The purpose of a Medicaid Cost/Accountability Report is to gather financial and statistical information for HHSC to use in developing reimbursement rates. Some cost reports are also used in the determination of accountability under the Attendant Compensation Rate Enhancement program.
The Cost and Accountability Reports for the following programs will be submitted through the State of Texas Automated Information Reporting System (STAIRS).
- 24-Hour Residential Child Care (24RCC)
- Community Living Assistance and Support Services - Case Management Agency (CLASS-CMA)
- Community Living Assistance and Support Services - Direct Service Agency (CLASS-DSA)
- Day Activity and Health Services (DAHS)
- Deaf Blind Multiple Disabilities Waiver (DBMD)
- Early Childhood Intervention (ECI) – Case Management
- Early Childhood Intervention (ECI) – Specialized Rehabilitative Services
- Home and Community based Services/Texas Home Living (HCS/TxHmL)
- Intermediate are Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)
- Nursing Facility (NF)
- Primary Home Care (PHC)
- Rehabilitation Services – Mental Health
- Residential Care (RC)
- Service Coordination – Individuals with an Intellectual Disability or Related Condition
- Targeted Case Management – Mental Health
- STAR+PLUS services affiliated with the above service types
- Accountability Report Rules
For all CLASS, DAHS, DBMD, HCS, ICF/IID, PHC, RC, and TxHmL providers, Title 1 of the Texas Administrative Code (1 TAC) §355.112(h)(2)(E) states that "Existing providers who become participants in the Attendant Compensation Rate Enhancement as a result of the open enrollment process on any day other than the first day of their fiscal year are required to submit an Attendant Compensation Report with a reporting period that begins on their first day of participation in the enhancement and ends on the last day of the provider's fiscal year."
For all NF providers, Title 1 of the Texas Administrative Code (TAC) §355.308(f)(2)(F) states that "Existing facilities which become participants in the enhancement as a result of the open enrollment process on any day other than the first day of their fiscal year are required to submit a Staffing and Compensation Report with a reporting period that begins on their first day of participation in the enhancement and ends on the last day of the provider's fiscal year."
As described in Title 1 of the Texas Administrative Code (TAC) 355.112(h) and 355.308(f), contracts that were participating in the Attendant Compensation Rate Enhancement program or the Direct Care Staffing Enhancement program may be required to submit an acceptable report in certain circumstances, such as a change of ownership, contract terminations, mid-year withdrawal from the Rate Enhancement, new participants for a partial year or other reason specified by the Health and Human Services Commission (HHSC) Provider Finance Department (PFD). Providers are notified of the requirement to submit this report in an HHSC Provider Finance letter that specifically requests this report.
Report Release, Request, and Due Date
The release date each year for STAIRS cost reports for all programs is February 1st with a due date of April 30th or as indicated on the request letter.
The STAIRS Cost and Accountability Report request will go out on February 1st, and will be distributed via two methods:
- The request letter will be posted to the HHSC website in the Report Request Letters section below. In addition, an email will be sent to all providers through the HHSC GovDelivery alerts.
- An email will also be sent out from STAIRS directly to all Entity and Financial Contacts that have been identified for each provider in STAIRS
- Cost Report Reform Training and Cycle
Introduction to Cost Report Reform
Beginning with the 2018 cost reports, cost report reform began as a pilot for Home and Community-based Services and Texas Home Living (HCS/TxHmL) waiver programs and the Intermediate Care Facilities for Individuals with an Intellectual or Developmental Disability or Related Conditions (ICF/IID) program providers to submit cost reports biennially rather than annually. The Texas Health and Human Services Commission (HHSC) Executive Commissioner directed the Provider Finance Department (PFD) to expand cost report reform to all Long-term Services and Supports (LTSS) programs. The intended frequency of cost report submission is on a biennial basis rather than annual basis.
The Attendant Compensation Rate Enhancement and Direct Care Staffing Compensation Participants
A provider who participates in the Attendant Compensation Rate Enhancement or the Direct Care Staff Compensation programs (rate enhancement) are required to submit accountability reports in the years that they are not required to submit full cost reports. Providers are notified of the requirement to submit this report in an HHSC Provider Finance Department letter that specifically requests this report.
Providers who do not participate in the rate enhancement program are only required to submit cost reports every two years; no reports will be required in the interim years if they continue to be non-participants in the rate enhancement program.
