(a) HHSC denies a provisional contract application
if:
(1) HHSC has not approved the applicant or contractor
for enrollment in accordance with 1 TAC Chapter 352 (relating to Medicaid
and Children's Health Insurance Program Provider Enrollment) and 1
TAC Chapter 371, Subchapter E (relating to Provider Disclosure and
Screening);
(2) HHSC has denied the enrollment application of the
applicant or contractor, or has disenrolled the applicant or contractor,
in accordance with 1 TAC Chapter 352 or Chapter 371, Subchapter E;
(3) the applicant or a controlling person of the applicant
is under an application denial period as described in §49.702
of this chapter (relating to Application Denial Period);
(4) the applicant or a controlling person of the applicant
is under a period of exclusion in accordance with §§1128,
1128A, 1136, 1156, or 1842(j)(2) of the Social Security Act;
(5) the applicant or a controlling person of the applicant
is listed on:
(A) the HHSC employee misconduct registry as unemployable;
(B) the HHSC nurse aide registry as revoked or suspended;
(C) the United States System for Award Management maintained
by the General Services Administration;
(D) the LEIE maintained by the United States Department
of Health and Human Services, Office of Inspector General;
(E) the LEIE maintained by the HHSC Office of Inspector
General;
(F) the Debarred Vendor List maintained by the Texas
Comptroller of Public Accounts and the period of debarment has not
expired; or
(G) the HHS list of exclusions;
(6) the applicant has not submitted a completed application
packet as required by §49.203 of this subchapter (relating to
Provisional Contract Application Process);
(7) the applicant does not have a license, certification,
accreditation, or other document required by §49.205 of this
subchapter (relating to License, Certification, Accreditation, and
Other Requirements);
(8) the applicant is applying because of a change of
ownership or a change of legal entity and HHSC has denied the application
for change of ownership of any license required to be a contractor
as described in §49.205 of this subchapter;
(9) the applicant or a controlling person of the applicant
is ineligible to contract with HHSC in accordance with §49.206
of this subchapter (relating to Ineligibility Due to Criminal History);
(10) the applicant or a controlling person of the applicant
is prohibited from contracting with HHSC in accordance with Chapter
79, Subchapter S, of this title (relating to Contracting Ethics);
(11) the applicant does not meet a requirement described
in §49.204 of this subchapter (relating to Additional Provisional
Contract Application Requirements);
(12) a DSA in the CLASS Program is applying to be a
CMA in the CLASS Program in the same catchment area in which the applicant
is a DSA;
(13) a CMA in the CLASS Program is applying to be a
DSA in the CLASS Program in the same catchment area in which the applicant
is a CMA;
(14) the applicant is applying to be a DSA and CMA
in the CLASS Program in the same catchment area;
(15) the applicant is required to register with the
Texas Secretary of State and the applicant's status with the Texas
Secretary of State is not "in existence"; or
(16) the applicant is required to pay Texas franchise
tax and the applicant's right to transact business status with the
Texas Comptroller of Public Accounts is not "active."
(b) HHSC may deny a provisional contract application
for good cause, including that:
(1) the application packet contains incorrect information;
(2) the applicant or a controlling person of the applicant
terminated a contractual agreement with a governmental entity in a
federal health care program, as defined in §1128B(f) of the Social
Security Act, while an adverse action or sanction was proposed or
in effect;
(3) the applicant or a controlling person of the applicant
terminated a contract while an action or sanction by DADS or HHSC,
as described in §49.521 or §49.531 of this chapter (relating
to Action by HHSC; Sanction by HHSC) was proposed or in effect;
(4) DADS or HHSC proposed or imposed an action or sanction,
as described in §49.521 or §49.531 of this chapter, against:
(A) a contract of the applicant, contractor or a controlling
person of the applicant; or
(B) a contract of a person for whom the applicant or
a controlling person of the applicant was a controlling person;
(5) HHSC, another governmental entity, or a managed
care organization contracting with a governmental entity, proposed
or imposed a termination, suspension, recoupment, or penalty against:
(A) a contractual agreement of the applicant or a controlling
person of the applicant; or
(B) a contract of a person for whom the applicant or
a controlling person of the applicant was a controlling person;
(6) HHSC or another governmental entity proposed or
imposed a penalty, revocation, denial, termination, or suspension
against a license, certification, or registration held by the applicant
or a controlling person of the applicant;
(7) the applicant or a controlling person of the applicant
has an unresolved financial liability with HHSC or another governmental
entity; or
(8) the applicant or a controlling person of the applicant
has been confirmed by DFPS or HHSC as having committed abuse, neglect,
or exploitation.
(c) If HHSC denies a provisional contract application,
HHSC provides written notification to the applicant. If the applicant
wants to be a contractor, the applicant must repeat the application
process described in §49.203 and §49.204 of this subchapter.
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