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Vendor Hold

Vendor Holds Initiated by PFD

The following information is specific to vendor holds initiated by the Texas Health and Human Services Commission (HHSC) Provider Finance Department (PFD). Vendor holds will be initiated for failure to submit cost reports (CR) or accountability reports (AR) as required by Title 1 of the Texas Administrative Code (1 TAC).

PFD Vendor Hold Supplemental Training Presentation

The following supplemental trainings related to vendor hold and final AR review and reconciliation process is below:

Training Presentation Video (.mp4)

Failure to Submit an Acceptable CR

Following 1 TAC Section 355.111, if a provider does not submit a CR by the due date, HHSC grants the provider a compliance period of no more than 15 calendar days. If the provider does not submit a CR within the compliance period, HHSC imposes a vendor hold on payments to the provider.

Attendant Compensation Rate Enhancement

Attendant Compensation Rate Enhancement program

Under 1 TAC Section 355.112, the Attendant Compensation Rate Enhancement program requires an annual Attendant Compensation Report. Providers must file Attendant Compensation Reports as follows:

  • The report must reflect the provider’s activities while delivering contracted services from the first day through the last day of the rate year.
  • Contracted providers that do not submit an acceptable annual report within 60 days of the end of the rate year will be placed on vendor hold. CRs and ARs may serve as Attendant Compensation Reports. This vendor hold will remain in effect until HHSC PFD receives an acceptable report.
  • When a participating provider changes ownership through a contract assignment, the prior owner must submit a report covering the period from the beginning of the rate year to the effective date of the contract assignment. This report will be used to determine any recoupment amounts as described in 1 TAC Section 355.112(s). The new owner must submit a report covering the period from the day after the contract-assignment effective date to the end of the rate year.
  • Participating providers whose contracts are terminated voluntarily or involuntarily must submit a report covering the period from the beginning of the rate year to the contract termination date. This report will be used to determine recoupment.
  • Participating providers who voluntarily withdraw from participation must submit a report within 60 days from the withdrawal date. This report must cover the period from the beginning of the rate year through the withdrawal date and will be used to determine any recoupment amounts.

Direct Care Staff Enhancement program

Under 1 TAC Section 355.308, participating providers must file Staffing and Compensation Reports for services delivered on or before August 31, 2009.

  • This report must reflect the facility’s activities while delivering contracted services from the first day through the last day of the rate year. This report will be used to determine compliance with the staffing requirements and recoupment amounts and to determine the spending requirements and recoupment amounts.
  • Participating facilities that do not submit an acceptable report within 60 days of the end of the rate year will be placed on vendor hold until HHSC has received and processed an acceptable report.
  • Participating facilities that do not submit an acceptable report completed by following all applicable rules and instructions within 60 days of the due dates described in 1 TAC 355.308(f) or, for CRs, the due dates described in 1 TAC Section 355.105(b), will become nonparticipants retroactive to the first day of the corresponding reporting period. They will also be subject to immediate recoupment of funds paid to the facility for services provided during the reporting period. These facilities will remain nonparticipants and recouped funds will not be restored until they submit an acceptable report and repay HHSC funds identified for recoupment.
  • If HHSC does not receive an acceptable report within 365 days of the due date, the recoupment will become permanent, and if HHSC or its designee has recouped all funds associated with participation during the corresponding reporting period, HHSC will release the vendor hold associated with the report.
  • Participating facilities with an ownership change or contract termination that do not submit an acceptable report completed following all applicable rules and instructions within 60 days of the change in ownership or contract termination will become nonparticipants retroactive to the first day of the corresponding reporting period. They will also be subject to immediate recoupment of funds related to participation paid to the facility for services provided during the corresponding reporting period. These facilities will remain nonparticipants and recouped funds will not be restored until they submit an acceptable report and repay HHSC funds identified for recoupment.
  • If HHSC does not receive an acceptable report within 365 days of the change of ownership or contract termination date, the recoupment will become permanent, and if HHSC or its designee has recouped all funds associated with participation during the corresponding reporting period, HHSC will release the vendor hold associated with the report.

FAQS:

Why am I on Vendor Hold?

Under 1 TAC Section 355.112, the Attendant Compensation Rate Enhancement program requires contracted providers to submit an annual Attendant Compensation Report to HHSC PFD. This report must reflect the provider’s activities while delivering contracted services from the first day through the last day of the rate year. Providers must submit this report for each participating contract if they requested participation individually for each contract; or, if they requested participation as a group, the report must be submitted as a single aggregate report covering all contracts participating at the end of the rate year within one program of the provider.

A participating contract that has been terminated or that has undergone a contract assignment must meet compliance reporting requirements for the owner before the termination or contract assignment. This report will be used to determine compliance with the spending requirements and recoupment amounts.

Contracted providers failing to submit an acceptable annual Attendant Compensation Report within 60 days of the end of the rate year will be placed on vendor hold until HHSC PFD has received and processed an acceptable report.

I am no longer on Vendor Hold for Rate Enhancement, but I am not receiving payments. Whom do I contact?

