reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter B - CONTRACTOR ENROLLMENT › Section 52.39 - Provisional Contract Application Approval

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  HHSC approves a provisional contract application if it is not denied in
				  accordance with §
										49.207
				  of this subchapter (relating to Provisional Contract Application
				  Denial).
(b) If HHSC approves a
				  provisional contract application, HHSC:
(1)
				  provides written notification to the applicant;
(2) enters into a provisional contract with
				  the applicant; and
(3) except as
				  provided in §
											49.302(b)
				  of this chapter (relating to General Requirements), places the contract on the
				  choice list for the program or service covered by the provisional
				  contract.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter B - CONTRACTOR ENROLLMENT › Section 52.41 - Standard Contract

Current through Reg. 49, No. 28; July 12, 2024
(a) During the term
				  of a provisional or standard contract, HHSC may offer the contractor a standard
				  contract that will be effective the day after the existing contract ends. HHSC
				  offers a standard contract that is for the same program, service, or facility,
				  in the same service, catchment, or waiver contract area as the existing
				  contract, but other terms of the contract offered may be different than the
				  terms of the existing contract.
(b)
				  HHSC may subject a standard contract to conditions in accordance with 1 TAC
				  Chapter 352 (relating to Medicaid and the Children's Health Insurance Program
				  Provider Enrollment) and 1 TAC Chapter 371, Subchapter E (relating to Provider
				  Disclosure and Screening).
(c) If
				  HHSC offers a standard contract to a contractor and the contractor does not
				  enter into the standard contract in accordance with HHSC's instructions, HHSC
				  notifies the contractor and any controlling person of the contractor, in
				  writing, of the application denial period set in accordance with §
										49.702(c)
				  of this chapter (relating to Application Denial Period).
(d) HHSC and a contractor may agree, in
				  writing, to extend the term of a standard contract. A standard contract may be
				  extended only once and for no more than one year. The extension of a standard
				  contract is not a decision by HHSC that it will offer the contractor another
				  standard contract.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter B - CONTRACTOR ENROLLMENT › Section 52.43 - Contractor Change of Ownership or Legal Entity

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  If a contractor intends to undergo a change of ownership or change of legal
				  entity, the following action must be taken to obtain a new provisional
				  contract:
(1) at least 60 days before the
				  proposed date of the change of ownership or change of legal entity, the
				  contractor must notify HHSC in accordance with §
											49.551
				  of this chapter (relating to Contractor Terminating Contract or Not Entering
				  into a Standard Contract) that it intends to terminate the contract;
(2) the contractor (for a change of
				  ownership) or new legal entity (for a change of legal entity) must apply for a
				  provisional contract in accordance with §
											49.203
				  of this subchapter (relating to Provisional Contract Application Process) at
				  least 60 days before the proposed date of the change of ownership or change of
				  legal entity;
(3) the contractor or
				  new legal entity must receive approval from HHSC of the provisional contract
				  application before the date of the change of ownership or change of legal
				  entity in accordance with §
											49.208
				  of this subchapter (relating to Provisional Contract Application Approval);
				  and
(4) if required to have a
				  license under §
											49.205
				  of this subchapter (relating to License, Certification, Accreditation, and
				  Other Requirements) to be a contractor, the contractor or new legal entity must
				  ensure that the date of the change of ownership or change of legal entity is
				  the same as the date of the change of ownership or change of legal entity for
				  the new license.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter B - CONTRACTOR ENROLLMENT › Section 52.45 - Religious Organization Applicants

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  provisions in this section are based on Code of Federal Regulations, Title 45,
				  Part 87.
(b) An applicant that is a
				  religious organization is eligible to become a contractor on the same basis as
				  any other applicant.
(c) HHSC does
				  not discriminate against an applicant based on the applicant's religious
				  character or affiliation, in approving or denying an applicant's
				  application.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.101 - Contractors Not Subject to Certain Portions of Subchapter C

