TITLE 40.SOCIAL SERVICES AND ASSISTANCE

Part 1. TEXAS DEPARTMENT OF HUMAN SERVICES

Chapter 49. CONTRACTING FOR COMMUNITY CARE SERVICES

The Texas Department of Human Services (DHS) proposes to repeal §§49.1, 49.3, 49.5, 49.7, 49.9 - 49.11, 49.13 - 49.15, 49.17, 49.19, 49.21, 49.23, 49.25, and 49.27, concerning DHS's requirements for contracting for Community Care services, in its Contracting for Community Care Services chapter. DHS proposes new Subchapter A, concerning definitions, §49.1; new Subchapter B, concerning contractor requirements, §§49.11 - 49.20; new Subchapter C, concerning records, §§49.31 - 49.33; new Subchapter D, concerning billings and payment, §§49.41 - 49.43; new Subchapter E, concerning audits, monitoring, and reviews, §§49.51 - 49.54; and new Subchapter F, concerning sanctions and termination, §§49.61 - 49.63, in its Contracting for Community Care Services chapter. The purpose of the repeals and new sections is to reorganize the chapter and rewrite the rules in plain language format to make the sections easier to read and understand. The rules cover requirements and responsibilities of provider agencies contracting with DHS to provide Community Care services, including general requirements for participation, provisional contracts, contract assignments, record keeping requirements, billings and payment methods, audits, monitoring, and sanctions for noncompliance.

The proposed rules were written to complement licensure rules for DHS licensed entities and to place rules specific to Community Care contractors as much as possible within the same chapter. Therefore, rules outlining requirements for contractors providing services for Consolidated Waiver Program, Community Based Alternatives, and Primary Home Care are proposed for placement in Chapter 49 and will be deleted from Chapters 47, 48, and 50 of this title (relating to Primary Home Care, Community Care for Aged and Disabled, and §1915(c) Consolidated Waiver Program) in a subsequent issue of the Texas Register . Rules regarding access to a contractor's records that appear in Chapter 69 of this title (relating to Contracted Services) are restated in proposed §49.33 for the convenience of the public and provider agencies. Proposed §49.12 requires those entities contracting with DHS to provide Community Care services to complete a pre-contract orientation, as authorized in §69.202(c)(2) of this title (relating to Procurement).

Bobby Halfmann, Chief Financial Officer, has determined that, for the first five-year period the proposed sections are in effect, there are no fiscal implications for state or local government as a result of enforcing or administering the sections.

Bettye Mitchell, Deputy Commissioner for Long Term Care, has determined that, for each year of the first five years the sections are in effect, the public benefit anticipated as a result of enforcing the sections is that the public and provider agencies will have rules that are easier to understand and that complement licensure rules for DHS licensed entities. There is no adverse economic effect on small or micro businesses, or on businesses of any size, as a result of enforcing or administering the sections, because most of the proposals exist in program policy with which provider agencies are already complying. There is no anticipated effect on local employment in geographic areas affected by these sections.

Questions about the content of this proposal may be directed to Marilyn Eaton at (512) 438-2856 in DHS's Community Care Contracting section. Written comments on the proposal may be submitted to Supervisor, Rules and Handbooks Unit-220, Texas Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, within 30 days of publication in the Texas Register .

Under §2007.003(b) of the Government Code, DHS has determined that Chapter 2007 of the Government Code does not apply to these rules. Accordingly, DHS is not required to complete a takings impact assessment regarding these rules.

40 TAC §§49.1, 49.3, 49.5, 49.7, 49.9 - 49.11, 49.13 - 49.15, 49.17, 49.19, 49.21, 49.23, 49.25, 49.27

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Human Services or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeals are proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The repeals affect the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.1.General Requirements for Participation.

§49.3.General Contractual Requirements.

§49.5.Contract Assignment.

§49.7.Method of Payment.

§49.9.Billings and Claims Payment.

§49.10.Expedited Payment System for Community Based Alternatives and Primary Home Care Personal Assistance Services.

§49.11.Record Documentation Requirements.

§49.13.Client Rights and Responsibilities.

§49.14.Complaint Procedures.

§49.15.Audits.

§49.17.Fiscal Monitoring.

§49.19.Sanctions.

§49.21.Recontracting.

§49.23.Advertising and Solicitation of Clients.

§49.25.Contract/Program Monitoring.