A vendor hold is released after all required reports are submitted and HHSC determines that it is complete. Vendor-hold funds may have to go through one nightly billing cycle before they are released. Once these funds are released, two payment periods may elapse before you receive a payment via direct deposit. Please anticipate waiting until the first business day two Saturdays after your vendor hold has been released to receive payment. If you still have questions, whom to contact is based on whom you bill with:

Providers who bill through Managed Care Organizations (MCOs): HHSC releases the vendor hold and shares the release information with the MCOs through a nightly data file. Contact the individual MCO for which the release was expected.

Providers who bill through Texas Medicaid & Healthcare Partnership (TMHP): Contact Provider Recoupments and Holds (PRH) at 512-438-2200, option 3.

Can I be excused from submitting a CR?

A provider may be excused from submitting a CR if certain criteria have been met for their fiscal year. Providers meeting any of the following criteria provided on the Cost Report Excusal Information webpage must email PFD to request an exemption from filing CRs. HHSC PFD may request documentation or verify billing data to grant the excusal. If the provider is excused from submission of the CR but is a participant in the Attendant Compensation Rate Enhancement program or the Direct Care Staffing Enhancement program, they may be later required to submit data related to attendants or direct care staff to determine if they met the program requirements.

To request an excusal from filing a CR, the Entity Contact may email CostInformationPFD@hhs.texas.gov.

How long does it take to get off vendor hold if my contract is going through a CHOW or Termination?

A vendor hold is required for any contract participating in rate enhancement 15-30 days before termination. The contracting manager will reach out to the PFD Rate Enhancement (RE) team and provide Termination or Change of Ownership (CHOW) documents and an effective date. Once the RE team processes the termination, the signature authority will receive an AR notification via email. PFD–RE will include details about the type of final report, contract information, reporting period, and due date. Please refer to the State of Texas Automated Information Reporting System (STAIRS) portal for updates on the audit examination process and the necessary actions needed by the provider.

Once the final AR reflects a status of completion, the RE team will proceed with a vendor hold release request. The vendor hold will remain until this process is complete.

How do we submit the final AR?

Providers must submit the AR online through the web-based STAIRS. Providers and preparers who have previously submitted a CR via STAIRS will use the same login information to access this report. If the login is no longer valid, please email costinformationpfd@hhs.texas.gov to request a new username and password.

New providers without STAIRS access are required to create a password. Please visit the Fairbanks website, click on the “Client Login” link, and then “Texas Cost Reporting.” Next, type in your username. Then click on “Reset Password.”

The Primary Entity Contact is responsible for assigning Financial and Preparer contacts in STAIRS. This must be done before AR or CR completion can begin. Primary Entity Contacts are strongly encouraged to access the system as soon as possible and make these assignments to ensure adequate time to become familiar with the system. All supporting documents, including signed and notarized certification pages, must be uploaded into STAIRS. No documentation will be accepted via mail or email.

PFD–RE will communicate with the provider via email and include details about the type of final report, contract information, reporting period, and due date. Please refer to the STAIRS portal for updates on the audit examination process and the necessary actions needed by the provider.

Are there preparer requirements for the AR?

Under 1 TAC Section 355.102(d), it is the provider’s responsibility to ensure that each CR preparer has completed the required state-sponsored CR training. Preparers may be employees of the provider or persons who have been contracted by the provider for CR preparation. Preparers must complete CR training for each program for which a CR is submitted.

The AR can be prepared only by someone who has completed the mandatory CR training. More information about the training requirements can be found on the Cost Report Training Page.

Will I be able to submit claims and receive payments while on Vendor Hold?

Failure to submit an acceptable CR by the due date will result in HHSC withholding payments from the provider until an acceptable report is submitted. Providers can submit claims during a vendor hold; however, payment will not be issued until the vendor hold is released.

What is the HHSC process for review of an AR?

HHSC conducts desk reviews and field audits of provider CRs to ensure that all financial and statistical information in the CRs conforms to all applicable rules and instructions under 1 TAC Section 355.105(b)(4).

Each HHSC Financial Examiner (FE) will complete certain tasks for each desk review to ensure that each CR submitted is following TAC. Each desk review is peer-reviewed to ensure all tasks were reviewed, followed Government Auditing Standards and performed per HHSC policies and procedures.

PFD–RE will email the provider and include details about the type of final report, contract information, reporting period, and due date. Please refer to the STAIRS portal for updates on the audit examination process and the necessary actions needed by the provider.

How do inquire about my final AR or CR?

Final CR/AR inquiries need to be sent to PFD-RE@hhs.texas.gov.

Resources:

The following resources are available to assist you.

For assistance with CR or AR completion, instructions, informal reviews, or general guidance, contact (737) 867-7817 or PFD-LTSS@hhs.texas.gov.

For questions regarding mandatory Preparer training, contact (737) 867-7812 or costinformationpfd@hhs.texas.gov.

For problems accessing STAIRS, contact Fairbanks, LLC (877) 354-3831 or info@fairbanksllc.com.

If you have any questions regarding Vendor Holds related to Rate Enhancement, contact PFD RE via e-mail at PFD-RE@hhs.texas.gov.