Current through Reg. 49, No. 28; July 12, 2024
Section
					 49.310
					 of this subchapter (relating to Abuse, Neglect, and Exploitation Allegations)
					 does not apply to a contractor for one or more of the following programs and
					 services:
(1) CLASS-CMA;
(2) CLASS-DSA;
(3) the CMPAS Program;
(4) the DBMD Program;
(5) FMSA-CLASS;
(6) FMSA-DBMD;
(7) FMSA-HCS;
(8) FMSA-PHC/CAS/FC;
(9) FMSA-TxHmL;
(10) the HCS Program;
(11) the PHC Program;
(12) the CAS Program;
(13) the FC Program; and
(14) the TxHmL Program.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.103 - General Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor
				  must have and maintain a license, certification, accreditation, or other
				  documentation required of an applicant in §
										49.205
				  of this chapter (relating to License, Certification, Accreditation, and Other
				  Requirements), except:
(1) a contractor that
				  has had a contract for the DBMD Program continuously since September 1, 1999,
				  and that does not provide home health or personal assistance services is not
				  required to have a HCSSA license issued in accordance with Chapter 558 of Title
				  26 (relating to Licensing Standards for Home and Community Support Services
				  Agencies) for a contract in effect on September 1, 2014; and
(2) a contractor that has had a contract for
				  AFC services in a four-bed home continuously since January 15, 2009, and that
				  has an assisted living facility Type C license issued in accordance with
				  Chapter 553 of Title 26 (relating to Licensing Standards for Assisted Living
				  Facilities) is not required to have an assisted living facility Type A or Type
				  B license issued in accordance with Chapter 553 of Title 26.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.105 - Confidentiality of Information

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  contractor must comply with applicable federal and state laws regarding
				  confidentiality of information regarding an individual.
(b) A contractor may use confidential
				  information, including the names and contact information of an individual
				  receiving services from another contractor, only for the authorized purpose for
				  which the confidential information was legally obtained.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.107 - Background Checks

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor
				  that is required to have a license, as described in §
										49.302(a)
				  of this subchapter (relating to General Requirements), must comply with
				  licensure requirements regarding criminal history record checks, the HHSC
				  employee misconduct registry and the HHSC nurse aide registry for employees,
				  subcontractors, and volunteers.
(b)
				  A contractor that is not required to have a license, as described in §
										49.302(a)
				  of this subchapter, must:
(1) before offering
				  employment to an unlicensed applicant for employment or contracting with an
				  unlicensed potential subcontractor, obtain directly or through a private agency
				  the criminal history record of the applicant or potential subcontractor from
				  the Department of Public Safety (DPS);
(2) before accepting an unlicensed volunteer
				  applicant for a volunteer position that directly interacts with an individual,
				  obtain directly or through a private agency the criminal history record of the
				  applicant from DPS;
(3) review the
				  criminal history record of the unlicensed applicant or potential
				  subcontractor;
(4) not employ an
				  unlicensed applicant for employment, contract with an unlicensed potential
				  subcontractor, or accept an unlicensed applicant for a volunteer position, for
				  the time periods set forth in Texas Health and Safety Code, §
											250.006, if
				  the applicant or potential subcontractor has been convicted of an offense
				  listed in Texas Health and Safety Code, §
											250.006;
				  and
(5) not employ an unlicensed
				  applicant for employment, contract with an unlicensed potential subcontractor,
				  or accept an unlicensed applicant for a volunteer position if the applicant or
				  potential subcontractor has been convicted of an offense that the contractor
				  determines is a contraindication to the applicant's employment, contracting, or
				  volunteering.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.109 - Records

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor must develop and maintain
				  records in accordance with its contract, this subchapter, and HHSC rules
				  governing services provided under the contract.
(b) A contractor must:
(1) use forms required by HHSC or, if a
				  specific form is not required by HHSC, develop records that include elements
				  required by HHSC; and
(2) ensure
				  that:
(A) a beginning time for a service is
				  not documented until after the service being documented has been initiated;
				  and
(B) an ending time or a time
				  period for a service is not documented until after the service has been
				  provided.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.111 - Electronic Visit Verification System

