| (a) HHSC establishes, in accordance with 42 C.F.R. §435.1102(b)(3),
oversight mechanisms to ensure that qualified hospitals and qualified
entities are making presumptive eligibility determinations consistent
with statute and regulations.
(b) HHSC establishes, in accordance with 42 C.F.R. §435.1110(d)(1),
standards for qualified hospitals making presumptive Medicaid eligibility
determinations related to the proportion of individuals determined
presumptively eligible for Medicaid by the hospital who:
(1) Submit a regular application, as described in 42
C.F.R. §435.907, before the end of the presumptive eligibility
period and in accordance with HHSC timeliness standards; and/or
(2) Are determined eligible for Medicaid by HHSC based
on such application.
(c) HHSC monitors qualified hospitals to determine
if the hospitals are meeting the standards set by HHSC and approved
in the Texas State Plan for Medical Assistance.
(d) HHSC takes action, including disqualification of
a hospital from the Presumptive Medicaid Program if HHSC determines
that the hospital is not:
(1) Making or capable of making presumptive eligibility
determinations in accordance with HHSC policies and procedures; or
(2) Meeting the standards established by HHSC.
(e) Prior to disqualifying a hospital, HHSC provides
additional training or takes other reasonable corrective action measures
to address the issue.
(f) HHSC cancels the qualified provider status of qualified
entities, in accordance with 42 C.F.R. §435.1102(b)(3), or qualified
hospitals, in accordance with 42 C.F.R. §1110(d)(2), that intentionally
misrepresent program eligibility requirements or are negligent in
determining eligibility.
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