| (a) HHSC may impose and collect an administrative penalty
against a program provider for:
(1) a violation of a certification principle that applies
to a program provider; and
(2) any of the following:
(A) willfully interfering with the work of a representative
of HHSC or the enforcement of this subchapter, which may include:
(i) making a false statement of material fact that
the program provider knows or should know is false with respect to
a matter under investigation by HHSC; and
(ii) falsifying documentation, including documenting
the provision of a service before the service has been provided; or
(B) failing to pay an administrative penalty within
10 calendar days after the date the assessment of the penalty becomes
final.
(b) The range of the administrative penalty that may
be imposed against a program provider each day for a violation described
in subsection (a)(1) of this section is based on the scope and severity
of the violation and whether it is an initial or repeated violation,
as set forth in the following figure:
Attached Graphic
(c) In determining the amount of an administrative
penalty within a range, HHSC considers:
(1) the seriousness of the violation, including:
(A) the nature, circumstances, extent, and gravity
of the violation; and
(B) the hazard to the health or safety of individuals
resulting from the violation;
(2) the program provider's history of previous violations;
(3) whether the program provider:
(A) had prior knowledge of the violation, including
whether the program provider identified the violation through the
program provider's internal quality assurance process; and
(B) made any efforts to mitigate or correct the identified
violation;
(4) the penalty amount necessary to deter future violations;
and
(5) any other matter that justice may require.
(d) If HHSC determines that a violation is not a critical
violation, HHSC allows a program provider one opportunity to correct
the violation to avoid the imposition of an administrative penalty.
If HHSC determines that a violation is a critical violation, HHSC
does not allow a program provider an opportunity to correct the violation
before HHSC imposes an administrative penalty.
(e) If HHSC imposes an administrative penalty for a
violation described in subsection (a)(1) of this section, the administrative
penalty begins accruing:
(1) for a critical violation, on the date HHSC identifies
the violation; or
(2) for a violation that is not critical, on the date
of the exit conference of the post 45-day follow-up survey.
(f) An administrative penalty accrues each day until
the earliest of the following:
(1) the program provider completes corrective action
for that violation, as determined by HHSC;
(2) HHSC imposes a vendor hold for that violation;
or
(3) HHSC withholds payments as the result of a proposed
contract termination.
(g) If the program provider demonstrates that corrective
action is complete on the same day an administrative penalty begins
accruing, HHSC imposes an administrative penalty for one day.
(h) For an administrative penalty imposed in accordance
with subsection (a)(2) of this section:
(1) HHSC imposes the penalty no more than once per
survey;
(2) HHSC does not allow a program provider an opportunity
to correct the action before imposing the penalty; and
(3) the amount of the penalty is $1000.
(i) If HHSC imposes an administrative penalty against
a program provider in accordance with subsection (a) of this section,
HHSC does not, at the same time, impose a vendor hold or otherwise
withhold contract payments from the program provider for the same
violation, action, or failure to act.
|
| Source Note: The provisions of this §565.45 adopted to be effective April 28, 2020, 45 TexReg 2704; transferred effective June 19, 2023, as published in the May 26, 2023 issue of the Texas Register, 48 TexReg 2731 |