Current through Reg. 49, No. 28; July 12, 2024
A contractor using an electronic visit verification system
					 must comply with Chapter 68 of this title (relating to Electronic Visit
					 Verification (EVV) System).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.113 - Record Retention and Disposition

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  provided in subsections (c) and (d), a contractor must retain a record in the
				  form in which it was created as follows:
(1)
				  a record developed and maintained in accordance with §
											49.305
				  of this subchapter (relating to Records) until the latest of the following:
(A) seven years after the contractor submits
				  a claim for the service about which the record relates;
(B) seven years after all issues that arise
				  from any litigation, claim, negotiation, audit, open records request,
				  administrative review, or other action involving the record are resolved;
				  or
(C) the individual about whom
				  the record relates becomes 21 years of age.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.115 - Subcontracts

Current through Reg. 49, No. 28; July 12, 2024
If a contractor uses a subcontractor to provide a service
					 to an individual, the contractor must:
(1) have a written agreement with the
				  subcontractor that requires the subcontractor and any of its subcontractors to
				  comply with applicable provisions of the contract, this subchapter, and HHSC
				  rules governing services provided under the contract, as if the subcontractor
				  and its subcontractors were the contractor;
(2) monitor the subcontractor to ensure that
				  the subcontractor is in compliance with the written agreement referenced in
				  paragraph (1) of this section; and
(3) maintain records of its monitoring of the
				  subcontractor.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.117 - Complaint Process

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor
				  must develop and implement written procedures for investigating and resolving a
				  complaint about services provided under a contract, other than an allegation of
				  abuse, neglect, or exploitation, that:
(1)
				  allow a complaint to be submitted to the contractor:
(A) either orally or in writing;
				  and
(B) anonymously; and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.119 - Abuse, Neglect, and Exploitation Allegations

Current through Reg. 49, No. 28; July 12, 2024
A contractor must develop and implement written procedures
					 for reporting and investigating an allegation of abuse, neglect or exploitation
					 regarding an individual that:
(1)
				  comply with applicable laws and rules governing services provided under the
				  contract;
(2) require the
				  contractor to report an allegation of abuse, neglect, or exploitation to the
				  appropriate investigative authority;
(3) ensure that the contractor's employees,
				  subcontractors, and volunteers:
(A) are
				  knowledgeable of:
(i) acts that constitute
				  abuse, neglect, or exploitation of an individual;
(ii) the requirement to report acts of abuse,
				  neglect, or exploitation, or suspicion of such acts to the appropriate
				  investigative authority;
(iii) how
				  to report allegations of abuse, neglect, or exploitation to the appropriate
				  investigative authority; and
(iv)
				  methods to prevent the occurrence of abuse, neglect, and exploitation;
				  and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.121 - Claims Payment

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC pays a
				  contractor for a claim for services that meets the requirements described in
				  subsection (b) of this section.
(b)
				  A contractor must ensure a claim for services is:
(1) for a service that has been provided by a
				  contractor;
(2) a clean
				  claim;
(3) complete and
				  accurate;
(4) submitted within 12
				  months after one of the following, whichever is later:
(A) the last day of the month in which the
				  service was provided, the adaptive aid or medical supply delivered, or the
				  minor home modification completed; or
(B) the date the individual's eligibility for
				  the service was determined;
(5) for a type and amount of service that is
				  authorized by HHSC;
(6) for a
				  service provided to an individual who is eligible for the service;
(7) except as provided in HHSC rules
				  governing services provided under the contract, for a service provided to an
				  individual whose authorization for services has not been suspended or
				  terminated by HHSC;
(8) for a
				  service provided during a time period authorized by HHSC;
(9) for a service provided during the term
				  of, and in accordance with, the contract, this subchapter, and HHSC rules
				  governing services provided under the contract;
(10) supported by records required by the
				  contract and HHSC rules governing services provided under the
				  contract;
(11) for a service
				  provided by a qualified service provider in accordance with HHSC rules
				  governing services provided under the contract;
(12) for a service ordered by a qualified
				  practitioner, if required by the contract or HHSC rules governing services
				  provided under the contract;
(13)
				  submitted in accordance with procedures required by HHSC rules governing
				  services provided under the contract and by the claims administrator;
				  and
(14) not for a service that a
				  source other than HHSC would have paid for if the contractor had submitted a
				  proper, complete, and timely request for payment to the other source.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.123 - Personal Attendants

