(a) HHSC imposes a vendor hold on a contractor if:
(1) HHSC has proposed to terminate the contract and
the contractor participates in attendant compensation rate enhancement
as described in 1 TAC §355.112 (relating to Attendant Compensation
Rate Enhancement); or
(2) The HHSC Office of Inspector General determines
that a vendor hold must be imposed in accordance with 42 CFR §455.23(a)
due to a credible allegation of fraud for which an investigation is
pending under the Medicaid Program.
(b) HHSC may impose a vendor hold on a contractor:
(1) if HHSC has proposed to terminate the contract
and the contractor does not participate in attendant compensation
rate enhancement as described in 1 TAC §355.112;
(2) if HHSC does not offer the contractor a standard
contract when its contract expires;
(3) if the contractor does not enter into a standard
contract when its contract expires;
(4) if the contractor terminates the contract;
(5) if HHSC determines the contractor has not complied
with the contract, including a determination of non-compliance described
in §49.411(e) of this chapter (relating to Contract and Fiscal
Monitoring) or §49.413(e) of this chapter (relating to Investigation);
(6) if the contractor has not submitted or has not
complied with an immediate protection plan as described in §49.511(d)
of this subchapter (relating to Immediate Protection and Immediate
Protection Plan);
(7) if the contractor has not submitted or has not
complied with a corrective action plan as described in §49.522(d)
of this subchapter (relating to Corrective Action Plan); or
(8) if the contractor's application packet described
in §49.203(a)(3) of this chapter (relating to Provisional Contract
Application Process):
(A) contained incorrect information; or
(B) contains information that has become incorrect
and the contractor has not notified HHSC in accordance with §49.302(i)
- (q) of this chapter (relating to General Requirements);
(9) for a contractor that has a contract for the HCS
Program, in accordance with §9.183 of this title (relating to
Program Provider Compliance and Corrective Action); or
(10) for a contractor that has a contract for the TxHmL
Program, in accordance with §9.587 of this title (relating to
Program Provider Compliance and Corrective Action).
(c) If HHSC imposes a vendor hold on a contractor in
accordance with subsection (a) or (b) of this section, HHSC notifies
the contractor of the vendor hold in writing. HHSC may impose a vendor
hold pending an administrative hearing appealing the vendor hold.
(d) HHSC releases a vendor hold less any amounts being
recouped by HHSC:
(1) imposed in accordance with subsections (a)(1) and
(b)(1) - (4) of this section if:
(A) the contract has been terminated or expires and
any amounts owed to individuals and LARs have been paid by the contractor;
(B) HHSC withdraws the proposed contract termination;
or
(C) the contractor appeals the proposed contract termination
and the final decision from the administrative hearing is favorable
to the contractor;
(2) imposed in accordance with subsection (a)(2) of
this section, if the HHSC Office of Inspector General determines that
HHSC must resume payment under the contract;
(3) imposed in accordance with subsection (b)(5) -
(8) of this section, if HHSC determines the contractor has resolved
the reason for the vendor hold; or
(4) imposed in accordance with subsection (b)(9) -
(10) of this section if HHSC determines it may be released as described
in §9.183 or §9.587 of this title.
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Source Note: The provisions of this §49.532 adopted to be effective September 1, 2014, 39 TexReg 6637; amended to be effective September 1, 2018, 43 TexReg 5230; amended to be effective April 28, 2020, 45 TexReg 2725; amended to be effective December 22, 2020, 45 TexReg 9234 |