(a) Any service purchased or reimbursed by DARS may be monitored at the discretion of DARS or HHSC.
(b) DARS and HHSC may conduct compliance monitoring reviews of the contractor's services to determine if the contractor is in compliance with the contract and with program rules and requirements. These reviews are conducted at the location where the contractor is providing the services unless DARS or HHSC specifies a different location. DARS and HHSC assess contractor performance based on contract standards.
(c) During the monitoring review, the contractor must provide:
  (1) adequate working space for reviewing the records;
  (2) every record DARS or HHSC requests for review; and
  (3) copies, or access for DARS and HHSC staff to make needed copies, of documents.
(d) During the monitoring review, DARS or HHSC may:
  (1) review a sample of consumer records to determine the contractor's compliance with contract requirements;
  (2) interview consumers and staff members;
  (3) observe consumers and staff members;
  (4) consult with others, as appropriate; and
  (5) conduct other activities, as appropriate.
(e) DARS or HHSC may expand a compliance monitoring review period or the review sample at any time.
(f) DARS and HHSC also conduct fiscal monitoring, which is the review of documentation that supports the contractor's billing, as it exists at the time the DARS or HHSC staff reviews the billing documentation. DARS or HHSC may recoup payment if the service delivery documentation does not support the contractor's billing.
(g) DARS and HHSC may conduct a fiscal monitoring review:
  (1) in conjunction with a compliance monitoring review;
  (2) independent of a compliance monitoring review;
  (3) when a contract is terminated;
  (4) as a result of a complaint; or
  (5) at other times as DARS or HHSC considers necessary.
(h) Fiscal monitoring is designed to ensure that:
  (1) DARS received the goods or services paid for;
  (2) The total amount paid by DARS was allowable under the contract; and
  (3) The contractor maintained the financial records and internal controls necessary to adequately account for claims under the contract.
(i) DARS and HHSC may use sampling methods in monitoring and auditing contracts.
(j) The contractor has the burden of proof in establishing entitlement to payments made under the contract.
(k) The contractor must provide the same accommodations for fiscal monitoring as related to compliance monitoring.

Source Note: The provisions of this §392.313 adopted to be effective June 17, 2015, 40 TexReg 3638