Revision 19-0; Effective July 1, 2019

 

 

Financial Reporting

Voucher and Report Submission – Categorical

Program Information:

Program Name: HHSC FPP

Contract Type: Categorical

Contract Term: July 1 thru August 31

Voucher:

Voucher Name: Form 4116, State of Texas Purchase Voucher.

Submission Date: By the last business day of the month following the month in which expenses were incurred or services provided. Final voucher due within 45 days after end of the contract term.

Submit Copy to:

Name of Area Original Signature Required Accepted Method of Submission No. of Copies
  Yes No  

Women’s Health & Educational Services Mailbox:

X Email 1

WHSFinance@hhsc.state.tx.us

 

Instructions: Attach B-13X to Voucher Form 4116.

Note: Vouchers must be submitted each month even if there are zero expenditures. Vouchers must still be submitted each month for actual expenditures of the program even if the contract limit has been reached. 

Voucher Supporting Document:

Report Name: Supporting Schedule for Family Planning Reimbursement Vouchers Form B-13X in Excel format.

Submission Date: By the last business day of the month following the month in which expenses were incurred or services provided. Final B-13X due within 45 days after end of the contract term.

Submit Copy to:

Name of Area Original Signature Required Accepted Method of Submission No. of Copies
  Yes No  

Women’s Health & Educational Services Mailbox:

X Email 1

WHSFinance@hhsc.state.tx.us

 

Instructions: Attach B-13X to Form 4116.

Financial Report:  Financial Status Quarterly Report

Report Name: Financial Status Report Form 269A

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 days after the end of each quarter. The final quarterly FSR is due 45 days after the end of the contract term. The final quarter report includes all final charges and expenses associated with the program contract. Mark it as "Final."

Submit Copy to:

Name of Area Original Signature Required Accepted Method of Submission No. of Copies
  Yes No  

Women’s Health & Educational Services Mailbox:

X   Email 1

WHSFinance@hhsc.state.tx.us

 

Instructions: Form 269A must have an original signature (scanned email or fax accepted).   

Financial Report:  Fee-for-Service Report        

Program Information:

Program Name: HHSC FPP

Contract Type: Fee-for-Service (File Furnished Voucher through TMHP TexMed Connect/Compass 21)

Contract Term: September 1 through August 31

Fee-For-Service Claims Submission Information:

2017 Claim Form: File Furnished Voucher through TMHP TexMed Connect/Compass 21

Claims Filing Deadline: Within 95 days from date of service or date of third-party insurance EOB form. Within 45 days after the end of the contract term.

Claims Submission Entity: Texas Medicaid Healthcare Partnership/Compass 21

Notes: Claims must continue to be submitted to TMHP TexMed Connect/Compass 21 even if the contract limit has been reached.

Appeals must be submitted within 120 days of rejection during the contract term.

All appeals must be submitted and finalized within 45 days after the end of the contract term.

Report Name: Financial Reconciliation Report (FRR)

Submission Date: No later than 60 days after the end of the contract term.

Submit Copy to:

Name of Area Original Signature Required Accepted Method of Submission No. of Copies
  Yes No  

Women’s Health & Educational Services Mailbox:

X   Email, scan, or fax 1

WHSFinance@hhsc.state.tx.us

 

Instructions: FRR form does require a signature (scanned or fax accepted).  FRR only necessary if contractor only has fee for service component without cost reimbursement component. 

Financial Status Reports (FSRs) for Categorical Family Planning Contracts

The HHSC FPP operates using the FFS award, categorical award and anticipated co-pays to be collected as the total budget. All revenue directly generated by, or earned because of, the project (co-pays), along with FFS reimbursement is considered program income on the quarterly FSRs. FPP contractors with categorical funding are required to identify and report receipt and expenditure of co-pays and FFS payments quarterly and annually on the FSR Form 269A. See quarters for categorical FSR submission below. Program income (co-pays and FFS payments), must be expended prior to receiving reimbursement for program costs. 

The quarterly reports are due by the last business day of the month following the end of each quarter of the contract term. The final FSR, Form 269A, is due within 45 days after the end of the contract term, unless stipulated differently in the contract attachment following the end of the contract term. HHSC reserves the right to base funding levels, in part, upon the contractor’s proficiency in identifying, billing, collecting and reporting income, and in utilizing it for the delivery of family planning services.

Quarters for Categorical FSR submission:

Quarter 1: September through November
Quarter 2: December through February
Quarter 3: March through May
Quarter 4: June through August

FPP Categorical Budget Revisions

Contractors are not required to obtain approval from HHSC for cumulative budget transfers up to 10% of their total FPP categorical direct budget, except for the equipment category. Transfer to or from the equipment category requires prior approval from HHSC.

Contractors must obtain prior approval from HHSC for cumulative budget transfers that exceed 10% of their total FPP categorical direct budget.

Contractors are required to submit a revised budget to HHSC for review anytime a budget revision is made.

Programmatic Reporting

The FPP Promotion/Outreach Annual Report must be sent to: famplan@hhsc.state.tx.us. The report is due within 45 days after the end of the contract period (October 15).