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor
				  must comply with requirements regarding payment of a base wage to a personal
				  attendant as described in 1 TAC § 355.7051 (relating to Base Wage for a
				  Personal Attendant).
(b) A
				  contractor, other than a contractor that has an FMSA contract listed in §
										49.101(a)(4)
				  of this chapter (relating to Application), must notify a person who becomes
				  employed or contracts with the contractor as a personal attendant that the
				  contractor must pay at least the wage required by 1 TAC § 355.7051. The
				  contractor must make this notification within three days after the person
				  accepts employment or enters into a contract with the contractor. For purposes
				  of this subsection, a personal attendant has the meaning set forth in 1 TAC
				  § 355.7051(a).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter C - REQUIREMENTS OF A CONTRACTOR › Section 52.125 - Day Habilitation Requirements in the HCS Program, the TxHmL Program, and the DBMD Program and Prevocational Services Requirements in the CLASS Program

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor that has a contract for the
				  HCS Program, the TxHmL Program, the CLASS Program, or the DBMD Program must:
(1) in a building or a portion of a building
				  that is owned or leased by the contractor and in which the contractor provides
				  day habilitation in the HCS Program, the TxHmL Program, or the DBMD Program or
				  provides prevocational services in the CLASS Program:
(A) conduct, at least once every 90 days, a
				  fire drill during which individuals evacuate the building; and
(B) prominently post, in an area of the
				  building that is readily accessible to individuals, employees, subcontractors,
				  volunteers, and visitors, a notice of the requirement to report an allegation
				  of abuse, neglect, or exploitation of an individual and how to report such an
				  allegation to the DFPS toll free telephone number at 1-800-647-7418;
				  and
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter D - MONITORING AND INVESTIGATION OF A CONTRACTOR › Division 1 - APPLICABILITY OF SUBCHAPTER › Section 52.201 - Contractors Not Subject to Subchapter D

Current through Reg. 49, No. 28; July 12, 2024
This subchapter does not apply to a contractor that has a
						contract for the HCS Program, TxHmL Program, or hospice.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter D - MONITORING AND INVESTIGATION OF A CONTRACTOR › Division 2 - MONITORING AND INVESTIGATION › Section 52.211 - Contract and Fiscal Monitoring

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
					 conducts contract and fiscal monitoring on site or by desk review:
(1) to determine if:
(A) a contractor is in compliance with its
					 contract, which requires compliance with applicable federal and state laws,
					 rules, and regulations, provider manuals and handbooks, billing guidelines, and
					 communications promulgated by HHSC, including information letters; or
(B) a contractor is in compliance with a
					 corrective action plan as described in §
													49.522
					 of this chapter (relating to Corrective Action Plan) or an immediate protection
					 plan as described in §
													49.511
					 of this chapter (relating to Immediate Protection and Immediate Protection
					 Plan);
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter D - MONITORING AND INVESTIGATION OF A CONTRACTOR › Division 2 - MONITORING AND INVESTIGATION › Section 52.213 - Investigation