Cost Reporting Cycle
CPC (Primary Home Care (PHC), Community Living Assistance and Support Services (CLASS)-Direct Service Agency (DSA), Community Living Assistance and Support Services (CLASS)-Case Management Agency (CMA)), and Day Activity and Health Services (DAHS) providers will be required to submit cost reports to HHSC Rate Analysis Department in odd-numbered years.
Nursing Facility (NF), Residential Care (RC), HCS/TxHmL, and ICF/IID providers will be required to submit cost reports in even years.
NF providers who are members of the Pediatric Care Facility class, The Department of Family and Protective Services’ (DFPS) 24-Hour Residential Child Care (24-HR RCC) providers will continue to submit their cost reports every year.
Deaf-Blind Multiple Disabilities Waiver providers enrolled in the Rate Enhancement program will submit their accountability reports every year.
Below is the cost reporting cycle for all LTSS programs:
Even-Year Cost Reports
Even Year cost reports collected in the Odd Year. (i.e. 2021 reports collected in 2022)
Report Type Reports Collected CR 24RCC CR HCS/TxHmL CR ICF/IDD CR NF CR RC AR CPC AR DAHS AR DBMD
Odd-Year Cost Reports
Odd Year cost reports collected in the Even Year. (i.e. 2020 reports collected in 2021)
Report Type Reports Collected CR 24RCC CR CPC CR DAHS AR DBMD AR HCS/TxHmL AR ICF/IDD AR NF AR RC
Cost Report Training
The Long-term Services and Supports (LTSS) cost report reform initiative requires preparers of most LTSS cost reports and accountability reports to attend state-sponsored cost report training in the same year that a cost report is required to be submitted to HHSC. Preparers of LTSS cost reports and accountability reports are required to attend training on a schedule that is related to their cost reporting deadlines.
There are no substantive changes to the Department of Family Protective Services (DFPS) 24-hour Residential Child Care program, and the Deaf-Blind with Multiple Disabilities (DBMD) training requirements.
STAIRS - State of Texas Automated Information Reporting System
STAIRS is an online application through which providers will prepare and submit their Cost and Accountability reports.
Providers who submitted a previous Cost Report via STAIRS will use the same logon information to access the current year's Cost and Accountability Report. An email will be sent to these providers from the STAIRS system that will include reminder information about accessing the system.
New providers without prior access to STAIRS will be sent an email from the STAIRS system by February 1st, containing STAIRS login information including their username and password.
This email will be sent to the Primary Entity Contact designated by HHSC Provider Finance Department (PFD) based on enrollment information previously submitted to HHSC or DFPS. Questions regarding STAIRS access for new providers should be sent to CostInformationPFD@hhs.texas.gov.
It is important to understand that each entity controls who is given access to their cost report. Access to STAIRS is granted through the assignment of roles that consist of:
- Entity Contact (primary or secondary)
- Financial Contact (primary or secondary)
The Primary Entity Contact must assign a "primary Financial Contact". Then, either of these Primary Contacts must assign at least one "Preparer" who will be responsible for completing the entity's cost report.
Only the Primary Entity Contact and the Primary Financial Contact may grant access to their cost report in STAIRS. Persons who feel they need access to the entity's cost report should consult with the Primary Contacts for that Entity.
When a Contact or Preparer is added, STAIRS will automatically send an email to that person providing them with access information including a username and password.
Reference materials are available once you log onto STAIRS at the bottom of the main screen. Please take time to review the reference material document titled Helpful Information for Contacts and Preparers. This document includes information on managing (adding, deleting, modifying) contacts and roles as well as descriptions regarding the functionality of these roles.
Mandatory Training Requirements for Preparers in STAIRS
Per Title 1 of the Texas Administrative Code (1 TAC), Part 15, Chapter 355, Subchapter A, Rule 355.102(d) HHSC requires that all cost report preparers attend a mandatory training prior to completing a cost or accountability report. HHSC provides a list of preparers who have met the mandatory cost report training requirements. The entity must select a preparer from this list through the STAIRS application. If the entity’s desired Preparer is not on the trained preparers list this means the desired preparer has not met the training requirements and must do so before they can be added to the list and selected to complete a report (see Cost Report Training below for additional information).