Texas Register, Volume 37, Number 40, Pages 7815-8094, October 5, 2012 Page: 8,004
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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 2. GROUNDS FOR ENFORCEMENT
1 TAC 371.1651, 371.1653, 371.1655, 371.1657, 371.1659,
371.1661, 371.1663, 371.1665, 371.1667, 371.1669
Legal Authority
The new sections 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.
The substantive requirements are generally adopted un-
der Texas Government Code 531.102. Additionally, new
371.1651 is authorized by Texas Government Code 411.1143
and Texas Human Resources Code 32.0322; new 371.1653
is authorized by Texas Government Code 531.024161; new
371.1655 is further supported by Texas Health and Safety
Code 62.1561 and 42 U.S.C. 1396cc(j); new 371.1661 is
authorized by Texas Human Resources Code 32.039; and
new 371.1663 is authorized by Texas Government Code
531.1131, 531.1132, and 531.117.
371.1659. Compliance with Health Care Standards.
A person is subject to administrative actions or sanctions if the person:
(1) engages in any negligent or abusive practice that results
in death, injury, or substantial probability of death or injury to a recip-
ient;
(2) fails to provide an item or service to a recipient in ac-
cordance with accepted medical community standards or standards re-
quired by statute, regulation, or contract, including statutes and stan-
dards that govern occupations;
(3) furnishes or orders services or items for a recipient un-
der the Medicaid or other HHS program that substantially exceed a re-
cipient's needs, are not medically necessary, are not provided econom-
ically or are of a quality that fails to meet professionally recognized
standards of health care;
(4) is the subject of a voluntary or involuntary action taken
by a licensing or certification agency or board, which action is based
upon the agency or board's receipt of evidence of noncompliance with
licensing or certification requirements;
(5) has its license to provide health care revoked, sus-
pended, or probated by any state's licensing or certification authority,
or surrenders a license or certification while a formal disciplinary
proceeding is pending before any state's licensing or certification
authority;(6) fails to abide by applicable statutes and standards gov-
erning providers;
(7) fails to comply with the privacy standards of the Health
Insurance Portability and Accountability Act (HIPAA) and regulations
promulgated under HIPAA;
(8) fails to timely provide notice of electronic disclosure to
a recipient for whom the person creates or receives protected health
information that is subject to electronic disclosure;
(9) electronically discloses or permits the electronic disclo-
sure of a recipient's protected health information to any person without
a separate, documented authorization from the recipient or the recip-
ient's legally authorized representative for each disclosure, unless the
disclosure is:
(A) to a covered entity as defined by 181.001 of the
Health and Safety Code or to a covered entity as that term is defined by
602.001 of the Insurance Code for the purpose of:
(i) treatment;
(ii) payment;
(iii) health care operations; or
(iv) performing an insurance or health maintenance
organization function as described by 602.053 of the Insurance Code;
or
(B) as otherwise authorized by state or federal law; or
(10) employs any treatment modality that has been de-
clared unsafe or ineffective by the Food and Drug Administration
(FDA), CMS, the Public Health Service (PHS), or other state or federal
agency with regulatory authority.
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-201205074
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 3. ADMINISTRATIVE ACTIONS
AND SANCTIONS
1 TAC 371.1701, 371.1703, 371.1705, 371.1707, 371.1709,
371.1711, 371.1713, 371.1715, 371.1717, 371.1719
Legal Authority
The new sections 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 proper37 TexReg 8004 October 5, 2012 Texas Register
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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/m1/189/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.