Current through Reg. 49, No. 28; July 12, 2024
(a) If HHSC receives an oral or written
					 allegation that indicates a contractor may have violated a contract or program
					 requirement, HHSC conducts an unannounced investigation of the contractor. The
					 investigation is conducted on-site or by a desk review.
(b) To conduct an investigation, HHSC:
(1) conducts an entrance conference with the
					 contractor if the investigation is conducted on-site;
(2) performs other activities, which may
					 include:
(A) reviewing the contractor's
					 records;
(B) reviewing the
					 contractor's policies and procedures;
(C) reviewing consumer satisfaction
					 surveys;
(D) interviewing a person
					 with knowledge relevant to the contract, including an individual receiving
					 services or the contractor's employee; and
(E) observing an individual receiving
					 services.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter D - MONITORING AND INVESTIGATION OF A CONTRACTOR › Division 2 - MONITORING AND INVESTIGATION › Section 52.215 - Financial Review

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may
					 conduct a financial review, including an audit, of a contractor at any time.
					 The review is conducted on-site or by a desk review.
(b) To conduct a financial review, HHSC:
(1) conducts an entrance conference with the
					 contractor; and
(2) performs other
					 activities, which may include:
(A) reviewing
					 the contractor's records;
(B)
					 reviewing the contractor's policies and procedures; or
(C) interviewing a person with knowledge
					 relevant to the contract.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 1 - APPLICABILITY OF SUBCHAPTER › Section 52.231 - Contractors Not Subject to Certain Portions of Subchapter E

Current through Reg. 49, No. 28; July 12, 2024
(a) Divisions 2 and 3 of this subchapter
					 (relating to Immediate Protection; and Actions) do not apply to a contractor
					 that has a contract for the HCS Program or the TxHmL Program.
(b) Section 49.523 of this subchapter
					 (relating to Referral Hold) does not apply to a contractor that has a contract
					 for hospice.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 2 - IMMEDIATE PROTECTION › Section 52.251 - Immediate Protection and Immediate Protection Plan

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC requires a contractor to immediately
					 protect an individual's health and safety if HHSC determines that:
(1) the contractor is not complying with its
					 contract; and
(2) the contractor's
					 failure to comply with its contract jeopardizes the health and safety of the
					 individual.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 3 - ACTIONS › Section 52.271 - Action by HHSC

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may take
					 one or more of the following actions against a contractor in accordance with
					 §49.522 and §49.523 of this division (relating to Corrective Action
					 Plan and Referral Hold):
(1) require the
					 development of and compliance with a corrective action plan; and
(2) impose a referral hold.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 3 - ACTIONS › Section 52.273 - Corrective Action Plan

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC requires
					 corrective action if the contractor's compliance score for a standard is less
					 than 90 percent as described in §
											49.411(d)
					 of this chapter (relating to Contract and Fiscal Monitoring).
(b) HHSC may require corrective action if
					 HHSC determines the contractor has not complied with its contract, including a
					 determination of non-compliance described in §
											49.411(e)
					 of this chapter or §
											49.413(e)
					 of this chapter (relating to Investigation). Corrective action may include the
					 contractor paying or ensuring payment to a personal attendant who was not paid
					 the wage required by §
											49.312 of
					 this chapter (relating to Personal Attendants) the difference between the
					 amount required and the amount paid to the personal attendant.
(c) If HHSC requires corrective action in
					 accordance with subsection (a) or (b) of this section, HHSC notifies the
					 contractor in writing that the contractor must submit and implement a written
					 corrective action plan.
(d) If HHSC
					 notifies the contractor in accordance with subsection (c) of this section, the
					 contractor must submit a written corrective action plan to HHSC within 10
					 business days after the date of the notice from HHSC.
(e) A corrective action plan submitted in
					 accordance with subsection (c) of this section must:
(1) describe the non-compliance that HHSC
					 identified from the monitoring or investigation resulting in the corrective
					 action plan;
(2) describe the
					 activities the contractor will perform to correct or prevent the non-compliance
					 described in paragraph (1) of this subsection from reoccurring;
(3) include the title of the person
					 responsible for performing the activities described in paragraph (2) of this
					 subsection; and
(4) include a
					 schedule for performing the activities described in paragraph (2) of this
					 subsection.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 3 - ACTIONS › Section 52.275 - Referral Hold

