Section 354.1699 - RHP Plan Update Review(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.1 Tex. Admin. Code § 354.1699
Adopted by Texas Register, Volume 42, Number 47, November 24, 2017, TexReg 6609, eff. 12/1/2017