Current through Reg. 49, No. 38; September 20, 2024
(a) If HHSC
assesses that the RHP plan meets the requirements in §354.1621(b) of this
division (relating to RHP Plan), HHSC will submit the RHP plan to the Centers
for Medicare and Medicaid Services (CMS) for review.
(b) Upon completion of HHSC's assessment,
HHSC notifies the anchor that HHSC:
(1) has
submitted the RHP plan to CMS for review;
(2) requires additional information to
complete its assessment;
(3)
requires modification of the RHP plan, including the specific deficiencies in
the RHP plan that HHSC has identified; or
(4) requires modification of a DSRIP project,
including the specific deficiencies in the DSRIP project that HHSC has
identified. If a particular DSRIP project needs modification, the funding IGT
entity and performer associated with that DSRIP project will be notified in
addition to the anchor.
(c) The anchor must respond to a notification
as described in subsection (b) of this section in accordance with the
directions in the notification, to ensure timely submission of the RHP plan to
CMS. Failure to respond in a timely manner may result in denial of the RHP
plan.
(1) If HHSC requires additional
information to complete its assessment, the anchor must provide the additional
information within the time frame specified in the notice.
(2) If HHSC requires a change in the RHP
plan, the anchor:
(A) must submit a corrected
RHP plan that addresses the specific deficiencies within the time frame
specified in the notice; or
(B)
request a review of the HHSC finding as described in subsection (d) of this
section within the time frame specified in the notice.
(3) If HHSC requires a change in a DSRIP
project, the anchor must:
(A) work with the
associated IGT entity and performer and submit a corrected DSRIP project that
addresses the specific deficiencies within the time frame specified in the
notice;
(B) request a review of the
HHSC finding as described in subsection (d) of this section within the time
frame specified in the notice; or
(C) certify that the DSRIP project is
withdrawn.
(d) If after responding to the notice as
described in subsection (c) of this section an RHP plan or DSRIP project is not
approved, the affected entities may request a review.
(1) If an RHP plan is not approved, the
anchor may request a review by HHSC in accordance with paragraph (4) of this
subsection.
(2) If a DSRIP project
is not approved, the affected performer may direct the anchor to request a
review in accordance with paragraph (4) of this subsection.
(3) The anchor must submit a request for
review in writing to HHSC within 12 calendar days of the date HHSC sent the
notification under this subsection.
(4) The review is:
(A) limited to the Regional Healthcare
Partnership's (RHP's) allegations of factual or calculation errors;
(B) supported by documentation submitted by
the RHP or used by HHSC in making its original determination; and
(C) not an adversarial hearing.
(5) HHSC will notify the RHP of
the results of the review in a timely manner.
(e) CMS review of an RHP plan can result in
multiple levels of approval. An anchor, or a performer through its anchor, may
supplement or revise the RHP plan to address any issue identified by CMS that
results in anything less than full approval. HHSC will review the supplemented
or revised information before submitting it for CMS review.
(f) HHSC may, at any time, require
clarifications to a DSRIP project if HHSC determines that the information
provided in the RHP plan is so unclear as to prevent a payment.