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may place
					 a contractor on a referral hold if:
(1) HHSC
					 has proposed to terminate the contract;
(2) 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);
(3) 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);
(4) the contractor has not
					 submitted or has not complied with a corrective action plan as described in
					 §49.522(d) of this division (relating to Corrective Action Plan);
					 or
(5) the contractor's application
					 packet:
(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).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 4 - SANCTIONS › Section 52.301 - Sanction by HHSC

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may take
					 one or more of the following sanctions:
(1)
					 for any contractor, impose a vendor hold in accordance with §49.532 of
					 this division (relating to Vendor Hold);
(2) for any contractor, recoup funds in
					 accordance with §49.533 of this division (relating to
					 Recoupment);
(3) for any
					 contractor, terminate the contract in accordance with §49.534 of this
					 division (relating to Termination of Contract by HHSC); and
(4) for a contractor that has a contract for
					 the HCS Program or TxHmL Program, impose an administrative penalty in
					 accordance with §49.535 of this division (relating to Administrative
					 Penalties in HCS and TxHmL Programs).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 4 - SANCTIONS › Section 52.311 - Vendor Hold

Current through Reg. 49, No. 28; July 12, 2024
(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.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 4 - SANCTIONS › Section 52.313 - Recoupment

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor is liable to HHSC for
					 amounts paid to the contractor for a service if the contractor has not complied
					 with contract requirements regarding a service claim or payment for a service,
					 including §
											49.305
					 of this chapter (relating to Records), §
											49.311
					 of this chapter (relating to Claims Payment), and other HHSC rules governing
					 services provided under the contract.
(b) If a contractor is liable to HHSC in
					 accordance with subsection (a) of this section, HHSC may propose to recoup
					 funds for the amount due to HHSC.
(c) If HHSC proposes to recoup funds paid to
					 a contractor in accordance with subsection (b) of this section, HHSC notifies
					 the contractor of the proposed recoupment in writing before the effective date
					 of recoupment.
(d) HHSC recoups
					 funds paid to contractor on the date given in HHSC's notice of proposed
					 recoupment if:
(1) the contractor does not
					 appeal the proposed recoupment; or
(2) the contractor appeals the proposed
					 recoupment and the final decision from the administrative hearing is favorable
					 to HHSC.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 4 - SANCTIONS › Section 52.317 - Administrative Penalties in the HCS and TxHmL Programs

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may impose an administrative
					 penalty:
(1) for a contractor that has a
					 contract for the HCS Program, in accordance with § 9.181 of this title
					 (relating to Administrative Penalties); or
(2) for a contractor that has a contract for
					 the TxHmL Program, in accordance with § 9.581 of this title (relating to
					 Administrative Penalties).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 5 - APPEALS › Section 52.351 - Contractor's Right to Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a) A
					 contractor may appeal a sanction, as described in §
											49.531(a)
					 of this subchapter (relating to Sanction by HHSC ), proposed or imposed by
					 HHSC.
(b) To appeal a sanction
					 proposed or imposed by HHSC, a contractor must request an administrative
					 hearing in accordance with 1 TAC §
											357.484(relating
					 to Request for a Hearing).
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 6 - CONTRACTOR TERMINATING CONTRACT OR NOT ENTERING INTO STANDARD CONTRACT › Section 52.371 - Contractor Terminating Contract or Not Entering into a Standard Contract

Current through Reg. 49, No. 28; July 12, 2024
(a) A contractor must notify HHSC if the
					 contractor intends to:
(1) terminate its
					 contract; or
(2) not enter into a
					 standard contract when its contract expires.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter E - ENFORCEMENT BY HHSC, TERMINATION BY CONTRACTOR, AND NO OFFER OF STANDARD CONTRACT BY HHSC › Division 7 - HHSC DOES NOT OFFER A STANDARD CONTRACT › Section 52.391 - HHSC Does Not Offer a Standard Contract

