Texas Register, Volume 37, Number 40, Pages 7815-8094, October 5, 2012 Page: 7,999
7533-7814 p. ; 28 cm.View a full description of this periodical.
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Steve Aragon
Chief Counsel
Texas Health and Human Services Commission
Effective date: October 14, 2012
Proposal publication date: August 10, 2012
For further information, please call: (512) 424-6900
DIVISION 6 ADMINISTRATIVE DAMAGES
AND PENALTIES
1 TAC 371.1721, 371.1723, 371.1725, 371.1727, 371.1729,
371.1731, 371.1733, 371.1735, 371.1737, 371.1739, 371.1741
Legal Authority
The repeals are adopted under Texas Government Code
531.033, which provides the Executive Commissioner of
HHSC with broad rulemaking authority; Human Resources
Code 32.021 and Texas Government Code 531.021(a),
which provide HHSC with the authority to administer the federal
medical assistance (Medicaid) program in Texas, to administer
Medicaid funds, and to adopt rules necessary for the proper
and efficient operation of the Medicaid program; and Texas
Government Code 531.021(b), which provides HHSC with the
authority to adopt rules governing the determination of Medicaid
reimbursements.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's
legal authority.
Filed with the Office of the Secretary of State on September 24,
2012.
TRD-201205071
Steve Aragon
Chief Counsel
Texas Health and Human Services Commission
Effective date: October 14, 2012
Proposal publication date: August 10, 2012
For further information, please call: (512) 424-6900
SUBCHAPTER G. ADMINISTRATIVE
ACTIONS AND SANCTIONS
DIVISION 1. GENERAL PROVISIONS
1 TAC 371.1601, 371.1603, 371.1605, 371.1607, 371.1609,
371.1611, 371.1613, 371.1615, 371.1617, 371.1619, 371.1621,
371.1623, 371.1625, 371.1627
Legal Authority
The new rules are adopted under Texas Government Code
531.033, which provides the Executive Commissioner of
HHSC with broad rulemaking authority; Human Resources
Code 32.021 and Texas Government Code 531.021(a),
which provide HHSC with the authority to administer the federal
medical assistance (Medicaid) program in Texas, to administer
Medicaid funds, and to adopt rules necessary for the proper
and efficient operation of the Medicaid program; and Texas
Government Code 531.021(b), which provides HHSC with theauthority to adopt rules governing the determination of Medicaid
reimbursements.
The substantive requirements are generally proposed un-
der Texas Government Code 531.102. Additionally, new
371.1609 is supported by Texas Government Code 531.1021;
new 371.1613 is supported by Texas Human Resources Code
32.039; new 371.1615 is partially supported by Texas Human
Resources Code 32.039; new 371.1617 is partially supported
by Texas Human Resources Code 32.039; new 371.1619 is
authorized by Texas Government Code 531.101.
371.1607. Definitions.
The following words and terms, when used in this subchapter, have the
following meanings unless the context clearly indicates otherwise.
(1) Abuse--Practices that are inconsistent with sound fiscal,
business, or medical practices and that result in unnecessary program
cost or in reimbursement for services that are not medically necessary,
do not meet professionally recognized standards for health care, or do
not meet standards required by contract, statute, regulation, previously
sent interpretations of any of the items listed, or authorized governmen-
tal explanations of any of the foregoing.
(2) Affiliate; affiliate relationship--A person who:
(A) has a direct or indirect ownership interest (or any
combination thereof) of 5% or more in the person;
(B) is the owner of a whole or part interest in any mort-
gage, deed of trust, note or other obligation secured (in whole or in
part) by the entity that interest is equal to or exceeds 5% of the value
of the property or assets of the person;
(C) is an officer or director of the person, if the person
is a corporation;
(D) is a partner of the person, if the person is organized
as a partnership;
(E) is an agent or consultant of the person;
(F) is a consultant of the person and can control or be
controlled by the person or a third party can control both the person
and the consultant;
(G) is a managing employee of the person, that is, a per-
son (including a general manager, business manager, administrator or
director) who exercises operational or managerial control over a person
or part thereof, or directly or indirectly conducts the day-to-day oper-
ations of the person or part thereof;
(H) has financial, managerial, or administrative influ-
ence over the operational decisions of a person;
(I) shares any identifying information with a person, in-
cluding tax identification numbers, social security numbers, bank ac-
counts, telephone number, business address, national provider num-
bers, Texas provider numbers, and corporate or franchise name; or
(J) has a former relationship with the person as de-
scribed in subparagraphs (A) - (I) of this paragraph, but is no longer
described, because of a transfer of ownership or control interest to
an immediate family member or a member of the person's household
of this section within the previous five years if the transfer occurred
after the affiliate received notice of an audit, review, investigation, or
potential adverse action, sanction, board order, or other civil, criminal,
or administrative liability.
(3) Agent--Any person, company, firm, corporation, em-
ployee, independent contractor, or other entity or association legally
acting for or in the place of another person or entity.ADOPTED RULES October 5, 2012 37 TexReg 7999
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Texas. Secretary of State. Texas Register, Volume 37, Number 40, Pages 7815-8094, October 5, 2012, periodical, October 5, 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth288982/m1/184/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.