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Texas Statutes (Last Updated: January 4, 2014) |
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HUMAN RESOURCES CODE |
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Title 2. DEPARTMENT OF HUMAN SERVICES AND DEPARTMENT OF PROTECTIVE AND REGULATORY SERVICES |
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Subtitle C. ASSISTANCE PROGRAMS |
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Chapter 32. MEDICAL ASSISTANCE PROGRAM |
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Subchapter B. ADMINISTRATIVE PROVISIONS |
Sec. 32.0322. CRIMINAL HISTORY RECORD INFORMATION; ENROLLMENT OF PROVIDERS
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(a) The department or the office of inspector general established under Chapter 531, Government Code, may obtain from any law enforcement or criminal justice agency the criminal history record information that relates to a provider under the medical assistance program or a person applying to enroll as a provider under the medical assistance program.
(a-1) The criminal history record information the department and the office of inspector general are authorized to obtain under Subsection (a) includes criminal history record information relating to:
(1) a person with a direct or indirect ownership or control interest, as defined by 42 C.F.R. Section 455.101, in a provider of five percent or more; and
(2) a person whose information is required to be disclosed in accordance with 42 C.F.R. Part 1001.
(b) The executive commissioner of the Health and Human Services Commission by rule shall establish criteria for the department or the commission's office of inspector general to suspend a provider's billing privileges under the medical assistance program, revoke a provider's enrollment under the program, or deny a person's application to enroll as a provider under the program based on:
(1) the results of a criminal history check;
(2) any exclusion or debarment of the provider from participation in a state or federally funded health care program;
(3) the provider's failure to bill for medical assistance or refer clients for medical assistance within a 12-month period; or
(4) any of the provider screening or enrollment provisions contained in 42 C.F.R. Part 455, Subpart E.
(c) As a condition of eligibility to participate as a provider in the medical assistance program, the executive commissioner of the Health and Human Services Commission by rule shall:
(1) require a provider or a person applying to enroll as a provider to disclose:
(A) all persons described by Subsection (a-1)(1);
(B) any managing employees of the provider; and
(C) an agent or subcontractor of the provider if:
(i) the provider or a person described by Subsection (a-1)(1) has a direct or indirect ownership interest of at least five percent in the agent or subcontractor; or
(ii) the provider engages in a business transaction with the agent or subcontractor that meets the criteria specified by 42 C.F.R. Section 455.105; and
(2) require disclosure by persons applying for enrollment as providers and provide for screening of applicants for enrollment in conformity and compliance with the requirements of 42 C.F.R. Part 455, Subparts B and E.
(d) In adopting rules under this section, the executive commissioner of the Health and Human Services Commission shall adopt rules as authorized by and in conformity with 42 C.F.R. Section 455.470 for the imposition of a temporary moratorium on enrollment of new providers, or to impose numerical caps or other limits on the enrollment of providers, that the department or the commission's office of inspector general, in consultation with the department, determines have a significant potential for fraud, waste, or abuse.