SECTION 371.1009. Verifications Required for Each Screening Level

(a) For an applicant or provider assigned a screening level of "Limited," the OIG verifies the accuracy and completeness of the information in or related to the enrollment application and 42 C.F.R. §455.450(a)(1), information about the applicant contained in state or federal records, including criminal history records, and any additional information requested of the applicant by the OIG.

(b) For an applicant assigned a screening level of "Moderate," the OIG:

(1) verifies all items described in subsection (a) of this section; and

(2) reviews the results of a pre-enrollment site visit in accordance with §352.9 of this title (relating to Screening Levels), if applicable.

(c) For an applicant or provider assigned a screening level of "High," HHSC or the OIG performs (notwithstanding subsection (f) of this section):

(1) all the verifications described in subsections (a) and (b) of this section; and

(2) a fingerprint-based criminal history check, in the form and manner prescribed by state or federal law, of each person that is an individual and has an ownership or control interest as defined in §371.1005 of this subchapter (relating to Disclosure Requirements) in the applicant.

(d) The OIG, in its sole discretion, may accept previously submitted fingerprints if an individual has been subjected to a fingerprint-based criminal history check by a licensing or regulatory authority or by another state's Medicaid, CHIP, or medical assistance program and the results are made available to HHSC.

(e) As provided in 42 C.F.R. §455.452, the OIG may establish provider screening methods in addition to or more stringent than those required by applicable federal regulations. The OIG may require a fingerprint-based criminal history check when required to do so under State law or because of the level of screening based on risk of fraud, waste, or abuse as determined for that category of provider.

(f) For the requirements outlined above, the OIG may rely on validated screenings as provided by 42 C.F.R. §455.410.

Source Note: The provisions of this §371.1009 adopted to be effective December 31, 2012, 37 TexReg 10189; amended to be effective May 1, 2016, 41 TexReg 2941; amended to be effective February 12, 2017, 42 TexReg 417