| (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 vendor hold on additional
contracts, and barring of new contract.
(x) Voluntary withdrawal. Participating contracts or
component codes wishing to withdraw from the attendant compensation
rate enhancement must notify HHSC Rate Analysis in writing by certified
mail and the request must be signed by an authorized representative
as designated per the DADS signature authority designation form applicable
to the provider's contract or ownership type. The requests will be
effective the first of the month following the receipt of the request.
Contracts or component codes voluntarily withdrawing must remain nonparticipants
for the remainder of the rate year. Providers whose contracts are
participating as part of a component code must request withdrawal
of all the contracts in the component code.
(y) Adjusting attendant compensation requirements.
Providers that determine that they will not be able to meet their
attendant compensation requirements may request to reduce their attendant
compensation requirements and associated enhancement payment to a
lower participation level by submitting a written request to HHSC
Rate Analysis by certified mail and the request must be signed by
an authorized representative as designated per the DADS signature
authority designation form applicable to the provider's contract or
ownership type. These requests will be effective the first of the
month following the receipt of the request. Providers whose contracts
are participating as part of a component code must request the same
reduction for all of the contracts in the component code.
(z) All other rate components. All other rate components
will continue to be calculated as specified in the program-specific
reimbursement methodology and will be uniform for all providers.
(aa) Failure to document spending. Undocumented attendant
compensation expenses will be disallowed and will not be used in the
determination of the attendant compensation spending per unit of service
in subsection (s) of this section.
(bb) Appeals. Subject matter of informal reviews and
formal appeals is limited as per §355.110 of this title.
(cc) Responsible entities. The contracted provider,
owner, or legal entity which received the attendant compensation rate
enhancement is responsible for the repayment of the recoupment amount.
(1) HCS and TxHmL providers required to repay enhancement
funds will be jointly and severally liable for any repayment.
(2) Failure to repay the amount due or submit an acceptable
payment plan within 60 days of notification will result in placement
of a vendor hold on all HHSC or DADS contracts controlled by the responsible
entity.
(dd) Manual Repayment. For the HCS and TxHmL programs,
if HHSC, or its designee, is unable to recoup owed funds using an
automated system, providers will be required to repay some or all
of the enhancement funds to be recouped through a check, money order
or other non-automated method. Providers will be required to submit
the required repayment amount within 60 days of notification.
(ee) Determination of compliance with spending requirements
in the aggregate.
(1) Definitions. The following words and terms have
the following meanings when used in this subsection.
(A) Commonly owned corporations--two or more corporations
where five or fewer identical persons who are individuals, estates,
or trusts own greater than 50 percent of the total voting power in
each corporation.
(B) Entity--a parent company, sole member, individual,
limited partnership, or group of limited partnerships controlled by
the same general partner.
(C) Combined entity--one or more commonly owned corporations
and one or more limited partnerships where the general partner is
controlled by the same identical persons as the commonly owned corporation(s).
Cont'd... |
