| (5) The provider must attest that it has not obtained
insurance from an insurer or person engaged in unauthorized insurance
as set forth in Chapter 101 of the Texas Insurance Code, Unauthorized
Insurance.
(g) Failure to maintain insurance coverage. It is the
provider's responsibility to notify the HHSC Provider Finance Department
of any changes to liability insurance coverage during a rate year
for which liability insurance rate add-ons are being paid, including
cancellation of, or failure to renew or to maintain coverage, within
15 calendar days of the effective date of the change. Failure to notify
HHSC Provider Finance Department of cancellation of or failure to
renew or maintain coverage could constitute Medicaid fraud and the
rate add-on amounts paid for a period during which liability insurance
is not maintained will be subject to recoupment under subsection (j)
of this section.
(h) New provider contracts. For the purposes of this
section, a new provider contract is a contract with an effective date
on or after the first day of the open enrollment period for that rate
year. To receive the liability insurance add-on rates, a provider
with a new provider contract must send a written request to complete
the attestation of agreement in subsection (f) of this section to
the HHSC Provider Finance Department. The attestation of agreement
must be completed according to instructions, signed by an authorized
agent of the provider's contract, and received by the HHSC Provider
Finance Department within 30 days of the date HHSC sends notification
to the provider that the attestation of agreement must be completed.
If the 30th day is on a weekend day, state holiday, or national holiday,
the HHSC Provider Finance Department must receive the attestation
by the next business day. A provider who fails to submit an acceptable
attestation of agreement in accordance with this section will not
receive the add-on rates during the rate year.
(i) Change of ownership. Payment of liability insurance
add-on rate confers to the new owner as defined in 26 TAC §554.2308
(relating to Change of Ownership) when there is a change of ownership.
If the change of ownership occurs during an open enrollment period
as defined in subsection (b) of this section, then the owner recognized
by HHSC, or its designee, may request to modify the enrollment status
of the facility by the last day of the enrollment period, in accordance
with subsection (e) of this section.
(j) Recoupment. HHSC will recoup add-on rates paid
to a provider under the following circumstances.
(1) It is the responsibility of the provider to ensure
that liability insurance is authorized. Liability insurance payments
will be recouped if made on insurance that is later determined by
TDI to be unauthorized insurance under Chapter 101, Texas Insurance
Code. The liability insurance payments that were recouped will be
returned to the provider if the determination by TDI that the insurance
is unauthorized is successfully appealed with TDI and the insurance
is determined to be authorized.
(2) It is the responsibility of the provider to ensure
that liability insurance coverage is maintained during a rate year
for which liability insurance rate add-ons are paid. Failure to maintain
coverage will result in recoupment of funds for any period in which
add-ons were paid and liability insurance coverage was not maintained.
(3) It is the responsibility of the provider to ensure
that its attestation of liability insurance coverage is accurate.
False attestations will result in recoupment of funds for the rate
year following the open enrollment in which the false attestation
was made.
|
| Source Note: The provisions of this §355.312 adopted to be effective December 1, 2001, 26 TexReg 9565; amended to be effective November 1, 2003, 28 TexReg 8310; amended to be effective May 1, 2005, 30 TexReg 2383; amended to be effective October 28, 2007, 32 TexReg 7469; amended to be effective May 1, 2022, 47 TexReg 2507 |
