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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 3 School Health and Related Services (SHARS) : 3.6 Cost Reporting, Cost Reconciliation, and Cost Settlement : 3.6.2 Cost Reconciliation and Cost Settlement

3.6.2
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.
If a provider has not complied with all cost report requirements or 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:
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 issues a notice of settlement that denotes the amount due to or from the provider.

Texas Medicaid & Healthcare Partnership
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