| (a) DARS or HHSC may impose an adverse action when
the contractor fails to follow the terms of the contract or fails
to comply with DARS or HHSC rules, policies, and procedures. DARS
or HHSC may impose adverse actions for reasons including:
(1) DARS' or HHSC's determination that consumer health
and safety is jeopardized;
(2) the contractor's failure to comply with its corrective
action plan;
(3) the contractor's failure to follow an agreed-upon
audit resolution payment plan;
(4) the contractor's failure to submit an acceptable
cost report, if applicable;
(5) the contractor's failure to comply with the contract
or program requirements;
(6) the contractor's failure to maintain a current
required license or the contractor allowing the expiration of any
required license, if applicable;
(7) the contractor's relocation to a new facility address
that does not have the appropriate license, if applicable;
(8) the contractor's exclusion from contracting with
DARS, any health and human services program, or the federal government;
or
(9) validated report(s) of abuse, neglect, or exploitation
when the perpetrator is an owner, employee, or volunteer who has direct
access to consumers.
(b) Types of adverse actions may include:
(1) Recoupment. DARS or HHSC collects money the contractor
owes as the result of overpayments or other billing irregularities.
(2) Vendor hold. DARS or HHSC withholds the contractor's
contract payments. DARS or HHSC may put one or all of the contractor's
contracts on vendor hold. The vendor hold is released when DARS or
HHSC determines that the contractor has resolved the reason(s) for
the hold. In addition to the reasons listed in subsection (a) of this
section, DARS or HHSC may place a vendor hold on the contractor's
contract(s):
(A) to recoup overpayments made to the contractor;
or
(B) to recover any audit exceptions assessed against
the contractor.
(3) Denial of claim. DARS or HHSC denies payment in
whole or part for a claim filed within program time limits.
(4) Suspension of subcontractor's participation or
payments; termination of subcontract. DARS or HHSC directs a contractor
to suspend a subcontractor's participation, suspend a subcontractor's
payments, or terminate a subcontract.
(5) Involuntary contract termination. DARS or HHSC
may terminate a contract for cause by citing the contractor's failure
to comply with the terms of the contract or with DARS or HHSC rules,
policies, and procedures.
(6) Suspension. DARS or HHSC temporarily suspends the
contractor's right to conduct business with DARS. The causes for and
conditions of suspension are described in §392.323 of this subchapter
(relating to Causes and Conditions of Suspension).
(7) Debarment. DARS or HHSC does not allow a contractor
to conduct business with DARS, in any capacity, for a certain period
of time. The causes for and conditions of debarment are described
in §392.321 of this subchapter (relating to Causes and Conditions
of Debarment).
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