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 HHSC may decide not to offer a standard contract to a contractor:
(1) for any reason for which HHSC may deny a
					 provisional contract application, as described in §
												49.207
					 of this chapter (relating to Provisional Contract Application Denial);
(2) for any reason for which HHSC
					 may terminate a contract, as described in §
												49.534
					 of this subchapter (relating to Termination of Contract by HHSC); or
(3) if the contractor has a provisional
					 contract for the HCS or TxHmL Program and HHSC imposed a vendor hold on the
					 contractor in accordance with §9.183 (relating to Program Provider
					 Compliance and Corrective Action) or § 9.587 of this title (relating to
					 Program Provider Compliance and Corrective Action) during the term of the
					 provisional contract.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter F - REVIEW BY HHSC OF EXPIRING OR TERMINATED CONTRACT › Section 52.601 - HHSC Review and Contractor Requirements Related to Expiring or Terminated Contract

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC may review
				  a contractor's records to evaluate billing standards in accordance with
				  program-specific requirements if:
(1) HHSC
				  proposes to terminate the contractor's contract;
(2) HHSC does not offer the contractor a
				  standard contract when its contract expires;
(3) the contractor does not enter into a
				  standard contract when its contract expires; or
(4) the contractor terminates its
				  contract.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter G - APPLICATION DENIAL PERIOD › Section 52.701 - Contractors Not Subject to Subchapter G

Current through Reg. 49, No. 28; July 12, 2024
This subchapter does not apply to a contractor that has a
					 contract for:
(1) the CMPAS
				  Program;
(2) SSPD; or
(3) SSPD - 24-hour shared attendant
				  care.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 52 - CONTRACTING FOR COMMUNITY SERVICES › Subchapter G - APPLICATION DENIAL PERIOD › Section 52.702 - Application Denial Period

Current through Reg. 49, No. 28; July 12, 2024
(a) If HHSC decides
				  not to offer a standard contract to a contractor, as described in § 49.561
				  of this chapter (relating to HHSC Does Not Offer a Standard Contract), HHSC
				  sets an application denial period for the contractor or controlling person of
				  the contractor that applies:
(1) to all
				  programs and services; and
(2) for
				  a period of time determined by HHSC, but no less than 12 months after the date
				  the previous contract expires.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.101 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings unless the context clearly indicates
					 otherwise.
(1) Compact with Texans--A
				  document that describes the Texas Health and Human Services Commission's
				  services, principles, and the process for filing complaints and requesting
				  information.
(2) Complaint--Any
				  expression of dissatisfaction by a consumer of a Texas Health and Human
				  Services (HHS) program or service about HHS benefits or services. Complaints do
				  not include the following, which are handled through other processes:
(A) allegations of abuse, neglect, or
				  exploitation;
(B) allegations of
				  discrimination or other civil rights violations;
(C) allegations of fraud, waste, or
				  abuse;
(D) requests for Fair
				  Hearings or administrative appeals; or
(E) concerns about regulated individuals and
				  entities.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.103 - Creation of the Office and Populations Served

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  OO is established by Texas Government Code §
										531.0171.
(1) OO has authority and responsibility over
				  the HHS system in:
(A) providing dispute
				  resolution services;
(B) performing
				  consumer protection and advocacy functions; and
(C) collecting consumer contact
				  data.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.105 - Contact Information

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  maintain a public website with its contact information and develop brochures
				  and other materials that can be distributed to consumers and health care
				  providers.
(b) Each HHS office that
				  provides direct service delivery of programs or services offers a process to a
				  consumer to submit complaints and advises the consumer how to contact OO staff
				  if that office does not resolve the complaint to the consumer's satisfaction.
				  These HHS programs ensure OO contact information is provided on appropriate web
				  pages, in written materials (such as consumer handbooks and denial notices),
				  and is available upon request in local offices. This includes communications
				  made to a consumer by a vendor contracted to provide services on behalf of an
				  HHS program.
(c) An HHS consumer,
				  the consumer's LAR, or a health care provider may contact OO staff through the
				  following methods:
(1) Toll-free phone,
				  relating to:
(A) A consumer, call
				  1-877-787-8999 (8:00 a.m. to 5:00 p.m., Central Standard Time, Monday through
				  Friday).
(B) A consumer needing
				  help with accessing services under a managed care plan, call
				  1-866-566-8989.
(C) A foster youth,
				  call 1-844-286-0769.
(D) A consumer
				  seeking behavioral health services, call 1-800-252-8154.
(E) An individual with IDD, call
				  1-800-252-8154.
(F) A resident of a
				  nursing facility or an assisted living facility, call 1-800-252-2412.
(G) An individual who has a hearing or speech
				  disability, call 7-1-1 or 1-800-735-2989.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.107 - Confidentiality

