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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER DHOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM AND COMMUNITY FIRST CHOICE (CFC)
RULE §9.181Administrative Penalties

(a) HHSC may impose and collect an administrative penalty against a program provider for:

  (1) a violation of a certification principle that applies to a program provider; and

  (2) any of the following:

    (A) willfully interfering with the work of a representative of HHSC or the enforcement of this subchapter, which may include:

      (i) making a false statement of material fact that the program provider knows or should know is false with respect to a matter under investigation by HHSC; and

      (ii) falsifying documentation, including documenting the provision of a service before the service has been provided; or

    (B) failing to pay an administrative penalty within 10 calendar days after the date the assessment of the penalty becomes final.

(b) The range of the administrative penalty that may be imposed against a program provider each day for a violation described in subsection (a)(1) of this section is based on the scope and severity of the violation and whether it is an initial or repeated violation, as set forth in the following figure:

Attached Graphic

(c) In determining the amount of an administrative penalty within a range, HHSC considers:

  (1) the seriousness of the violation, including:

    (A) the nature, circumstances, extent, and gravity of the violation; and

    (B) the hazard to the health or safety of individuals resulting from the violation;

  (2) the program provider's history of previous violations;

  (3) whether the program provider:

    (A) had prior knowledge of the violation, including whether the program provider identified the violation through the program provider's internal quality assurance process; and

    (B) made any efforts to mitigate or correct the identified violation;

  (4) the penalty amount necessary to deter future violations; and

  (5) any other matter that justice may require.

(d) If HHSC determines that a violation is not a critical violation, HHSC allows a program provider one opportunity to correct the violation to avoid the imposition of an administrative penalty. If HHSC determines that a violation is a critical violation, HHSC does not allow a program provider an opportunity to correct the violation before HHSC imposes an administrative penalty.

(e) If HHSC imposes an administrative penalty for a violation described in subsection (a)(1) of this section, the administrative penalty begins accruing:

  (1) for a critical violation, on the date HHSC identifies the violation; or

  (2) for a violation that is not critical, on the date of the exit conference of the post 45-day follow-up survey.

(f) An administrative penalty accrues each day until the earliest of the following:

  (1) the program provider completes corrective action for that violation, as determined by HHSC;

  (2) HHSC imposes a vendor hold for that violation; or

  (3) HHSC withholds payments as the result of a proposed contract termination.

(g) If the program provider demonstrates that corrective action is complete on the same day an administrative penalty begins accruing, HHSC imposes an administrative penalty for one day.

(h) For an administrative penalty imposed in accordance with subsection (a)(2) of this section:

  (1) HHSC imposes the penalty no more than once per survey;

  (2) HHSC does not allow a program provider an opportunity to correct the action before imposing the penalty; and

  (3) the amount of the penalty is $1000.

(i) If HHSC imposes an administrative penalty against a program provider in accordance with subsection (a) of this section, HHSC does not, at the same time, impose a vendor hold or otherwise withhold contract payments from the program provider for the same violation, action, or failure to act.


Source Note: The provisions of this §9.181 adopted to be effective April 28, 2020, 45 TexReg 2704

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