26 Tex. Admin. Code § 52.37 - Provisional Contract Application Denial

(a) HHSC denies a provisional contract application if:

(1) HHSC has not approved the applicant or contractor for enrollment in accordance with 1 TAC Chapter 352 (relating to Medicaid and Children's Health Insurance Program Provider Enrollment) and 1 TAC Chapter 371, Subchapter E (relating to Provider Disclosure and Screening);

(2) HHSC has denied the enrollment application of the applicant or contractor, or has disenrolled the applicant or contractor, in accordance with 1 TAC Chapter 352 or Chapter 371, Subchapter E;

(3) the applicant or a controlling person of the applicant is under an application denial period as described in § 49.702 of this chapter (relating to Application Denial Period);

(4) the applicant or a controlling person of the applicant is under a period of exclusion in accordance with §§1128, 1128A, 1136, 1156, or 1842(j)(2) of the Social Security Act;

(5) the applicant or a controlling person of the applicant is listed on:

(A) the HHSC employee misconduct registry as unemployable;

(B) the HHSC nurse aide registry as revoked or suspended;

(C) the United States System for Award Management maintained by the General Services Administration;

(D) the LEIE maintained by the United States Department of Health and Human Services, Office of Inspector General;

(E) the LEIE maintained by the HHSC Office of Inspector General;

(F) the Debarred Vendor List maintained by the Texas Comptroller of Public Accounts and the period of debarment has not expired; or

(G) the HHS list of exclusions;

(6) the applicant has not submitted a completed application packet as required by § 49.203 of this subchapter (relating to Provisional Contract Application Process);

(7) the applicant does not have a license, certification, accreditation, or other document required by § 49.205 of this subchapter (relating to License, Certification, Accreditation, and Other Requirements);

(8) the applicant is applying because of a change of ownership or a change of legal entity and HHSC has denied the application for change of ownership of any license required to be a contractor as described in § 49.205 of this subchapter;

(9) the applicant or a controlling person of the applicant is ineligible to contract with HHSC in accordance with § 49.206 of this subchapter (relating to Ineligibility Due to Criminal History);

(10) the applicant or a controlling person of the applicant is prohibited from contracting with HHSC in accordance with Chapter 79, Subchapter S, of this title (relating to Contracting Ethics);

(11) the applicant does not meet a requirement described in § 49.204 of this subchapter (relating to Additional Provisional Contract Application Requirements);

(12) a DSA in the CLASS Program is applying to be a CMA in the CLASS Program in the same catchment area in which the applicant is a DSA;

(13) a CMA in the CLASS Program is applying to be a DSA in the CLASS Program in the same catchment area in which the applicant is a CMA;

(14) the applicant is applying to be a DSA and CMA in the CLASS Program in the same catchment area;

(15) the applicant is required to register with the Texas Secretary of State and the applicant's status with the Texas Secretary of State is not "in existence"; or

(16) the applicant is required to pay Texas franchise tax and the applicant's right to transact business status with the Texas Comptroller of Public Accounts is not "active."

(b) HHSC may deny a provisional contract application for good cause, including that:

(1) the application packet contains incorrect information;

(2) the applicant or a controlling person of the applicant terminated a contractual agreement with a governmental entity in a federal health care program, as defined in §1128B(f) of the Social Security Act, while an adverse action or sanction was proposed or in effect;

(3) the applicant or a controlling person of the applicant terminated a contract while an action or sanction by DADS or HHSC, as described in § 49.521 or § 49.531 of this chapter (relating to Action by HHSC; Sanction by HHSC) was proposed or in effect;

(4) DADS or HHSC proposed or imposed an action or sanction, as described in § 49.521 or § 49.531 of this chapter, against:

(A) a contract of the applicant, contractor or a controlling person of the applicant; or

(B) a contract of a person for whom the applicant or a controlling person of the applicant was a controlling person;

(5) HHSC, another governmental entity, or a managed care organization contracting with a governmental entity, proposed or imposed a termination, suspension, recoupment, or penalty against:

(A) a contractual agreement of the applicant or a controlling person of the applicant; or

(B) a contract of a person for whom the applicant or a controlling person of the applicant was a controlling person;

(6) HHSC or another governmental entity proposed or imposed a penalty, revocation, denial, termination, or suspension against a license, certification, or registration held by the applicant or a controlling person of the applicant;

(7) the applicant or a controlling person of the applicant has an unresolved financial liability with HHSC or another governmental entity; or

(8) the applicant or a controlling person of the applicant has been confirmed by DFPS or HHSC as having committed abuse, neglect, or exploitation.

(c) If HHSC denies a provisional contract application, HHSC provides written notification to the applicant. If the applicant wants to be a contractor, the applicant must repeat the application process described in § 49.203 and § 49.204 of this subchapter.

Notes

26 Tex. Admin. Code § 52.37

Transferred from 40 TAC § 49.207 Texas Register, Volume 49, Number 13, March 29, 2024, TexReg 2091, eff. 4/29/2024