Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 352 - MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAM PROVIDER ENROLLMENT
Section 352.21 - Duty to Report Changes

Universal Citation: 1 TX Admin Code ยง 352.21

Current through Reg. 49, No. 38; September 20, 2024

(a) As a condition of continued enrollment, a provider must notify HHSC or its designee in writing of any change in its status or condition with respect to the information disclosed in an enrollment application or other supplemental form to an enrollment application, as determined by HHSC, including:

(1) National Provider Identifier or associated taxonomy code;

(2) Medicare number;

(3) Medicare certification status;

(4) federal tax identification number;

(5) responsible billing party for the provider;

(6) physical address for the provider or responsible billing party;

(7) the name, address, date of birth, and Social Security number of any managing employee of the provider;

(8) enrollment type;

(9) provider licensure, certification, accreditation;

(10) any change of ownership as required by RSA 489.18;

(11) a change in the person with an ownership or control interest in the provider;

(12) information required to be disclosed under Chapter 371 of this title (relating to Other Health and Human Services Fraud and Abuse Program Integrity);

(13) third-party billing vendor services; or

(14) any other information required by HHSC or its designee.

(b) Time frame for reporting changes.

(1) If a change described in subsection (a) of this section occurs due to a change of ownership or control interest, the provider must report the change to HHSC or its designee within 30 days of the change of ownership.

(2) For all other changes, the provider must report the change to HHSC or its designee within 90 days of the occurrence.

(c) Upon notification of a change that is reported in accordance with this section, HHSC or its designee may require the submission of a new enrollment application and fee, if applicable, provider agreement, provider licensure or certification, or other documentation necessary to verify the reported change.

(d) If a provider does not report a change as required by this section or RSA 489.18, or does not submit an item HHSC or its designee requires under subsection (c) of this section, HHSC or its designee may, retroactive to the date that the change should have been reported:

(1) disenroll the provider or terminate the provider's participation in Medicaid or CHIP;

(2) deny further reimbursement; and

(3) recoup payments made to the provider.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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