§49.27.Religious and Charitable Organizations.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304606

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Chapter 49. CONTRACTING FOR COMMUNITY CARE SERVICES

Subchapter A. DEFINITIONS

40 TAC §49.1

The new section is proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The new section affects the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.1.Definitions.

The following words and terms have the following meanings when used in this chapter, unless the context clearly indicates otherwise:

(1) Advanced directives--An instruction made under the Health and Safety Code, §§166.032, 166.034, or 166.035, to administer, withhold, or withdraw life-sustaining treatment in the event of a terminal or irreversible condition.

(2) Adverse action--An adverse action includes any action taken by the Texas Department of Human Services (DHS) that:

(A) terminates or suspends a DHS contract before its stated expiration date;

(B) denies, terminates, or suspends payments, in whole or part, to a contractor;

(C) demands repayment for an overpayment;

(D) directs one of its contractors to terminate or suspend a subcontract or payments to any subcontractor or provider of medical services;

(E) reduces a contractor's block grant funds by 25% or more of the amount DHS reimburses if DHS plans to allocate the withheld funds to another contractor for similar services in the same geographic area, if the contractor alleges that the reduction was in violation of DHS rules, was discriminatory, or was without reasonable basis in law or fact; this does not apply to funding or contracts subject to DHS's competitive procurement rules;

(F) prevents a legal entity from contracting with DHS for a prescribed period; or

(G) imposes any adverse sanction or other action to which a provider agency has a statutory right to a formal hearing.

(3) Alternative language--Any reference to an alternative language of a document means putting the document in a language that can be clearly understood by the person reading it (for example, Spanish or Braille).

(4) Assignee--A legal entity that assumes a Community Care contract through a legal assignment of the contract from the contracting entity.

(5) Assignor--A legal entity that assigns its Community Care contract to another legal entity.

(6) Cause--A determination that the contractor failed to comply with the terms of the contract or applicable program rules.

(7) Client--A person who is eligible to receive services according to program specific eligibility requirements.

(8) Client hold--The suspension of client referrals by DHS to the provider agency.

(9) Compliance monitoring--The systematic review of client case records and interviews with clients, provider agency staff, and others, as appropriate, to determine compliance with service delivery requirements.

(10) Contract--The formal, written agreement between DHS and a provider agency to provide services to eligible DHS clients in exchange for reimbursement.

(11) Contract assignment--The transfer of a contract by one legal entity to another legal entity.

(12) Contract manager--A DHS employee who is responsible for the overall management of the contract with the provider agency.

(13) Contractor--A provider agency.

(14) Controlling party--An owner who is a sole-proprietor, a partner owning 5% or more of the partnership, or a corporate stockholder owning 5% or more of the outstanding stock of the contracted provider, or a member of the board of directors.

(15) Corrective action plan (CAP)--The plan of action the provider agency proposes and submits to DHS to correct contract deficiencies DHS has cited.

(16) Cost reimbursement method of payment--Payment directly related to the allowable reimbursable costs incurred by the provider agency.

(17) Days--Any reference to days means calendar days unless otherwise specified in the text. Calendar days include weekends and holidays.

(18) Debarment--When DHS chooses to prohibit a legal entity from conducting business with DHS, in any capacity, for a certain period.

(19) DHS--The Texas Department of Human Services.

(20) Expedited payments system (EPS)--An automated payment system, offered to qualifying Community Based Alternatives/Home and Community Support Services (CBA/HCSS) and Primary Home Care/Family Care (PHC/FC) providers for Personal Assistance Services (PAS) only, which allows the provider agency to receive a substantial portion of its payment at the beginning of the month based on services provided in the previous month.

(21) Extrapolation--To predict outcomes by projecting past experience or known data.

(22) Fiscal monitoring--DHS's review of the documentation that supports the provider agency's billing.

(23) Involuntary contract termination--When DHS terminates a provider agency's contract without the consent of the provider agency.

(24) Level II administrative penalty--A penalty DHS assesses for violations of Home and Community Support Services Agencies (HCSSA) licensing rules, as described in Chapter 97 of this title (relating to Licensing Standards for Home and Community Support Services Agencies).

(25) HCSSA monitoring agreement--An agreement between the provider agency and DHS Long Term Care Regulatory (LTCR) in which the provider agency agrees to hire a professional consultant to assist in correcting license problems uncovered during the HCSSA survey.

(26) Practitioner--A currently licensed Texas physician or physician assistant, or a registered nurse approved by the Texas State Board of Nurse Examiners to practice as an advanced practice nurse.

