Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 371 - MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY › Subchapter G - ADMINISTRATIVE ACTIONS AND SANCTIONS › Division 3 - ADMINISTRATIVE ACTIONS AND SANCTIONS › Section 371.1717 - Reinstatement

Current through Reg. 49, No. 28; July 12, 2024
(a) A person excluded from the Medicaid
					 program, Titles V, XVIII, XIX, XX, CHIP, or any other HHS program may submit to
					 the OIG a written request for reinstatement at any time after the period of
					 exclusion has ended. The request for reinstatement must establish good cause
					 for granting reinstatement.
(b) The
					 OIG may require the requestor to furnish specific information and authorization
					 for the OIG to obtain information from private health insurers, peer review
					 bodies, probation officers, professional associates, investigative agencies,
					 and others as may be necessary to determine whether reinstatement should be
					 granted.
(c) The request for
					 reinstatement may be approved, abated, postponed, or denied by the OIG. The OIG
					 grants reinstatement only if it is reasonably certain that the types of actions
					 that formed the basis for the original exclusion have not recurred and will not
					 recur. In making this determination, the OIG considers:
(1) the conduct of the provider or person
					 before and after the date of the notice of exclusion;
(2) whether all fines, damages, penalties,
					 and any other debts due and owing to any federal, state, or local government
					 have been paid, or satisfactory arrangements have been made that fulfill these
					 obligations;
(3) the accessibility
					 of other health care to the recipient population that would be served by the
					 person who has been excluded;
(4)
					 the person's previous conduct, including conduct during participation in the
					 Titles V, XVIII, XIX, XX, CHIP, and any HHS programs in any state, or any
					 conduct or action for which a sanction could have been taken, as described in
					 this subchapter;
(5) any previous
					 criminal convictions of the person regardless of its relation to Titles V,
					 XVIII, XIX, XX, CHIP, or other HHS programs;
(6) whether the person complies with or has
					 made satisfactory arrangements to fulfill the applicable conditions of
					 participation or supplier conditions for coverage under the statutes and
					 regulations;
(7) whether the person
					 has, during the period of exclusion, submitted claims, or caused claims to be
					 submitted or payment to be made by the Medicaid program or any state health
					 care program, for items or services the excluded party furnished, ordered or
					 prescribed, including health care administrative services;
(8) whether a person has, during the period
					 of exclusion, submitted claims or caused claims to be submitted or payments to
					 be made by the Medicaid program or any state health care program for items or
					 services furnished, ordered, or prescribed, including administrative and
					 management services or salary, during the period of exclusion and before
					 reinstatement has been granted and re-enrollment completed; and
(9) any other factors or circumstances deemed
					 by the OIG to be relevant to the determination of reinstatement.