| (a) In lieu of requiring payment for an administrative
penalty imposed against a program provider in accordance with §565.45
of this chapter (relating to Administrative Penalties), the Texas
Health and Human Services Commission (HHSC) may give the program provider
the opportunity for amelioration in accordance with this section.
(b) HHSC does not give a program provider the opportunity
for amelioration:
(1) more than three times in a two-year period;
(2) more than one time in a two-year period for the
same or similar violation;
(3) for a critical violation that is an immediate threat;
or
(4) for the actions or failures to act described in §565.45
of this chapter.
(c) HHSC gives a program provider the opportunity for
amelioration in the notice required by 40 TAC §49.535(c) (relating
to Administrative Penalties in the HCS and TxHmL Programs). If the
program provider does not notify HHSC that the program provider chooses
amelioration within the required period described in the notice, the
program provider forfeits the opportunity to choose amelioration and
HHSC requires the program provider to pay the administrative penalty
in accordance with §565.45 of this chapter.
(d) If a program provider chooses amelioration in accordance
with the notice required by 40 TAC §49.535(c), the program provider
must submit a written plan for amelioration to HHSC within 45 calendar
days after the date of the notice required by 40 TAC §49.535(c).
If a program provider does not submit a plan for amelioration within
45 calendar days, HHSC requires the program provider to pay the administrative
penalty in accordance with 40 TAC §49.535(d)(1).
(e) A plan for amelioration must include:
(1) proposed changes to the management or operation
of the program provider that will improve services or the quality
of care for the individuals;
(2) the ways in which and the extent to which the proposed
changes will improve services or quality of care for the individuals
through measurable outcomes;
(3) clear goals to be achieved through the proposed
changes;
(4) a timeline for implementing the proposed changes;
(5) specific actions necessary to implement the proposed
changes;
(6) the cost of the proposed changes; and
(7) an agreement to waive the program provider's right
to appeal the imposition of the administrative penalty if HHSC approves
the plan for amelioration.
(f) The cost of the proposed changes must be incurred
by the program provider after HHSC approves the plan for amelioration.
If HHSC approves the plan and the cost of the proposed changes is
less than the amount of the administrative penalty, HHSC requires
the program provider to pay the difference between the cost of the
proposed changes and the administrative penalty.
(g) HHSC may require a plan for amelioration to propose
changes that result in conditions exceeding the requirements of this
subchapter.
(h) HHSC notifies a program provider of its decision
to approve or deny a plan for amelioration within 45 calendar days
after the date HHSC receives the plan. During the 45-day period, HHSC
may allow the program provider an opportunity to revise the plan.
(1) If HHSC approves the plan:
(A) the program provider must implement the plan; and
(B) HHSC:
(i) requires the program provider to pay the amount
of the difference between the cost of the proposed changes and the
administrative penalty, if any; and
(ii) determines in one or more surveys conducted in
accordance with §565.41 of this subchapter (relating to HHSC
Surveys of a Program Provider) if the program provider has implemented
the plan.
(2) If HHSC denies the plan, HHSC requires the program
provider to pay the amount of the administrative penalty in accordance
with 40 TAC §49.535(d)(2). The program provider may appeal the
administrative penalty in accordance with 40 TAC §49.541 (relating
to Contractor's Right to Appeal).
(i) If HHSC determines that a program provider did
not implement an approved plan for amelioration, HHSC requires the
program provider to pay the amount of the administrative penalty in
accordance with 40 TAC §49.535(d)(3). The program provider may
appeal the sole issue of whether the plan for amelioration was implemented.
|
