1 Tex. Admin. Code § 353.8 - Certification of Managed Care Organizations Prior to Contract Awards
(a) As provided by Texas Government Code
§
540.0203, the Texas
Health and Human Services Commission (HHSC) awards a contract under Texas
Government Code Chapter 540 to a managed care organization (MCO) only if the
MCO has been certified by HHSC as reasonably able to fulfill the terms of the
contract, including all requirements of applicable federal and state
law.
(b) HHSC determines whether to
certify an MCO following the evaluation of the proposals submitted in response
to a solicitation. Certification and the certification determination process
described in this section do not impact an MCO's final score in the evaluation,
but failure to obtain certification results in no further consideration of the
MCO for the contract award.
(c) In
its certification determination, HHSC may review:
(1) materials submitted by the MCO in
response to the solicitation;
(2)
materials related to the MCO's past performance in any state, including
materials required to be monitored by a state's managed care program under
42 C.F.R. §
438.66(c); and
(3) any additional information and assurances
requested by HHSC from the MCO for purposes of the certification
determination.
(d) HHSC
provides notice of approval or denial of certification by electronic mail to an
MCO. A notice of denial sets forth the reasons for the denial of certification.
If an MCO is denied certification, the MCO may appeal the denial by submitting
an appeal to the solicitation's sole point of contact no later than 10 business
days after the date HHSC transmits the notice of denial of
certification.
(e) An appeal must
specifically address the reasons for the denial of the certification as stated
in the notice of denial and precisely state the argument, authorities, and
evidence the MCO offers in support of its appeal.
(f) To resolve an appeal, HHSC:
(1) dismisses the appeal as
untimely;
(2) upholds the denial of
certification; or
(3) reverses the
denial of certification and certifies the MCO as reasonably able to fulfill the
terms of the contract, including all requirements of applicable federal and
state law.
(g) After the
expiration of the appeal period and the resolution of any pending appeals, MCOs
that obtained the required certification will proceed to the next phase of the
contract award process.
(h) HHSC's
determination whether to certify that an MCO is reasonably able to fulfill the
terms of a contract is not a contested case proceeding under the Texas
Administrative Procedure Act, Texas Government Code, Chapter 2001.
Notes
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