairbanks email to the district’s superintendent, the primary SHARS financial contact and all secondary SHARS financial contacts.

V3. Our cost report is incorrect and we would like to dispute the Settlement, what do we need to do?

First, the district must complete Step 8 of the SHARS Cost Report in STAIRS by submitting a “Disagree” response. Next, the district must submit an informal review request. An ISD or their legal representative who disagrees with the adjustments made during the cost reconciliation process has the right to request an informal review of the adjustments. The request for an informal review of the adjustments must be sent via certified mail and should include the settlement notice, a concise statement of the specific actions or determinations the district disputes, the ISD's recommended resolution, and any supporting documentation deemed relevant to the dispute. The request for an informal review must be received by HHSC no later than 30 days after the Settlement Notice has been issued. Failure to follow these instructions will result in the denial of the request. Informal review requests can be sent to:

Certified Mail:
HHSC Rate Analysis
Mail Code: H-400
P.O. Box 149030 
Austin, TX 78714
 
Overnight/Courier Delivery:
HHSC Rate Analysis 
Mail Code H-400
4900 North Lamar 
Austin, TX 78751
 

V5. Our interim payments on the Cost Settlement does not agree with the R&S Statement for the same period, what do we do?

Verify that all paid claims for services delivered during the reporting period have been included in the district’s reconciliation total. The R&S report reflects claim payments processed during the period stated on the R &S report. Oftentimes claims are paid in the federal fiscal year that follows the federal fiscal year in which the services were delivered. If the district feels its records are incomplete, please call the TMHP Contact Center at 1-800-925-9126 to request archived copies of past R&S reports.

V6. My settlement reflects a recoupment, how do we repay this amount?

If a provider’s interim payments exceed the actual certified Medicaid-allowable costs, HHSC will recoup the federal share of the overpayment by one of the following methods:

  • Offset all future claims payments to the provider until the amount of the federal share of the overpayment is recovered;
  • Recoup an agreed-upon percentage from future claims payments to the provider to ensure recovery of the overpayment within a year;
  • Recoup an agreed-upon dollar amount from future claims payments to ensure recovery of the overpayment within a year.

If you are interested in establishing a special payment arrangement, please contact HHSC for more information. Each request will be evaluated on a case by case basis to determine if a special payment arrangement will be granted.