Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter J - MEDICAID THIRD PARTY RECOVERY
Division 5 - HEALTH INSURER REQUIREMENTS
Section 354.2343 - Administrative Penalties for Failure to Provide Information

Universal Citation: 1 TX Admin Code § 354.2343

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

(a) HHSC may impose administrative penalties on an insurer who fails to provide information requested by HHSC as required by §354.2341(c) of this division (relating to Third Party Health Insurer Payment and Information Requirements) within 180 days from the date of the request.

(b) If the insurer does not provide the requested information, the administrative penalty will be assessed on a daily basis for each day of non-compliance beginning on the day following the 180th day HHSC made a request for information and continuing until the information is received by HHSC.

(1) HHSC's request for information may be made by any method that provides verification of receipt.

(2) The 180th day will be calculated from the date HHSC obtains written or electronic verification of receipt by the insurer.

(c) The amount of the administrative penalty may not exceed $10,000 per day for each day of non-compliance. The amount of the administrative penalty will be based on:

(1) the seriousness of the non-compliance, including the nature, circumstances, extent, and gravity of the non-compliance;

(2) the economic harm caused by the non-compliance;

(3) the history of previous non-compliance;

(4) the amount necessary to deter future non-compliance;

(5) efforts made by the insurer to correct the non-compliance; and

(6) other factors presented by the insurer or HHSC which affect the amount and the appropriateness of the administrative penalty.

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