(27) Program specific documents/rules/requirements--Those documents/rules/requirements specifically identified and/or stated in the program rules.

(28) Provider agency--An agency that has a contract with DHS to provide Community Care services to DHS clients.

(29) Provisional contract--A time-limited contract that is limited to one year and meets the requirements in §49.12 of this chapter (relating to General Requirements for Participation).

(30) Recoupment--When DHS recovers an overissuance to a provider agency by reducing payments to that provider agency until the overissuance is recovered.

(31) Re-enrollment--DHS's requirement to complete and submit new contract application forms and enter into a new contract.

(32) Restitution--When a provider agency reimburses DHS for an overissuance that the provider agency has received.

(33) Sanction--An adverse action that DHS may take against a provider agency.

(34) Solicitation--When a provider agency entices or lures an individual to receive services from the provider agency when that provider agency knows that the individual is the client of another provider agency.

(35) Suspension--A contract sanction wherein DHS temporarily suspends or halts a provider agency's right to conduct business with DHS.

(36) Unit rate method of payment--Payment according to each unit of service provided.

(37) Vendor hold--A contract sanction wherein DHS withholds the provider agency's contract payments.

(38) Working days--Days DHS is open for business.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304607

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Subchapter B. CONTRACTOR REQUIREMENTS

40 TAC §§49.11 - 49.20

The new sections are proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The new sections affect the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.11.Contracting Requirements.

(a) The provider agency must meet all provisions described in this chapter, as well as in the program-specific rules.

(b) The provider agency is subject to provisions outlined in this chapter, in Chapter 69 of this title (relating to Contracted Services), and in Chapter 79, Subchapters Q and S, of this title (relating to Formal Appeals and Contracting Ethics).

(c) The provider agency must meet all local, state, and federal regulations that are applicable to the contract and program rules.

(d) The Texas Department of Human Services may require corrective action, impose a client hold, and/or impose a contract sanction against a provider agency for any failure to comply with the terms of the contract and/or subsections (a) - (c) of this section.

§49.12.General Requirements for Participation.

(a) To contract with the Texas Department of Human Services (DHS) to provide Community Care services, the provider agency must:

(1) meet eligibility requirements for contracting as described in §49.13 and §49.14 of this chapter (relating to General Contractual Requirements and Provisional Contracts) and Chapter 69 of this title (relating to Contracted Services);

(2) have and maintain the appropriate license(s);

(3) complete an application packet with all required documentation;

(4) meet all the program-specific requirements;

(5) complete a pre-contract orientation as specified by DHS; and

(6) if applicable, be authorized by the secretary of state to conduct business in the state of Texas.

(b) DHS will not enter into a contract with a legal entity when:

(1) there has been a validated report of abuse, neglect, or exploitation and the perpetrator is an employee, volunteer, or owner who has direct access to clients; or

(2) DHS determines that the entity has solicited clients from another provider agency.

(c) DHS may choose not to enter into a contract with a legal entity when, in DHS's opinion, the legal entity or a controlling party has a prior unsatisfactory history in contracting with DHS.

(d) DHS may require periodic re-enrollment of provider contracts.

(1) Provider agencies must complete contract re-enrollment within the time frames DHS specifies.

(2) Provider agencies that fail to re-enroll within the time frames DHS specifies lose their eligibility for a contract.

(e) Provider agencies must comply with:

(1) applicable licensure requirements; and

(2) any and all applicable DHS and Texas Health and Human Services Commission program rules.

(f) DHS reserves the right to refuse to contract with a provider agency if, in the opinion of DHS, the provider agency may not provide acceptable service under the contract.

§49.13.General Contractual Requirements.

(a) To be eligible to enter into a contract for Community Care programs, the provider agency must have:

(1) a minimum of two months operating funds available for conducting business on the effective date of the contract, and maintain two months operating funds to provide services for the duration of the contract; and

(2) adequate staff to provide services on the effective date of the contract and to maintain adequate staff to provide services for the duration of the contract.

(b) The provider agency must receive one service-specific orientation/training before the Texas Department of Human Services (DHS) makes any client referrals.

(c) The provider agency must report suspected violation of rules or laws to the appropriate investigative authority. This includes reporting abuse, neglect, and exploitation issues to the Texas Department of Protective and Regulatory Services or to the appropriate DHS licensing staff.

(d) The provider agency must comply with provisions of the Omnibus Budget Reconciliation Act of 1990 at 42 United States Code §1396a(w)(1), regarding advanced directives under state plans for medical assistance, when Medicaid services are being provided.

