|(a) HHSC reviews and assesses each submitted RHP plan
update to determine whether it meets the following criteria:
(1) It is in the prescribed format.
(2) It contains all required elements described in
the Program Funding and Mechanics Protocol and the Measure Bundle
Protocol, and is consistent with the waiver Special Terms and Conditions.
(3) It meets the requirements for Category A - Required
Reporting, Category B - MLIU Patient Population by Provider (PPP),
Category C - Measure Bundles and Measures, and Category D - Statewide
Reporting Measure Bundles, as described in the Program Funding and
Mechanics Protocol and the Measure Bundle Protocol.
(4) The funding amount and distribution is in accordance
with the Program Funding and Mechanics Protocol.
(5) It is consistent with the goals of the DSRIP program
and the objectives of the Medicaid program.
(b) Upon completion of HHSC's review, HHSC notifies
the anchor that HHSC:
(1) has approved the RHP plan update;
(2) requires additional information to complete its
(3) requires modification of the RHP plan update, including
the specific deficiencies in the RHP plan update that HHSC has identified.
(c) The anchor must respond to a notification as described
in subsection (b) of this section in accordance with the directions
in the notification. Failure to respond in a timely manner may result
in denial of the RHP plan update.
(1) If HHSC requires additional information to complete
its review, 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 update,
the anchor must submit a corrected RHP plan update that addresses
the specific deficiencies within the time frame specified in the notice.
(d) If after responding to the notice as described
in subsection (c) of this section an RHP plan update is not approved,
the affected entities may request a review.
(1) If an RHP plan update is not approved, the anchor
may request a review by HHSC in accordance with paragraph (3) of this
(2) The anchor must submit a request for review in
writing to HHSC within 12 calendar days of the date HHSC sent the
notification under subsection (b) of this section.
(3) The review is:
(A) limited to the RHP's allegations of factual or
(B) supported by documentation submitted by the RHP
or used by HHSC in making its original determination; and
(C) not an adversarial hearing.
(4) HHSC notifies the RHP of the results of the review
in a timely manner.