| (II) if more than one governmental entity is responsible
for the non-federal share of payments under the program, the additional
required funds are allocated proportional to each governmental entity's
initial contribution to funding the program; and
(III) HHSC notifies the governmental entities of the
amount and timing of the required transfers.
(iii) If the amount previously transferred is more
than the amount determined in clause (i)(II) of this subparagraph,
HHSC refunds the excess amount to the governmental entities in proportion
to each entity's initial contribution to funding the program.
(h) Failure of a governmental entity to transfer funds.
If a governmental entity does not timely complete the transfer of
funds described in this section, HHSC withholds Medicaid payments
from any provider operated by the governmental entity until HHSC has
recovered an amount equal to the amount of the funding shortfall.
(i) Failure of an MCO to comply with contract provisions.
HHSC may review MCO payments to network providers or other documentation
to verify that the MCO is in compliance with contract provisions directing
expenditures for delivery system and provider payment initiatives.
HHSC must investigate provider claims of contract violations. In the
event HHSC identifies any contract deficiency or violation, HHSC takes
corrective action to remedy such deficiency or violation, as authorized
by §353.5 of this chapter (relating to Internet Posting of Sanctions
Imposed For Contractual Violations).
(j) Disallowance of federal funds.
If payments under this subchapter are disallowed by CMS, HHSC
may recoup the amount of the disallowance from MCOs, providers, or
governmental entities that participated in the program associated
with the disallowance. If the recoupment from an MCO, provider, or
governmental entity for such a disallowance results in a subsequent
disallowance, HHSC will recoup the amount of that subsequent disallowance
from the same entity.
(k) Overpayment.
(1) If payments under this subchapter result in an
overpayment to an MCO, HHSC may recoup the amount of the overpayment
from the MCO, pursuant to the terms of the contract between them.
(2) If payments under this subchapter result in an
overpayment to a provider, the MCO may recoup an amount equivalent
to the overpayment.
(3) Payments made under this subchapter may be subject
to any adjustments for payments made in error or due to fraud, including
without limitation adjustments made under the Texas Administrative
Code, the Code of Federal Regulations, and state and federal statutes.
The MCOs may recoup an amount equal to any such adjustments from the
providers in question. Nothing in this section may be construed to
limit the independent authority of another federal or state agency
or organization to recover from the provider for a payment made due
to fraud.
(l) State's cost of administering programs. To the
extent authorized under state and federal law, HHSC will collect the
state's cost of administering a program authorized under this subchapter
from participants in the program generating the costs.
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