| (2) Requests for revision. A provider may request a
revision of its enrollment limitation if the provider's most recently
available audited Attendant Compensation Report or cost report functioning
as an Attendant Compensation Report does not represent its current
attendant compensation levels.
(A) A request for revision of enrollment limitation
must include the documentation specified in subparagraph (B) of this
paragraph and must be received by HHSC Rate Analysis no later than
the deadline indicated in the notification of open enrollment specified
in subsection (e) of this section. A request for revision that is
not received by the stated deadline will not be accepted, and the
enrollment limitation specified in STAIRS will apply.
(B) A provider that requests a revision of its enrollment
limitation must submit documentation that shows that, for the period
beginning September 1 of the current rate year and ending April 30
of the current rate year, the provider met a higher attendant compensation
level than STAIRS indicates. In such cases, the provider's enrollment
limitation will be established at the level supported by its request
for revision documentation. It is the responsibility of the provider
to render all required documentation at the time of its request for
revision. Requests that fail to support an attendant compensation
level different from what is indicated STAIRS will result in a rejection
of the request, and the enrollment limitation specified in STAIRS
will apply.
(C) A request for revision must be signed by an individual
legally responsible for the conduct of the provider or legally authorized
to bind the provider, such as the sole proprietor, a partner, a corporate
officer, an association officer, a governmental official, a limited
liability company member, a person authorized by the applicable DADS
signature authority designation form for the interested party on file
at the time of the request, or a legal representative for the interested
party. A request for revision that is not signed by an individual
legally responsible for the conduct of the interested party will not
be accepted, and the enrollment limitation specified in STAIRS will
apply.
(D) If the provider's Attendant Compensation Report
or cost report functioning as an Attendant Compensation Report for
the rate year that included the open enrollment period described in
subsection (e) of this section shows the provider compensated attendants
below the level it presented in its request for revision, HHSC will
immediately recoup all enhancement payments associated with the request
for revision documents, and the provider will be limited to the level
supported by the report for the remainder of the rate year.
(3) Informal reviews and formal appeals. The filing
of a request for an informal review or formal appeal relating to a
provider's most recently available, audited Attendant Compensation
Report or cost report functioning as an Attendant Compensation Report
under §355.110 of this title (relating to Informal Reviews and
Formal Appeals) does not stay or delay implementation of an enrollment
limitation applied in accordance with the requirements of this subsection.
If an informal review or formal appeal relating to a provider's most
recently available, audited Attendant Compensation Report or cost
report functioning as an Attendant Compensation Report is pending
at the time the enrollment limitation is applied, the result of the
informal review or formal appeal shall be applied to the provider's
enrollment retroactively to the beginning of the rate year to which
the enrollment limitation was originally applied.
(4) New owners after a contract assignment or change
of ownership that is an ownership change from one legal entity to
a different legal entity. Enhancement levels for a new owner after
a contract assignment or change of ownership that is an ownership
change from one legal entity to a different legal entity will be determined
in accordance with subsection (w) of this section. A new owner after
a contract assignment or change of ownership that is an ownership-change
from one legal entity to a different legal entity will not be subject
to enrollment limitations based upon the prior owner's performance.
(5) New providers. A new provider's enrollment will
be determined in accordance with subsection (g) of this section.
(v) Contract terminations. For contracted providers
or component codes required to submit an Attendant Compensation Report
due to a termination as described in subsection (h) of this section,
HHSC, or its designee, will place a vendor hold on the payments of
the contracted provider until HHSC receives an acceptable Attendant
Compensation Report, as specified in subsection (h) of this section,
and funds identified for recoupment from subsection (s) of this section
are repaid to HHSC, or its designee. Informal reviews and formal appeals
relating to these reports are governed by §355.110 of this title.
HHSC, or its designee, will recoup any amount owed from the provider's
vendor payments that are being held. In cases where funds identified
for recoupment cannot be repaid from the held vendor payments, the
responsible entity from subsection (cc) of this section will be jointly
and severally liable for any additional payment due to HHSC, or its
designee. Failure to repay the amount due or submit an acceptable
payment plan within 60 days of notification will result in the recoupment
of the owed funds from other HHSC and/or DADS contracts controlled
by the responsible entity, placement of a vendor hold on all HHSC
and/or DADS contracts controlled by the responsible entity, and will
bar the responsible entity from enacting new contracts with HHSC and/or
DADS until repayment is made in full. The responsible entity for these
contracts will be notified as described in subsection (t) of this
section prior to the recoupment of owed funds, placement of vendor
hold on additional contracts, and barring of new contracts.
(w) Contract assignments. The following applies to
contract assignments.
(1) Definitions. The following words and terms have
the following meanings when used in this subsection.
(A) Assignee--A legal entity that assumes a Community
Care contract through a legal assignment of the contract from the
contracting entity as provided in 40 TAC §49.210 (relating to
Contractor Change of Legal Entity).
(B) Assignor--A legal entity that assigns its Community
Care contract to another legal entity as provided in 40 TAC §49.210.
(C) Contract assignment--The transfer of a contract
by one legal entity to another legal entity as provided in 40 TAC §49.210.
(i) Type One Contract Assignment--A contract assignment
by which the assignee is an existing Community Care contract.
(ii) Type Two Contract Assignment--A contract assignment
by which the assignee is a new Community Care contract.
(2) Participation after a contract assignment. Participation
after a contract assignment is determined as follows:
(A) Type One Contract Assignments. For Type One contract
assignments, the assignee's level of participation remains the same
while the assignor's level of participation changes to the assignee's.
(B) Type Two Contract Assignments. For Type Two contract
assignments, the level of participation of the assignor contract(s)
will continue unchanged under the assignee contract(s).
(3) The assignee is responsible for the reporting requirements
in subsection (h) of this section for any reporting period days occurring
after the contract assignment effective date. If the contract assignment
occurs during an open enrollment period as defined in subsection (e)
of this section, the owner recognized by HHSC, or its designee, on
the last day of the enrollment period may request to modify the enrollment
status of the contract in accordance with subsection (f) of this section.
(4) For contracted providers required to submit an
Attendant Compensation Report due to contract assignment, as described
in subsection (h) of this section, HHSC, or its designee, will place
a vendor hold on the payments of the existing contracted provider
until HHSC receives an acceptable Attendant Compensation Report, as
specified in subsection (h) of this section, and until funds identified
for recoupment from subsection (s) of this section are repaid to HHSC,
or its designee. HHSC, or its designee, will recoup any amount owed
from the provider's vendor payments that are being held. In cases
where funds identified for recoupment cannot be repaid from the held
vendor payments, the responsible entity from subsection (cc) of this
section will be jointly and severally liable for any additional payment
due to HHSC, or its designee. Failure to repay the amount due within
60 days of notification will result in the recoupment of the owed
funds from other HHSC and/or DADS contracts controlled by the responsible
entity, placement of a vendor hold on all HHSC and/or DADS contracts
controlled by the responsible entity, and will bar the responsible
entity from enacting new contracts with HHSC and/or DADS until repayment
is made in full. The responsible entity for these contracts will be
notified, as described in subsection (t) of this section, prior to
the recoupment of owed funds, placement of Cont'd... |