(e) A provider agency is not eligible to enter into or maintain a contract for Community Care programs if the provider agency:

(1) has been excluded from participating under Title XVIII or Title XIX of the Social Security Act; and/or

(2) allows direct care staff with communicable diseases or open infectious wounds to come into direct contact with clients or with products clients may consume or handle.

(f) DHS may choose not to enter into or maintain a contract for Community Care programs if the provider agency:

(1) subcontracts any direct care services without specific authorization from DHS; and/or

(2) assigns or transfers the contract without the written prior approval of DHS.

(g) The provider agency must notify DHS in writing of changes to contract information according to the following timelines:

(1) 30 calendar days in advance of any address change, which includes the location of the agency's office, physical address, and/or mailing address;

(2) immediately of any change in administrator or director;

(3) immediately of any change in the provider agency's organizational structure;

(4) within seven working days of any change in telephone number; and

(5) within 10 working days of any change in the provider agency's comptroller vendor ID number, resulting from circumstances other than through a change in the legal entity responsible for the contract.

(h) DHS assigns the effective date of a contract. The effective date of the contract is no earlier than the first day of the month after DHS signs the contract. DHS may issue a contract with an earlier effective date if it is in the best interest of the program.

§49.14.Provisional Contracts.

(a) All new Primary Home Care/Family Care, Community Based Alternatives/Home and Community Support Services, and Consolidated Waiver Program contracts are provisional contracts.

(b) Provisional contracts are limited to one year and are subject to the requirements specified in this section.

(c) Before applying for a provisional contract, the provider agency must:

(1) have held the appropriate Home and Community Support Services Agencies (HCSSA) license, used to qualify for the contract, for at least one year;

(2) have completed an on-site HCSSA health survey;

(3) be eligible to have the HCSSA license renewed; and

(4) have provided attendant or home health services:

(A) to at least 10 clients, with at least two of the clients having received ongoing services during a 60-day period; and

(B) for a total of at least 500 hours during the 12 months immediately preceding the provider agency's contract application in the region in which the provider agency is applying for a contract.

(d) The Texas Department of Human Service (DHS) does not enter into a provisional contract if the provider agency:

(1) has not completed a pre-contract orientation from DHS;

(2) is under a HCSSA monitoring agreement with DHS Long Term Care Regulatory (LTCR);

(3) has a Level II administrative penalty pending with DHS LTCR;

(4) has a license revocation action pending with DHS LTCR; or

(5) had any Community Care program contract involuntarily terminated in the 24 months preceding the provider agency's contract application.

(e) DHS may choose not to enter into a provisional contract if the provider agency was assessed any Level II administrative penalties in the 12 months preceding the provider agency's contract application and there is no pending administrative hearing on the administrative penalties.

(f) If the provider agency's provisional contract is allowed to expire due to noncompliance with program-specific rules, the provider agency cannot enter into another provisional contract for the same Community Care services until at least 24 months after the effective date of the expiration.

(g) If the provider agency chooses to voluntarily withdraw from a provisional contract, the provider agency cannot enter into another provisional contract for the same Community Care services for at least 12 months after the effective date of the withdrawal.

(h) DHS may terminate the provider agency's provisional contract at any time if DHS finds the provider agency does not meet the requirements for provisional contracting as outlined in subsection (c) of this section or if DHS finds that the provider agency does not meet other contracting requirements.

(i) DHS conducts at least one formal monitoring review of each provisional contract during the provisional period.

(j) The provider agency may request an administrative review of the formal monitoring by following the procedures described in §49.54 of this chapter (relating to Administrative Review).

§49.15.Contract Assignment.

(a) A provider agency must assign a contract if there will be a change in the legal entity responsible for the contract. Assignment is also required when there is a change in the contracting entity's:

(1) employer identification number; or

(2) tax status (for example, changing from a partnership to a corporation).

(b) No contract assignment is effective until the Texas Department of Human Services (DHS) approves it in writing.

(c) To assign a contract, the provider agency must inform DHS's Community Care Contracting (CCC) Section at least 60 days before the legal transfer of ownership. Failure to provide this information in a timely manner may delay the assignment of the contract. The notification to CCC must:

(1) be in writing; and

(2) include the legal name of the entity that is assuming the contract.

