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42.3.1.3 Cost Reconciliation and Cost Settlement
The cost reconciliation process must be completed within 24 months of the end of the reporting period covered by the annual SHARS cost report. The total Medicaid-allowable costs are compared to the provider's interim payments for SHARS delivered during the reporting period, which results in a cost reconciliation. The SHARS cost report is due on or before March 1, 2008, with the cost reconciliation and settlement processes completed no later than August 31, 2009.
If a provider's interim payments exceed the actual, certified, Medicaid-allowable costs of the provider for SHARS to Medicaid clients, 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 overpayments within one year.
•Recoup an agreed upon dollar amount from future claims payments to ensure recovery of the overpayment within one year.
If the actual, certified, Medicaid-allowable costs of a provider for SHARS exceed the provider's interim payments, HHSC will pay the federal share of the difference to the provider in accordance with the final, actual certification agreement and submit claims to CMS for reimbursement of that payment in the federal fiscal quarter following payment to the provider.
HHSC shall issue a notice of settlement that denotes the amount due to or from the provider.
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