Section 354.1622 - RHP Plan Assessment(a) If HHSC assesses that the RHP plan meets the requirements in §354.1621(b) of this division (relating to RHP Plan), HHSC will submit the RHP plan to the Centers for Medicare and Medicaid Services (CMS) for review.(b) Upon completion of HHSC's assessment, HHSC notifies the anchor that HHSC: (1) has submitted the RHP plan to CMS for review;(2) requires additional information to complete its assessment;(3) requires modification of the RHP plan, including the specific deficiencies in the RHP plan that HHSC has identified; or(4) requires modification of a DSRIP project, including the specific deficiencies in the DSRIP project that HHSC has identified. If a particular DSRIP project needs modification, the funding IGT entity and performer associated with that DSRIP project will be notified in addition to the anchor.(c) The anchor must respond to a notification as described in subsection (b) of this section in accordance with the directions in the notification, to ensure timely submission of the RHP plan to CMS. Failure to respond in a timely manner may result in denial of the RHP plan. (1) If HHSC requires additional information to complete its assessment, 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, the anchor: (A) must submit a corrected RHP plan that addresses the specific deficiencies within the time frame specified in the notice; or(B) request a review of the HHSC finding as described in subsection (d) of this section within the time frame specified in the notice.(3) If HHSC requires a change in a DSRIP project, the anchor must: (A) work with the associated IGT entity and performer and submit a corrected DSRIP project that addresses the specific deficiencies within the time frame specified in the notice;(B) request a review of the HHSC finding as described in subsection (d) of this section within the time frame specified in the notice; or(C) certify that the DSRIP project is withdrawn.(d) If after responding to the notice as described in subsection (c) of this section an RHP plan or DSRIP project is not approved, the affected entities may request a review. (1) If an RHP plan is not approved, the anchor may request a review by HHSC in accordance with paragraph (4) of this subsection.(2) If a DSRIP project is not approved, the affected performer may direct the anchor to request a review in accordance with paragraph (4) of this subsection.(3) The anchor must submit a request for review in writing to HHSC within 12 calendar days of the date HHSC sent the notification under this subsection.(4) The review is: (A) limited to the Regional Healthcare Partnership's (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.(5) HHSC will notify the RHP of the results of the review in a timely manner.(e) CMS review of an RHP plan can result in multiple levels of approval. An anchor, or a performer through its anchor, may supplement or revise the RHP plan to address any issue identified by CMS that results in anything less than full approval. HHSC will review the supplemented or revised information before submitting it for CMS review.(f) HHSC may, at any time, require clarifications to a DSRIP project if HHSC determines that the information provided in the RHP plan is so unclear as to prevent a payment.1 Tex. Admin. Code § 354.1622
The provisions of this §354.1622 adopted to be effective October 31, 2012, 37 TexReg 8453; Amended to be effective September 1, 2013, 38 TexReg 5431; Amended by Texas Register, Volume 39, Number 38, September 19, 2014, TexReg 7571, eff. 9/30/2014