Current through Reg. 49, No. 38; September 20, 2024
(a) HHSC assigns an
applicant or re-enrolling provider a screening level of "Limited," "Moderate,"
or "High" based on:
(1) the federal screening
level for the type of provider as provided by
RSA
424.518, if applicable;
(2) the federal screening level for the type
of provider as provided by
RSA
455.450; or
(3) HHSC's assessment of:
(A) the risk level for potential fraud,
waste, or abuse associated with the type of provider or the geographical area;
or
(B) other factors as determined
by HHSC, including:
(i) a change in business
structure or organization;
(ii)
past practices and circumstances; and
(iii) access to care in a geographical
area.
(b) For a screening level of "Limited" or
"Moderate" assigned under subsection (a) of this section, HHSC may assign a
higher screening level based on provider, type of provider, or geographical
area. For the requirements outlined in subsection (c) of this section, HHSC may
rely on other validated screenings performed by Medicare, as provided for by
RSA
455.410.
(c) Requirements for screening levels.
(1) Limited.
(A) For a provider assigned a screening level
of "Limited," HHSC:
(i) verifies that a
provider meets any federal or state requirements for that type of
provider;
(ii) verifies licensure
certifications, including licensure certifications in Texas and any other
state; and
(iii) conducts database
checks pursuant to
RSA
455.436.
(B) A provider assigned a screening level of
"Limited" must submit a new enrollment application at least every five years,
unless HHSC determines a shorter enrollment period.
(2) Moderate.
(A) For a provider assigned a screening level
of "Moderate," HHSC:
(i) performs the
screening described in paragraph (1)(A) of this subsection; and
(ii) performs at least one unscheduled and
unannounced pre- and post-enrollment site visit in accordance with
RSA
455.432.
(B) A provider assigned a screening level of
"Moderate" must submit a new enrollment application at least every five years,
unless HHSC determines a shorter enrollment period.
(3) High.
(A) For a provider assigned a screening level
of "High," HHSC:
(i) performs the screening
described in paragraph (2)(A) of this subsection;
(ii) conducts a criminal background check;
and
(iii) requires the submission
of a set of fingerprints if applicable under
RSA
455.434.
(B) A provider assigned a screening level of
"High" must submit a new enrollment application at least every three to five
years, unless:
(i) HHSC determines a shorter
enrollment period; or
(ii) the
provider meets the requirements of §
RSA 371.1007 of
this title (relating to Screening Levels).
(d) In addition to the screening
requirements provided under this section, additional screening may be performed
under §
RSA
371.1009 of this title (relating to
Verifications Required for Each Screening Level).
(e) A screening level assigned under
subsection (a)(3) of this section is within the sole discretion of HHSC and is
not subject to administrative review.
