Current through Reg. 49, No. 38; September 20, 2024
(a) A surety
bond may be required for each enrolled location pursuant to the requirements of
this section if:
(1) a provider or type of
provider has been identified by federal or state agencies to have a significant
history of, or potential for, fraud, waste, or abuse; or
(2) HHSC, in its sole discretion, has
determined that a provider, based on the provider's conduct, including
falsifying information or any material misrepresentation, will be subject to
this requirement.
(b) If
a surety bond is required, a provider must maintain a current surety bond to
continue participation in Medicaid or CHIP.
(c) HHSC or its designee will not reimburse a
provider for items or services furnished during a period in which the provider
does not have a current surety bond, if a surety bond is required.
(d) An entity operated or administered by a
federal, state, local, or tribal government agency is exempt from the
requirements of subsection (a) of this section if, during the preceding five
years, the entity has not had any uncollected overpayments associated with
Medicaid or CHIP.
(e) A surety bond
required pursuant to this section must:
(1)
include a statement that the surety company issuing the bond:
(A) is licensed by the Texas Department of
Insurance; and
(B) maintains a
valid Certificate of Authority with the United States Department of Treasury in
accordance with
RSA 9304 -
RSA 9308 and Title
31 of the Code of Federal Regulations parts 223, 224, and 225 as a
surety;
(2) state on the
face of the bond the Parties, to include:
(A)
the provider as Principal;
(B) HHSC
as Obligee; and
(C) the surety
company (and its heirs, executors, administrators, successors, and assignees,
jointly and severally) as Surety; and
(3) include an effective date and expiration
date for the bond.
(f)
The amount of the surety bond must be no less than $50,000.
(g) The surety bond must provide that:
(1) the Surety is liable for uncollected
overpayments determined to have occurred during the term of the bond,
regardless of when the overpayments are discovered;
(2) the Surety remains liable:
(A) for an additional two years after the
date of expiration of the bond for overpayments that occurred during the term
of the bond, if the provider fails to furnish a new, updated, or renewed bond
that meets the requirements of this section; and
(B) for an additional two years after the
date the provider's participation is terminated for services provided during
the bond period, if HHSC or its designee terminates the provider
agreement;
(3) the
Surety's liability to HHSC is not affected, diminished, or concluded by:
(A) any action by the provider or the Surety
to terminate, reduce, or limit the scope or term of the bond;
(B) any action by the provider to:
(i) cease operation;
(ii) sell or transfer any assets or ownership
interest;
(iii) file for
bankruptcy; or
(iv) fail to pay the
Surety; or
(C) the
provider's failure to exercise available appeal rights under Medicaid or
CHIP;
(4) the Surety's
liability may be terminated only if:
(A) the
Surety furnishes HHSC with written notice of its intent to terminate the bond
no later than 30 days before the effective date of termination; or
(B) the provider furnishes HHSC with a new
bond that meets the requirements of this section; and
(5) the Surety guarantees that upon receipt
of written request for payment by HHSC or its designee, the Surety will
reimburse Medicaid or CHIP the amount in the request up to the stated amount of
the bond.
