| (ii) If the governmental entity transfers less than
the maximum IGT described in paragraph (1) of this subsection for
all of the ICFs/IID it owns, each of the ICFs/IID will receive a proportion
of the Medicaid supplemental payment limit amount calculated for it
in subsection (f) of this section based on the proportion of the total
maximum IGT for all of the ICFs/IID owned by the governmental entity
that was actually transferred.
(C) Supplemental payments to remaining non-state government-owned
ICFs/IID will not be increased due to the failure of a governmental
entity to transfer the maximum IGT described in paragraph (1) of this
subsection.
(3) A governmental entity that did not transfer the
maximum IGT described in paragraph (1) of this subsection in one or
more of the first three quarters in a federal fiscal year will be
allowed to fund the remaining Medicaid supplemental payment limit
during the fourth quarter of that fiscal year, subject to the following:
(A) HHSC will give notice of the remaining Medicaid
supplemental payment limits and the maximum IGT that can be provided
for each non-state government-owned ICF/IID. Such notice will also
contain instructions and deadlines for governmental entities to notify
HHSC of the fourth-quarter transfer amount.
(B) Following the deadline for notification described
in subparagraph (A) of this paragraph, if HHSC determines that the
supplemental payments for the federal fiscal year will exceed the
applicable aggregate supplemental payment amount for non-state government-owned
ICFs/IID, HHSC will reduce the amount of the transfer for the fourth-quarter
payment under this clause proportionately for each participating ICF/IID
in an amount sufficient to ensure compliance with the applicable aggregate
supplemental payment amount.
(4) The amount of the payment to the ICF/IID will be
calculated using the FMAP in place when HHSC gave notice as described
in paragraph (1) or (3) of this subsection, as applicable.
(i) Recoupment.
(1) If payments under this section result in overpayment
to an ICF/IID, or in the event of a disallowance by the federal Centers
for Medicare and Medicaid Services (CMS) of federal participation
related to an ICF/IID's receipt or use of supplemental payments authorized
under this section, HHSC may recoup an amount equivalent to the amount
of supplemental payments overpaid or disallowed.
(2) Supplemental 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.
HHSC may recoup an amount equivalent to any such adjustment.
(3) HHSC may recoup from any current or future Medicaid
payments as follows:
(A) HHSC will recoup from the ICF/IID to which an overpayment
was made or against which any disallowance was directed.
(B) If, within 30 days of the ICF/IID's receipt of
HHSC's written notice of recoupment, the ICF/IID has not paid the
full amount of the recoupment or entered into a written agreement
with HHSC to do so, HHSC may withhold any or all Medicaid payments
from the ICF/IID until HHSC has recovered an amount equal to the amount
overpaid or disallowed. If funds identified for recoupment cannot
be repaid from the ICF/IID's Medicaid payments, the governmental entity
that owns the ICF/IID will be 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 Medicaid contracts
controlled by the governmental entity and will bar the governmental
entity from receiving any new contracts with HHSC or its designees
until repayment is made in full.
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