(a) As a condition of continued enrollment, a provider
must notify HHSC or its designee in writing of any change in its status
or condition with respect to the information disclosed in an enrollment
application or other supplemental form to an enrollment application,
as determined by HHSC, including:
(1) National Provider Identifier or associated taxonomy
code;
(2) Medicare number;
(3) Medicare certification status;
(4) federal tax identification number;
(5) responsible billing party for the provider;
(6) physical address for the provider or responsible
billing party;
(7) the name, address, date of birth, and Social Security
number of any managing employee of the provider;
(8) enrollment type;
(9) provider licensure, certification, accreditation;
(10) any change of ownership as required by 42 CFR §489.18;
(11) a change in the person with an ownership or control
interest in the provider;
(12) information required to be disclosed under Chapter
371 of this title (relating to Other Health and Human Services Fraud
and Abuse Program Integrity);
(13) third-party billing vendor services; or
(14) any other information required by HHSC or its
designee.
(b) Time frame for reporting changes.
(1) If a change described in subsection (a) of this
section occurs due to a change of ownership or control interest, the
provider must report the change to HHSC or its designee within 30
days of the change of ownership.
(2) For all other changes, the provider must report
the change to HHSC or its designee within 90 days of the occurrence.
(c) Upon notification of a change that is reported
in accordance with this section, HHSC or its designee may require
the submission of a new enrollment application and fee, if applicable,
provider agreement, provider licensure or certification, or other
documentation necessary to verify the reported change.
(d) If a provider does not report a change as required
by this section or 42 CFR §489.18, or does not submit an item
HHSC or its designee requires under subsection (c) of this section,
HHSC or its designee may, retroactive to the date that the change
should have been reported:
(1) disenroll the provider or terminate the provider's
participation in Medicaid or CHIP;
(2) deny further reimbursement; and
(3) recoup payments made to the provider.
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