Header:
TEXAS ADMINISTRATIVE CODE
TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART 1. DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9. MENTAL RETARDATION SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER D. HOME AND COMMUNITY-BASE
Date:
08/31/2009
Document:
40 TAC § 9.185 (2011)
§ 9.185. Certification Processes
(a) If DADS determines that the program provider is in compliance with all certification principles at the end of the review exit conference, DADS certifies the program provider and no action by the program provider is required.
(b) If DADS determines that the program provider is out of compliance with 10 percent or fewer of the certification principles at the end of the review exit conference, but the program provider is in compliance with all principles found out of compliance in the previous review, the program provider must submit a corrective action plan to DADS for approval within 14 calendar days after the program provider receives DADS' certification report.
(1) The corrective action plan must specify a date by which corrective action will be completed, and such date must be no later than 90 calendar days after the certification review exit conference.
(2) If the program provider submits a corrective action plan in accordance with this subsection and the plan is approved by DADS, DADS certifies the program provider. DADS evaluates the program provider's required corrective action during DADS' first review of the program provider after the corrective action completion date.
(3) If the program provider does not submit a corrective action plan in accordance with this subsection or the plan is not approved by DADS, DADS initiates termination of the program provider's waiver program provider agreement, implements vendor hold against the program provider and, in conjunction with the local MRA, coordinates the provision of alternate services for the individuals receiving HCS Program services from the program provider.
(c) If DADS determines that the program provider is out of compliance with 10 percent or fewer of the certification principles at the end of the review exit conference, including any principles found out of compliance in the previous review, DADS:
(1) certifies the program provider, if the program provider:
(A) presents evidence before the end of the current certification period that it is in compliance with all principles found out of compliance in the previous review; and
(B) submits a corrective action plan in accordance with subsection (b) of this section addressing any new principles found out of compliance; or
(2) does not certify the program provider and initiates termination of the program provider's waiver program provider agreement, if the program provider does not:
(A) present evidence before the end of the current certification period that it is in compliance with all principles found out of compliance in the previous review; and
(B) submit a corrective action plan in accordance with subsection (b) of this section addressing any new principles found out of compliance.
(d) If DADS determines that the program provider is out of compliance with between 10 and 20 percent of the certification principles at the end of the review exit conference, including any principles found out of compliance in the previous review, DADS does not certify the program provider and applies Level I sanctions against the program provider.
(1) Under Level I sanctions, the program provider must complete corrective action within 30 calendar days after the review exit conference and DADS conducts an on-site follow-up review within 30 to 45 calendar days after the review exit conference.
(2) Based on the results of the follow-up review, DADS:
(A) certifies the program provider if DADS determines that the program provider is in compliance, by the end of the follow-up review exit conference, with the principles found out of compliance; or
(B) denies certification of and implements vendor hold against the program provider if DADS determines that the program provider is not in compliance, by the end of the follow-up review exit conference, with the principles found out of compliance.
(3) If DADS implements vendor hold against the provider, DADS conducts a second on-site follow-up review between 30 and 45 calendar days after the effective date of the vendor hold. Based on the results of the review, DADS:
(A) certifies the program provider and removes the vendor hold if DADS determines that the program provider is in compliance, by the end of the follow-up review exit conference, with the principles found out of compliance; or
(B) denies certification of the program provider and initiates termination of the program provider's waiver program provider agreement if DADS determines that the program provider is not in compliance, by the end of the follow-up review exit conference, with the principles found out of compliance.
(e) If DADS determines that the program provider is out of compliance, at the end of the review exit conference, with 20 or more percent of the certification principles, including any principles found out of compliance in the previous review, DADS does not certify the program provider, implements vendor hold, and applies Level II sanctions against the program provider.
(1) Under Level II sanctions:
(A) the program provider must complete corrective action within 30 calendar days after the review exit conference; and
(B) DADS conducts an on-site follow-up review within 30 to 45 calendar days after the required correction date.
(2) Based on the results of the follow-up review, DADS:
(A) certifies the program provider and removes the vendor hold if DADS determines that the program provider is in compliance, by the end of the follow-up review exit conference, with all principles found out of compliance; or
(B) denies certification of the program provider and initiates termination of the program provider's waiver program provider agreement if DADS determines that the program provider is not in compliance, by the end of the follow-up review exit conference, with all principles found out of compliance.
(f) Notwithstanding subsections (b) - (e) of this section, if DADS determines that a hazard to the health or safety of one or more individuals exists and the hazard is not eliminated before the end of the review exit conference, DADS denies certification of the program provider, initiates termination of the program provider's waiver program provider agreement, implements vendor hold against the program provider, and, in conjunction with the local MRA, coordinates the provision of alternate services for individuals receiving HCS Program services from the program provider. A hazard to health or safety is any condition that could result in life-threatening harm, serious injury, or death of an individual or other person within 48 hours. If hazards are identified by DADS during a review and the program provider corrects the hazards before the end of the review exit conference, the correction will be designated in DADS' report of the review.
(g) Notwithstanding subsections (b) - (e) of this section, if DADS determines that a program provider's failure to comply with one or more of the certification principles is of a serious or pervasive nature, DADS may, at its discretion, take any action described in this section against the program provider. Serious or pervasive failure to comply includes:
(1) conditions that have potentially dangerous consequences for individuals served by the program provider; or
(2) conditions that affect a large percentage of individuals served by the program provider.
(h) Notwithstanding subsections (b) - (e) of this section, if DADS determines that a program provider has falsified documentation used to demonstrate compliance with this subchapter, DADS may, at its discretion, take any action described in this section against the program provider.
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