| (a) A program provider must notify the department's
Office of Medicaid Administration in writing at least 30 days prior
to the date of a proposed assignment. The notice must include:
(1) the legal name and federal tax identification number
of the proposed assignee;
(2) the proposed date of the assignment, which must
be on the first day of a month;
(3) the provider vendor number of the assignor;
(4) an application for enrollment obtained from the
department and completed by the assignee as required for provider
applicants by §419.206(d) of this title (relating to Application
Process); and
(5) a copy of the assignment agreement, which must
include a statement that the assignee:
(A) must keep, perform, and fulfill all of the terms,
conditions, and obligations that must be performed by the assignor
under the provider agreement;
(B) is subject to all pending conditions that exist
against the assignor including, but not limited to, any plan of correction,
audit exception, vendor hold, or proposed contract termination; and
(C) is liable to the department for any liabilities
or obligations that arise from any act, event, or condition that occurred
or existed prior to the effective date of the assignment and that
is identified in any survey, review, or audit conducted by the department.
(b) The department may establish the date of assignment
if:
(1) notice of a proposed assignment is not provided
to the department at least 30 days prior to the proposed date of assignment;
or
(2) the proposed date of assignment is not on the first
day of a month.
(c) Upon receipt of notice provided in accordance with
subsection (a) of this section, the department will:
(1) impose a vendor hold on payments due to the assignor
under the provider agreement until an audit conducted in accordance
with §419.269 of this title (relating to Audits) is complete;
and
(2) review the application for enrollment.
(d) After the department reviews the application for
enrollment, the department will provide written notice to the assignee
and assignor stating whether the application is approved or rejected.
(e) The department may reject an application for enrollment
for the same reasons a provider applicant's application for enrollment
may be rejected as set forth in §419.206(e) of this title (relating
to Application Process). If the department rejects the application
for enrollment, the assignor may withdraw the proposed assignment.
If the assignment is not withdrawn, the department may terminate the
assigned provider agreement.
(f) If the department approves the proposed assignee's
application for enrollment, the department will notify the state survey
agency of the assignment and request that the state survey agency
initiate licensure and certification action.
(g) The assignor must, prior to the effective date
of the assignment, give written notice to each individual residing
in the facility or LAR of the proposed assignment and the proposed
effective date of the assignment.
(h) If the facility is licensed in accordance with
state law and determined by the state survey agency to meet certification
requirements on or before the 90th day after the effective date of
the assignment, the department will pay the assignee for services
provided on and after the effective date of the assignment, except
the department will not pay the assignee for any period of time during
the 90-day period that the facility was determined by the state survey
agency to not meet certification requirements.
(i) If the facility is not licensed in accordance with
state law and determined by the state survey agency to meet certification
requirements on or before the 90th day after the effective date of
the assignment, the department will terminate the provider agreement
effective on the 91st day. A survey completed more than 90 days after
the effective date of the assignment will not be used to determine
if the facility met the licensure and certification requirements within
the 90-day period.
(j) During the 90-day period after the effective date
of the assignment, the provider agreement is subject to sanctions,
including termination, in accordance with Division 7 of this subchapter
(relating to Provider Agreement Sanctions).
(k) Upon the effective date of the assignment, the
assignee:
(1) must keep, perform, and fulfill all of the terms,
conditions and obligations that must be performed by the assignor
under the provider agreement;
(2) is subject to all pending conditions which exist
against the assignor, including but not limited to, any plan of correction,
audit exception, vendor hold, or proposed contract termination; and
(3) is liable to the department for any liabilities
or obligations that arise from any act, event, or condition that occurred
or existed prior to the effective date of the assignment and that
is identified in any survey, review, or audit conducted by the department.
(l) The assignor must complete and submit billing claims
to the department in accordance with §419.219 of this title (relating
to Provider Reimbursement) for services that were provided prior to
the effective date of the assignment.
|
| Source Note: The provisions of this §261.217 adopted to be effective September 1, 2001, 26 TexReg 5384; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8841; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127 |
