Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter D - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM
Division 7 - DSRIP PROGRAM DEMONSTRATION YEARS 7-8
Section 354.1699 - RHP Plan Update Review
Universal Citation: 1 TX Admin Code ยง 354.1699
Current through Reg. 49, No. 38; September 20, 2024
(a) HHSC reviews and assesses each submitted RHP plan update to determine whether it meets the following criteria:
(1) It is in
the prescribed format.
(2) It
contains all required elements described in the Program Funding and Mechanics
Protocol and the Measure Bundle Protocol, and is consistent with the waiver
Special Terms and Conditions.
(3)
It meets the requirements for Category A - Required Reporting, Category B -
MLIU Patient Population by Provider (PPP), Category C - Measure Bundles and
Measures, and Category D - Statewide Reporting Measure Bundles, as described in
the Program Funding and Mechanics Protocol and the Measure Bundle
Protocol.
(4) The funding amount
and distribution is in accordance with the Program Funding and Mechanics
Protocol.
(5) It is consistent with
the goals of the DSRIP program and the objectives of the Medicaid
program.
(b) Upon completion of HHSC's review, HHSC notifies the anchor that HHSC:
(1) has approved the RHP plan
update;
(2) requires additional
information to complete its review; or
(3) requires modification of the RHP plan
update, including the specific deficiencies in the RHP plan update that HHSC
has identified.
(c) The anchor must respond to a notification as described in subsection (b) of this section in accordance with the directions in the notification. Failure to respond in a timely manner may result in denial of the RHP plan update.
(1) If HHSC requires additional information
to complete its review, 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
update, the anchor must submit a corrected RHP plan update that addresses the
specific deficiencies within the time frame specified in the notice.
(d) If after responding to the notice as described in subsection (c) of this section an RHP plan update is not approved, the affected entities may request a review.
(1) If an RHP plan update is not approved,
the anchor may request a review by HHSC in accordance with paragraph (3) of
this subsection.
(2) The anchor
must submit a request for review in writing to HHSC within 12 calendar days of
the date HHSC sent the notification under subsection (b) of this
section.
(3) The review is:
(A) limited to the 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.
(4) HHSC notifies the RHP of the results of
the review in a timely manner.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
