Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 261 - INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM-CONTRACTING
Subchapter C - PROVIDER ADMINISTRATIVE REQUIREMENTS
Section 261.217 - Assignment of Provider Agreement

Universal Citation: 26 TX Admin Code § 261.217

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

(a) A program provider must notify the department's Office of Medicaid Administration in writing at least 30 days prior to the date of a proposed assignment. The notice must include:

(1) the legal name and federal tax identification number of the proposed assignee;

(2) the proposed date of the assignment, which must be on the first day of a month;

(3) the provider vendor number of the assignor;

(4) an application for enrollment obtained from the department and completed by the assignee as required for provider applicants by § 261.206(d) of this chapter (relating to Application Process); and

(5) a copy of the assignment agreement, which must include a statement that the assignee:

(A) must keep, perform, and fulfill all of the terms, conditions, and obligations that must be performed by the assignor under the provider agreement;

(B) is subject to all pending conditions that exist against the assignor including, but not limited to, any plan of correction, audit exception, vendor hold, or proposed contract termination; and

(C) is liable to the department for any liabilities or obligations that arise from any act, event, or condition that occurred or existed prior to the effective date of the assignment and that is identified in any survey, review, or audit conducted by the department.

(b) The department may establish the date of assignment if:

(1) notice of a proposed assignment is not provided to the department at least 30 days prior to the proposed date of assignment; or

(2) the proposed date of assignment is not on the first day of a month.

(1) impose a vendor hold on payments due to the assignor under the provider agreement until an audit conducted in accordance with § 261.269 of this chapter (relating to Audits) is complete; and

(2) review the application for enrollment.

(d) After the department reviews the application for enrollment, the department will provide written notice to the assignee and assignor stating whether the application is approved or rejected.

(e) The department may reject an application for enrollment for the same reasons a provider applicant's application for enrollment may be rejected as set forth in § 261.206(e) of this chapter (relating to Application Process). If the department rejects the application for enrollment, the assignor may withdraw the proposed assignment. If the assignment is not withdrawn, the department may terminate the assigned provider agreement.

(f) If the department approves the proposed assignee's application for enrollment, the department will notify the state survey agency of the assignment and request that the state survey agency initiate licensure and certification action.

(g) The assignor must, prior to the effective date of the assignment, give written notice to each individual residing in the facility or LAR of the proposed assignment and the proposed effective date of the assignment.

(h) If the facility is licensed in accordance with state law and determined by the state survey agency to meet certification requirements on or before the 90th day after the effective date of the assignment, the department will pay the assignee for services provided on and after the effective date of the assignment, except the department will not pay the assignee for any period of time during the 90-day period that the facility was determined by the state survey agency to not meet certification requirements.

(i) If the facility is not licensed in accordance with state law and determined by the state survey agency to meet certification requirements on or before the 90th day after the effective date of the assignment, the department will terminate the provider agreement effective on the 91st day. A survey completed more than 90 days after the effective date of the assignment will not be used to determine if the facility met the licensure and certification requirements within the 90-day period.

(j) During the 90-day period after the effective date of the assignment, the provider agreement is subject to sanctions, including termination, in accordance with Subchapter G of this chapter (relating to Provider Agreement Sanctions).

(k) Upon the effective date of the assignment, the assignee:

(1) must keep, perform, and fulfill all of the terms, conditions and obligations that must be performed by the assignor under the provider agreement;

(2) is subject to all pending conditions which exist against the assignor, including but not limited to, any plan of correction, audit exception, vendor hold, or proposed contract termination; and

(3) is liable to the department for any liabilities or obligations that arise from any act, event, or condition that occurred or existed prior to the effective date of the assignment and that is identified in any survey, review, or audit conducted by the department.

(l) The assignor must complete and submit billing claims to the department in accordance with § 261.219 of this chapter (relating to Provider Reimbursement) for services that were provided prior to the effective date of the assignment.

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