| (iv) If the amount transferred by the Non-state Governmental
Entity is less than the non-federal amount expended during the eligibility
period by HHSC for all Qualified Nursing Facilities owned by the Non-state
Governmental Entity, HHSC will notify the Non-state Governmental Entity
of the amount of the shortfall and of a deadline for the Non-state
Governmental Entity to transfer the shortfall.
(D) If the Non-state Governmental Entity does not timely
complete the transfer described in subparagraph (A), (B), or (C) of
this paragraph, HHSC may:
(i) withhold any or all future Medicaid payments from
the Non-state Governmental Entity until HHSC has recovered an amount
equal to the shortfall; and
(ii) retain any funds that would normally be returned
to the Non-state Governmental Entity as part of the reconciliation
process.
(5) All IGT calculations are solely at the discretion
of HHSC and are not open to desk review or appeal.
(h) Changes of Ownership. If a Qualified Nursing Facility
changes ownership to another non-state government entity during either
of the eligibility periods described in subsection (e) of this section,
then the data used for the calculations described in subsection (d)
of this section will include data from the facility for the entire
Calculation Period, including data relating to payments for days of
service provided under the prior owner.
(i) Recoupment.
(1) If payments under this section result in an overpayment
to a nursing facility, or in the event of a disallowance by CMS of
federal participation related to a nursing facility's receipt of or
use of payment amounts authorized under subsection (d) of this section,
the MCO(s) may recoup an amount equivalent to the amount of the second
payment amount that was overpaid or disallowed.
(2) Second payment amount payments under this section
may be subject to any adjustments for payments made in error, including,
without limitation, adjustments made under the Texas Administrative
Code, the Code of Federal Regulations and state and federal statutes.
The MCO(s) may recoup an amount equivalent to any such adjustment
from the nursing facility in question.
(3) If HHSC determines that part of any payment made
under the Minimum Payment Amount program was used to pay a contingent
fee, consulting fee, or legal fee associated with the nursing facility's
receipt of the Minimum Payment Amount funds, the MCO(s) may recoup
an amount equal to the second payment amount from the nursing facility
in question.
(4) If HHSC determines that an ownership change to
a Non-state Governmental Entity was based on fraudulent or misleading
statements on a nursing facility CHOW application or during the CHOW
process, the MCO(s) may recoup an amount equal to the second payment
amount from the nursing facility in question for any eligibility period
affected by the fraudulent or misleading statement.
(j) Dates the Minimum Payment Amount is available.
The minimum payment requirements described in this section will only
cover dates of service from the later of March 1, 2015, or the date
on which nursing facility services become managed care services, to
August 31, 2017.
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| Source Note: The provisions of this §353.608 adopted to be effective November 1, 2014, 39 TexReg 8376; amended to be effective March 1, 2015, 40 TexReg 807; amended to be effective June 21, 2015, 40 TexReg 3631; amended to be effective May 22, 2016, 41 TexReg 3473; amended to be effective June 4, 2017, 42 TexReg 2815 |
