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RULE §352.21Duty to Report Changes

(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.

Source Note: The provisions of this §352.21 adopted to be effective December 31, 2012, 37 TexReg 9899; amended to be effective May 2, 2016, 41 TexReg 3095

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