(d) Before a contract assignment is made, the contract assignee must:

(1) resolve, to DHS's satisfaction, all audits related to the contracted program;

(2) prepare a contract assignment agreement that includes the following statements:

(A) the reason(s) for the contract assignment;

(B) both the assignee and assignor are responsible for collecting and reporting financial and statistical data on DHS's cost reports that corresponds to its respective contract periods;

(C) DHS reserves the right to require restitution for any audit/contract exceptions from either provider agency;

(D) any adverse action pending or in place when the contract is assigned is the responsibility of both the assignee and the assignor;

(E) the assignee agrees to adhere to all DHS contract requirements, including appropriate statutes and rules;

(F) the assignee meets all program criteria for being a provider agency. Documentation of the assignee's eligibility must be provided before DHS will agree to a contract assignment;

(G) identity of both legal entities; and

(H) the current contract number(s) and service(s) to be assigned.

(e) The contract assignment agreement must:

(1) be signed by persons with signature authority for the assignee and the assignor;

(2) be notarized; and

(3) include a line for DHS's representative to sign, showing its approval.

(f) DHS reserves the right to refuse to approve any contract assignment if, in DHS's opinion, the proposed assignee may not be able to provide acceptable service under the contract.

(g) If the provider agency fails to complete the contract assignment application correctly, DHS returns the application to the provider agency for corrections.

(h) The effective date of the contract assignment is no earlier than the first day of the following month after DHS has fully processed and signed the contract. DHS may award a contract at an earlier date if it is in the best interest of the program.

§49.16.Background Checks.

The provider agency must comply with its licensure requirements regarding background searches for facility/provider agency staff.

§49.17.Complaint Procedures.

(a) The provider agency must document, investigate, and resolve all complaints that the client and/or the Texas Department of Human Services (DHS) reports.

(b) Provider agencies with contracts that require a DHS license must investigate and resolve complaints in accordance with applicable licensure rules. If there are no such rules, the provider agency must adhere to the requirements outlined in subsections (c) - (e) of this section.

(c) Provider agencies with contracts that require licensure by an entity other than DHS must investigate and resolve complaints within five workdays from the receipt of the complaint report unless a different time frame is found in the service-specific program requirements.

(d) The provider agency must maintain a log of client complaints and must ensure that:

(1) all written complaints are stamped with the date of receipt;

(2) all verbal complaints are documented with the date of receipt and a narrative of the allegation(s); and

(3) the complaint log is accessible to DHS staff.

(e) All documentation of complaint investigations must contain the following information:

(1) who conducted the investigation;

(2) who was contacted during the investigation;

(3) the findings of the investigation; and

(4) any actions taken as a result of the investigation.

(f) When a client-initiated complaint is resolved, the provider agency must obtain:

(1) the client's initials; or

(2) a witness's signature if the client refuses to sign.

§49.18.Client Rights and Responsibilities.

(a) The provider agency must provide each client with the following information no later than the time services begin:

(1) a general orientation on tasks to be provided;

(2) consumer rights and responsibilities, as described in the Human Resources Code, Chapter 102;

(3) client conduct requirements;

(4) procedures for filing complaints;

(5) the name and/or title and telephone number of the person to call to make a verbal complaint; and

(6) the provider agency's responsibilities in providing the services.

(b) The provider agency must make an interpreter available to the client(s) upon request.

(c) The provider agency must make written material available to the client(s) in alternative languages upon request and maintain a copy of the material in the alternative languages provided.

(d) The provider agency must give the information in subsection (a) of this section to the client both verbally and in writing, with no more than 12 months between each notification.

(e) The Texas Department of Human Services (DHS) must receive a copy of any changes before the provider agency amends its policies affecting the items specified in this section. In addition, each client must receive written notification of the change before it becomes effective.

(f) The provider agency cannot enact any DHS-approved policy changes before providing written notification to each client.

(g) The provider agency must not require clients to perform services for the provider agency or other clients.

§49.19.Advertising and Solicitation of Clients.

(a) The provider agency may advertise for clients as long as the provider agency does not:

(1) state or imply that the provider agency provides better services than other providers;

(2) solicit clients from other providers; or

(3) limit or influence a client's freedom of choice.

(b) The provider agency's advertisement may only be an announcement of available services and must not target specific clients.

(c) If the Texas Department of Human Services (DHS) determines that the provider agency has violated this section, DHS may deny the provider agency's application for a contract or impose a sanction against the provider agency's existing contract, up to and including contract termination.

§49.20.Religious and Charitable Organizations.

(a) A religious or charitable organization is eligible to become a contractor on the same basis as any other private organization.

