(a) Not later than the 45th calendar day after the
date ODHHS receives the voucher and all required supporting documentation
from the STAP vendor, or the date the vendor has claimed the voucher
in the ODHHS STAP claiming system, whichever date occurs later, the
ODHHS will pay the STAP vendor from TUSF the lesser of the:
(1) ODHHS established equipment value;
(2) STAP vendor's advertised purchase price; or
(3) voucher value established by ODHHS for the voucher
category of the equipment or service exchanged.
(b) Vouchers will not be reimbursed for partial exchanges.
All equipment must be exchanged as authorized on the voucher.
(c) STAP vendors will not be reimbursed for voucher
exchanges that are made during any time the STAP vendor is barred,
debarred, suspended, proposed for debarment, declared ineligible,
or excluded from participation in STAP by HHSC or any federal or Texas
state agency.
(d) STAP vendors seeking reimbursement for the sale
of STAP equipment from an additional source (such as Medicare, Medicaid,
or private insurance) in conjunction with a voucher exchange may not
receive more than the total price of the equipment from all sources.
(e) A STAP vendor that exchanges a STAP voucher in
person for the purchase of approved equipment or services in accordance
with STAP requirements may request reimbursement from ODHHS. ODHHS
will reimburse the STAP vendor from TUSF for a voucher exchanged in
accordance with this subchapter and STAP policy when the STAP vendor
claims the voucher in the ODHHS STAP claiming system, exchanges the
voucher for equipment with the customer, and provides ODHHS with the
following documentation:
(1) a voucher documenting equipment or service exchanged
and signed by both the voucher recipient, and vendor's registered
signature authority on file with ODHHS certifying that the equipment
or service was new, unused, and not reconditioned or obsolete and
has been delivered to the voucher recipient; and
(2) a receipt or invoice that contains:
(A) a description of the equipment or service exchanged
for the STAP voucher;
(B) manufacturer and model number;
(C) serial number; and
(D) the total price charged to the voucher recipient,
including the amount to be reimbursed by ODHHS for the equipment or
service exchanged.
(f) A STAP vendor that exchanges a STAP voucher by
mail for the purchase of approved equipment or services in accordance
with STAP policies and this subchapter may request reimbursement from
ODHHS. ODHHS will reimburse a voucher (exchanged in accordance with
this subchapter and STAP policies) upon receipt from the STAP vendor
of:
(1) proof of delivery of the equipment or service to
the voucher recipient; and
(2) a receipt or invoice that contains:
(A) a description of the equipment or service exchanged
by mail for the STAP voucher;
(B) manufacturer and model number;
(C) serial number; and
(D) the total price charged to the voucher recipient,
including the amount to be reimbursed by ODHHS for the equipment or
service exchanged.
(g) STAP vendors shall claim a voucher in the ODHHS
STAP claiming system and submit voucher reimbursement requests, along
with supporting documentation, to ODHHS within 120 calendar days after
the date of the voucher exchange or the date shown on the proof of
delivery.
(h) Vouchers exchanged in violation of STAP requirements
that are not corrected, and vouchers or supporting documentation submitted
or claimed after 120 calendar days from the date of the voucher exchange
will not be reimbursed.
(i) Vouchers submitted that do not have supporting
documentation, as required by this subchapter will not be reimbursed.
(j) ODHHS may investigate whether the presentation
of a voucher for payment represents a valid transaction for equipment
or service under STAP.
(k) If there is a dispute regarding the amount or propriety
of the payment or whether the equipment or service is appropriate
or adequate to meet the needs of the voucher recipient, ODHHS may:
(1) delay or deny payment of a voucher to a STAP vendor
until the dispute is resolved; or
(2) provide payment of a voucher, conditional upon
the return of the payment if the equipment is returned to the STAP
vendor or if the service is not used by the voucher recipient.
(l) Reimbursements may also be subject to other limitations
or conditions determined by ODHHS to be just and reasonable, including
investigation of whether the presentation of a STAP voucher represents
a valid transaction for equipment or services under STAP.
(m) If a dispute arises as to whether the submitted
documentation is sufficient to create a presumption of a valid STAP
sales transaction, ODHHS will make the final determination on the
sufficiency of the documentation.
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