(a) If HHSC assesses that the RHP plan meets the requirements
in §354.1621(b) of this division (relating to RHP Plan), HHSC
will submit the RHP plan to the Centers for Medicare and Medicaid
Services (CMS) for review.
(b) Upon completion of HHSC's assessment, HHSC notifies
the anchor that HHSC:
(1) has submitted the RHP plan to CMS for review;
(2) requires additional information to complete its
assessment;
(3) requires modification of the RHP plan, including
the specific deficiencies in the RHP plan that HHSC has identified;
or
(4) requires modification of a DSRIP project, including
the specific deficiencies in the DSRIP project that HHSC has identified.
If a particular DSRIP project needs modification, the funding IGT
entity and performer associated with that DSRIP project will be notified
in addition to the anchor.
(c) The anchor must respond to a notification as described
in subsection (b) of this section in accordance with the directions
in the notification, to ensure timely submission of the RHP plan to
CMS. Failure to respond in a timely manner may result in denial of
the RHP plan.
(1) If HHSC requires additional information to complete
its assessment, the anchor must provide the additional information
within the time frame specified in the notice.
(2) If HHSC requires a change in the RHP plan, the
anchor:
(A) must submit a corrected RHP plan that addresses
the specific deficiencies within the time frame specified in the notice;
or
(B) request a review of the HHSC finding as described
in subsection (d) of this section within the time frame specified
in the notice.
(3) If HHSC requires a change in a DSRIP project, the
anchor must:
(A) work with the associated IGT entity and performer
and submit a corrected DSRIP project that addresses the specific deficiencies
within the time frame specified in the notice;
(B) request a review of the HHSC finding as described
in subsection (d) of this section within the time frame specified
in the notice; or
(C) certify that the DSRIP project is withdrawn.
(d) If after responding to the notice as described
in subsection (c) of this section an RHP plan or DSRIP project is
not approved, the affected entities may request a review.
(1) If an RHP plan is not approved, the anchor may
request a review by HHSC in accordance with paragraph (4) of this
subsection.
(2) If a DSRIP project is not approved, the affected
performer may direct the anchor to request a review in accordance
with paragraph (4) of this subsection.
(3) The anchor must submit a request for review in
writing to HHSC within 12 calendar days of the date HHSC sent the
notification under this subsection.
(4) The review is:
(A) limited to the Regional Healthcare Partnership's
(RHP's) allegations of factual or calculation errors;
(B) supported by documentation submitted by the RHP
or used by HHSC in making its original determination; and
(C) not an adversarial hearing.
(5) HHSC will notify the RHP of the results of the
review in a timely manner.
(e) CMS review of an RHP plan can result in multiple
levels of approval. An anchor, or a performer through its anchor,
may supplement or revise the RHP plan to address any issue identified
by CMS that results in anything less than full approval. HHSC will
review the supplemented or revised information before submitting it
for CMS review.
(f) HHSC may, at any time, require clarifications to
a DSRIP project if HHSC determines that the information provided in
the RHP plan is so unclear as to prevent a payment.
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Source Note: The provisions of this §354.1622 adopted to be effective October 31, 2012, 37 TexReg 8453; amended to be effective September 1, 2013, 38 TexReg 5431; amended to be effective September 30, 2014, 39 TexReg 7570 |