| (2) Payments made under this section 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.
HHSC, or its designee, may recoup an amount equal to any such adjustments
from the providers in question. This section may not 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.
(h) Disallowance of federal funds. If payments under
this section are disallowed by CMS, HHSC may recoup the amount of
the disallowance from providers that participated in the program associated
with the disallowance. If the recoupment from a provider for such
a disallowance results in a subsequent disallowance, HHSC will recoup
the amount of that subsequent disallowance from the same entity.
(i) Duration. Payments under this section will be made
for services delivered between March 1, 2022, and August 31, 2022,
or as specified by HHSC.
(j) A provider that has a contract for financial management
services (FMS) must ensure that an employer in the CDS option, or
designated representative, uses payments made under this section as
defined in subsection (c)(2) - (c)(3) of this section.
(k) An MCO must require an MCO contractor, other than
an MCO contractor described in subsection (j) of this section, to
use payments made under this section as defined in subsection (c)
of this section.
(l) An MCO must require that an MCO contractor that
has a contract for FMS ensures that an employer in the CDS option
or designated representative uses payments made under this section
as defined in subsection (c)(2) - (c)(3) of this section.
(m) Payment methodology. HHSC calculates payments made
under this section in the following manner:
(1) Total approved funding pool is divided proportionally
based on historical claims paid from all HCBS services to calculate
an anticipated funding amount for each service.
(2) Anticipated funding amount for each HCBS service
is divided by projected utilization for the program period to calculate
a per unit payment factor for each service.
(3) Payments under this section will be distributed
on claims for services delivered during the duration specified in
subsection (i) of this section.
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