(a) DADS may terminate a provider agreement:
(1) for reasons set forth in federal or state laws,
rules or regulations, including this subchapter and 1 TAC Chapter
355 (relating to Reimbursement Rates);
(2) if the program provider fails to comply with the
terms of the provider agreement, including failure of the program
provider's facility to maintain ICF/IID Program certification;
(3) if federal or state laws, rules or regulations
are enacted, amended, repealed or judicially interpreted so as to
render the fulfillment of the provider agreement by either the program
provider or DADS unfeasible or impossible, and DADS and program provider
cannot agree upon amendments to the provider agreement necessary
to comply with such changes to laws, rules or regulation;
(4) if a certification made by the program provider
in the provider agreement is false or becomes inaccurate;
(5) if DADS determines that a program provider has
failed to implement a DPoC in accordance with §9.267 of this
division (relating to Directed Plan of Correction and Vendor Hold
Based on State Survey Agency Findings); or
(6) if, during an 18-month period, three vendor holds
are imposed on payments due under that provider agreement in accordance
with §9.267 of this division.
(A) A vendor hold may be used to terminate a provider
agreement in accordance with this paragraph regardless of whether
there was an actual interruption of payment to the program provider.
(B) A vendor hold may be used no more than once to
terminate a provider agreement in accordance with this paragraph.
(b) If DADS proposes to terminate a provider agreement,
DADS may place a vendor hold on payments due to the program provider
under the provider agreement until:
(1) an audit of the program provider's financial records,
conducted in accordance with §9.269 of this division (relating
to Audits) is completed;
(2) a review of the program provider's fiscal accountability
cost report, conducted in accordance with 1 TAC §355.452 (relating
to Cost Reporting Procedures) and 1 TAC §355.457 (relating to
Cost Finding Methodology) is completed; and
(3) any amounts owed to DADS as a result of the audit
and review are resolved.
(c) If DADS proposes to terminate a provider agreement,
DADS sends a written notice of the proposed termination to the program
provider. The program provider may submit a written request for an
informal reconsideration (IR) in accordance with paragraph (1) of
this subsection.
(1) DADS considers a request for an IR only if the
program provider submits the request and any supporting documentation
the program provider wants DADS to consider to DADS, within seven
days after receiving DADS notice of proposed termination.
(2) If the program provider submits a timely request
for an IR, DADS provides a written response to the program provider
affirming or reversing the proposed termination.
(3) If the program provider does not submit a timely
request for an IR, or DADS affirms the proposed termination, DADS
proceeds with the proposed termination in accordance with subsection
(d) of this section.
(d) If DADS proposes to terminate a provider agreement
after the process described in subsection (c) of this section, DADS
sends a second written notice of the proposed termination to the program
provider. The program provider may submit a written request for an
administrative hearing in accordance with 1 TAC §357.484 (relating
to Request for a Hearing).
(e) If DADS proposes to terminate a provider agreement
and the program provider requests an administrative hearing in accordance
with 1 TAC §357.484, DADS does not terminate the provider agreement
before the completion of the administrative hearing, but payments
to the program provider may be withheld by DADS.
(1) If the final decision of the administrative hearing
is favorable to DADS or the program provider does not make a timely
request for an administrative hearing, then payments withheld will
not be made by DADS to the program provider.
(2) If the final decision is favorable to the program
provider, then DADS pays amounts withheld and resumes payment under
the provider agreement.
(f) If DADS terminates a provider agreement, DADS does
not enter into a new provider agreement with the program provider
until at least two days have elapsed from the effective date of the
termination.
(g) DADS may enter into a new provider agreement with
a program provider that has had its provider agreement terminated
if:
(1) within 30 days after termination, the program provider
requests a new provider agreement; and
(2) within 90 days after termination, DADS determines
that all deficiencies or actions that led to termination of the provider
agreement have been corrected and the program provider is otherwise
qualified to enter into a provider agreement.
(h) In determining whether to enter into a new provider
agreement with a program provider that has had its provider agreement
terminated, DADS considers:
(1) the nature, severity, and pervasiveness of the
deficiencies or actions that led to termination of the provider agreement;
and
(2) the facility's or the program provider's history
of compliance with ICF/IID Program requirements.
(i) The term and effective date of a new provider agreement
entered into in accordance with subsection (f) of this section will
be determined by DADS.
(j) If DADS determines not to enter into a new provider
agreement:
(1) a local authority must assist DADS in relocating
individuals who choose to move from the facility; and
(2) the program provider must assist DADS or the local
authority in relocating individuals who choose to move from the facility.
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Source Note: The provisions of this §261.268 adopted to be effective January 1, 2001, 25 TexReg 12790; amended to be effective March 31, 2002, 27 TexReg 2475; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; amended to be effective November 4, 2013, 38 TexReg 7724; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127 |