Texas Register, Volume 12, Number 57, Pages 2453-2487, July 28, 1987 Page: 2,468
2453-2487 p. ; 28 cm.View a full description of this periodical.
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any recipient of medical assistance. State law
provides a criminal penalty for violation.
35.104. Access to Records. On request,
the provider must allow the department, the
Texas Attorney General Medicaid Fraud
Control Unit, and the Department of Health
and Human Services staffs immediate access
to the prescription files and to the drug ac-
quisition records that pertain to the Title
XIX Medical Assistance (Medicaid) Program
for review or audit. These staffs must be
given access to and a sample of the prescrip-
tion files of the provider's non-Medicaid cus-
tomers to determine the provider's usual and
customary price. The identification of the
prescription file may be removed. The pro-
vider must cooperate in regular reviews
(general audits and utilization reviews) of the
records of each recipient covered under the
Medicaid Program.
35.105. Nondiscrimination. The pro-
vider must provide services without dis-
criminating on the basis of race, color, na-
tional origin, age, sex, or '! ndicap.
35.106. Disclosure of Criminal Convic-
tions. On request, the provider must
disclose to the department or to the United
States Department of Health and Human
Services the name of any person who has
ownership or controlling interest in, or is an
agent or managing employee of, the phar-
macy when that person has been convicted
of a criminal offense related to the person's
involvement in any program under Title
XVIIl, XIX, or XX of the Social Security
Act. The provider must also supply, on re-
quest, the ownership, management, control,
and business transaction information re-
quired by 42 Code of Federal Regulations
455, Subpart B.
35.107. Termination of Participation.
(a) The department reserves the right
to reject any request for participation or to
immediately terminate participation should
the provider conduct his pharmaceutical
practices in violation of the criteria of the
Title XIX Vendor Drug Program, state or
federal laws, or the ethics adopted by the
profession.
(b) The department, on receipt of
written request, provides a contract appeal
to the provider if the department suspends
or cancels the provider's participation in the
program.
35.108. Provider Sanctions.
(a) The department reserves the right
to impose administrative sanctions on a pro-
vider who conducts his pharmaceutical prac-
tice in violation of the ethics adopted by the
profession, any applicable federal or state
laws, the criteria of the Vendor Drug Pro-
gram, or the department's rules regarding
fraud or abuse involving medical providers.
Sanctions include, but are not limited to, ter-
mination or suspension from participation,
suspension of payments, and recoupment of
overpayments.(b) On receipt of a written request, the
department provides a contract appeal to a
provider who has had department sanctions
placed on him.
35.109. Definition of Placing a Pharmacy
on vendor hold. In the context of this
chapter, the term "vendor hold" means de-
taining accrued vendor payments from the
effective date of the hold until the release
date.
35.110. Reasons for Placing a Pharmacy
on Vendor Hold. Reasons for placing a
pharmacy on vendor hold are as follows:
(1) violation of the provisions of the
Texas Title XIX Vendor Drug Program con-
tract;
(2) failure to pay, within the allot-
ted period of time, the amount of restitution
as revealed by the audit of the pharmacy;
(3) request by the Office of the In-
vestigator General, when that office is in-
vestigating a pharmacy for possible fraud;
(4) failure to renew the pharmacy's
permit with the Texas State Board of Phar-
macy;
(5) failure to file a required cost
report. Failure by a provider who is required
to file a cost report according to applicable
instructions and within the prescribed time
period results in a hold being placed on the
provider's vendor payments. A hold remains
in effect until all cost-reporting deficiencies
are corrected. If the cost reporting deficien-
cies are not corrected within three months
following the due date of the report, the con-
tract of a provider required to file a cost
report may be cancelled. The provider is
notified of contract cancellation when this
action is taken. Notice is considered to have
been made as of the date of delivery to the
United States Postal Service;
(6) failure to allow access to finan-
cial and other records. Failure by a provider
to allow department representatives or the
attorney general's Medicaid Fraud Control
Unit staff access to financial and other
records required to verify cost report infor-
mation results in the provider's vendor
payments being placed on hold. A hold re-
mains in effect until access to the requested
records is allowed. If access to the requested
records is not provided within 31 days of the
refusal, a contract of a provider required to
file a cost report and selected for on-site
audit may be cancelled. The provider is no-
tified of contract cancellation when the ac-
tion is taken.
This agency hereby certifies that the pro-
posal has been reviewed by legal counsel
and found to be within the agency's
authority to adopt.
Issued in Austin, Texas, on July 22, 1987.
TRD-8706021 Marlin W. Johnston
Commissioner
Texas Department of
Human ServicesProposed date of adoption:
November 2, 1987
For further information, please call
(512) 450-3766.
Subchapter C. Participation
* 40 TAC 35.201-35.203,
35.205-35.210
(Editor's note: The text of the following sec-
tions proposed for repeal will not be pub-
lished. The sections can be examined in the
offices of the Texas Department of Human
Services, 701 West 51st Street, Austin, or in
the Texas Register office, Room 503F, Sam
Houston Building, 201 East 14th Street,
Austin.)
The repeals are proposed under the
Human Resources Code, Title 2, Chapters
22 and 32, which provides the department
with the authority to administer public
and medical assistance programs.
35.201. Requirements for Participation.35.202.
35.203.Applications for Participation.
Termination of Participation.35.205. Access to Records.
35.206. Non-Discrimination.35.207.
victions.Disclosure of Criminal Con-
35.208. Confidentiality.
35.209. Provider Sanctions.
35.210. Retention of Eligibility
Documents By the Provider.
This agency hereby certifies that the pro-
posal has been reviewed by legal counsel
and found to be within the agency's
authority to adopt.
Issued in Austin, Texas, on July 22, 1987.
TRD-8706012 Marlin W. Johnston
Commissioner
Texas Department of
Human Services
Earliest possible date of adoption:
November 2, 1987
For further information, please call
(512) 450-3766.
Subchapter B. Administration
*40 TAC 35.201-35.205
The new sections are proposed under the
Human Resources Code, Title 2, Chapters
22 and 32, which provides the department
with the authority to administer public
and medical assistance programs.
35.201. Covered Drugs.
(a) Only those drugs listed in the latest
edition of the Texas Drug Code Index12 TexReg 2468 J.ulr 28, 1987 Texas Register 4
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Texas. Secretary of State. Texas Register, Volume 12, Number 57, Pages 2453-2487, July 28, 1987, periodical, July 28, 1987; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth243901/m1/16/: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.