Current through Reg. 49, No. 28; July 12, 2024
(a) Before sharing a consumer's information,
				  OO staff confirm the identity of the individual receiving the
				  information.
(b) If a person other
				  than a consumer or the consumer's LAR contacts OO staff, including a health
				  care provider, the person is told OO staff can take information from them but
				  that OO staff must have permission from either the consumer or the consumer's
				  LAR before OO staff can share information about their HHSC case.
(c) OO staff obtain a consumer's consent
				  before sharing the consumer's information with anyone other than HHS staff
				  involved in the review of the contact. Consent can be obtained from the
				  consumer's LAR.
(d) OO staff follow
				  HHSC's policies relating to transmission of consumer data, including use of
				  secure email to encrypt messages that contains a consumer's confidential
				  information or protected health information. OO staff can transmit data in a
				  non-secure format if the consumer or the consumer's LAR consents in
				  writing.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.109 - Data and Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) OO staff
				  maintain records of inquiries and complaints in the HEART system.
(b) Texas Government Code §
										531.0171(d),
				  allows OO staff to access any system or process for recording inquiries and
				  complaints used or maintained by an HHS agency.
(c) OO staff compile a monthly report of
				  consumer contacts received by HHS programs, including those received by vendors
				  contracted to provide services on behalf of an HHS program. OO submits this
				  report to the HHSC Executive Commissioner and designated program management
				  staff across the HHS agencies on a quarterly basis. OO staff may also provide
				  reporting of program-specific contact data to management teams of particular
				  HHS programs.
(d) HHS programs have
				  policies and procedures in place that address:
(1) Tracking. Use of a formal tracking system
				  that captures essential information necessary for analysis, including:
(A) contact name and other identifying
				  information;
(B) date contact
				  received;
(C) method of
				  receipt;
(D) reason for
				  contact;
(E) details to isolate
				  potential trends, such as location or particular service;
(F) resolution actions;
(G) date of resolution;
(H) whether the complaint was substantiated;
				  and
(I) record of final
				  communication with consumer, including date and method.
Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 87 - OMBUDSMAN SERVICES › Subchapter A - OFFICE OF THE OMBUDSMAN › Section 87.111 - Referrals to Other HHS Offices or Other Entities

Current through Reg. 49, No. 28; July 12, 2024
OO staff inform the consumer, the consumer's LAR, or a
					 health care provider of any referral made to other HHS offices or other
					 entities regarding their contact with OO and document the referral in the HEART
					 system. Referrals include:
(1)
				  Department of Family and Protective Services, for a contact that includes
				  information that makes OO staff suspect abuse, neglect, or
				  exploitation;
(2) HHSC Civil Rights
				  Office, for a contact alleging a violation of civil rights or discrimination
				  regarding the delivery of HHS programs or services, including those concerning
				  lack of access to benefits and services due to language or
				  disability;
(3) Office of Inspector
				  General, for a contact that includes allegations of fraud, waste, or abuse
				  regarding HHS programs or services;
(4) HHSC Appeals Division staff, for a
				  request for a fair hearing;
(5)
				  Medicaid managed care organization, for a request to appeal a decision by a
				  Medicaid managed care organization;
(6) HHSC Regulatory Services Division, for a
				  contact related to an entity regulated by HHSC; and
(7) LBHA or LMHA closest to the consumer or
				  local law enforcement, for a contact that includes threats of violence to a
				  consumer or others.