A person is subject to administrative actions or sanctions
if the person:
(1) engages in any negligent or abusive practice that
results in death, injury, or substantial probability of death or injury
to a recipient;
(2) fails to provide an item or service to a recipient
in accordance with accepted medical community standards or standards
required by statute, regulation, or contract, including statutes and
standards that govern occupations;
(3) furnishes or orders services or items for a recipient
under the Medicaid or other HHS program that substantially exceed
a recipient's needs, are not medically necessary, are not provided
economically or are of a quality that fails to meet professionally
recognized standards of health care;
(4) is the subject of a voluntary or involuntary action
taken by a licensing or certification agency or board, which action
is based upon the agency or board's receipt of evidence of noncompliance
with licensing or certification requirements;
(5) has its license to provide health care revoked,
suspended, or probated by any state's licensing or certification authority,
or surrenders a license or certification while a formal disciplinary
proceeding is pending before any state's licensing or certification
authority;
(6) fails to abide by applicable statutes and standards
governing providers;
(7) fails to comply with the security, privacy, marketing,
disclosure, notification, business associate and breach requirements
of HIPAA and regulations promulgated under HIPAA or the Texas Medical
Records Privacy Act in chapter 181 of the Texas Health and Safety
Code and regulations promulgated under that Act;
(8) fails to timely provide notice of electronic disclosure
to a recipient for whom the person creates or receives protected health
information that is subject to electronic disclosure;
(9) electronically discloses or permits the electronic
disclosure of a recipient's protected health information to any person
without a separate, documented authorization from the recipient or
the recipient's legally authorized representative for each disclosure,
unless the disclosure is:
(A) to a covered entity as defined by §181.001
of the Texas Health and Safety Code or to a covered entity as that
term is defined by §602.001 of the Texas Insurance Code for the
purpose of:
(i) treatment;
(ii) payment;
(iii) health care operations; or
(iv) performing an insurance or health maintenance
organization function as described by §602.053 of the Texas Insurance
Code; or
(B) as otherwise authorized by state or federal law;
(10) employs any treatment modality that has been declared
unsafe or ineffective by the Food and Drug Administration, CMS, the
Public Health Service, or other state or federal agency with regulatory
authority; or
(11) fails to comply with eligibility or meaningful
use or other standards of the Health Information Technology for Economic
and Clinical Health Act incentive programs and regulations promulgated
under the Act.
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| Source Note: The provisions of this §371.1659 adopted to be effective October 14, 2012, 37 TexReg 7989; amended to be effective April 15, 2014, 39 TexReg 2833; amended to be effective May 1, 2016, 41 TexReg 2941 |