(b) A religious or charitable organization retains its independence from all state and local governments, including its control over the definition, development, practice, and expression of its charitable or religious beliefs.

(c) A religious or charitable organization is not required to change its method of governance or remove any of its organizational symbols unless it is required to do so under applicable federal law.

(d) Funds provided under the contract:

(1) must be kept separate from other organizational funds; and

(2) are subject to Texas Department of Human Services audit.

(e) Any contract with a religious or charitable organization is not an endorsement of that organization, its practices, or what it symbolizes.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304608

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Subchapter C. RECORDS

40 TAC §§49.31 - 49.33

The new sections are proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The new sections affect the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.31.Record Requirements.

(a) The provider agency must maintain all financial and contract-related records:

(1) according to recognized fiscal and accounting practices; and

(2) in accordance with Texas Department of Human Services (DHS) contract requirements.

(b) The provider agency must maintain DHS client documentation, including:

(1) the service plan;

(2) service delivery records;

(3) significant incidents regarding progress, illnesses, and accidents that may be used to maintain or revise the service plans;

(4) suspension and termination records, discharge plans, client referrals, and placements;

(5) client rights and responsibilities provided to clients;

(6) complaint procedures provided to clients;

(7) orientations completed;

(8) abuse, neglect, or exploitation incidents referred to the appropriate investigative authority;

(9) records of client conduct;

(10) provider agency responsibilities provided to the client; and

(11) additional program-specific requirements.

(c) The provider agency must maintain personnel records on every employee and volunteer, and must also maintain records on subcontractors.

(d) The provider agency must complete all service delivery records in ink when using paper service delivery records.

(e) The provider agency must use the official DHS form to document services delivered or to document all of the required elements of the services delivered, as provided in program- specific rules.

(f) The provider agency must not preprint or pre-enter any record of time on any form used to document services delivered.

§49.32.Record Retention.

(a) The provider agency must maintain all records pertaining to the services provided to individuals in the Medicaid program for at least five years from the date the services were provided. If any litigation or claim involving these records is still ongoing at the conclusion of five years, the provider agency must maintain the records until all litigation or claims are resolved.

(b) The provider agency must maintain all work papers and records supporting information reported on cost reports, budgets, or other cost surveys for at least three years and 90 days after the end of the fiscal year in which the services were provided. If any litigation or claim involving these records is still ongoing at the conclusion of three years and 90 days, the provider agency must maintain the records until all litigation or claims are resolved.

§49.33.Access to Contractor's Records.

(a) The provider agency must allow the Texas Department of Human Services (DHS) and all appropriate federal and state agencies and their representatives to examine and copy client records and supporting documents pertaining to services provided. The provider agency must make the records available at reasonable times and for reasonable periods.

(b) The provider agency must provide DHS with client records and supporting documents upon request. If the provider agency fails to provide records upon request, DHS may take adverse action against the provider agency's contract.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304609

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Subchapter D. BILLINGS AND PAYMENT

40 TAC §§49.41 - 49.43

The new sections are proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The new sections affect the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.41.Billings and Claims Payment.

(a) A provider agency must not charge and cannot take any action against or require any supplemental payment from a client, family member, or persons acting on the client's behalf for any claim(s) the Texas Department of Human Services (DHS) denies or reduces because of the provider agency's failure to comply with any DHS or federal rule or procedure.

(b) A provider agency is responsible for the accuracy of the claims submitted for payment.

(c) A provider agency is entitled to payment if:

(1) the services are:

(A) authorized by DHS in writing;

(B) submitted on a verbally approved form or as a facility-initiated referral to DHS within the required time frames, if applicable; or

(C) submitted by way of a prior verbally approved form or facility-initiated referral form that is supportive of the verbal approval, if applicable;

(2) the reimbursement corresponds to the provider agency's service authorization and service delivery record;

(3) services, when allowed to be ordered by a practitioner, are allowed under Title XVIII and Title XIX of the Social Security Act;

(4) services were ordered by a practitioner whose license has not been suspended or who has not been excluded from participation in either Title XVIII or XIX of the Social Security Act;

(5) practitioner orders are available, when required;

(6) appropriate billing forms are used and approved billing procedures are followed;

(7) services are provided to a client on or before the date services are terminated;

(8) services are provided by an individual whose license or certification, if applicable to the services provided, has not been suspended or who has not been excluded from participation in either Title XVIII or XIX of the Social Security Act;

(9) the provider agency submits correct and appropriate billings after services have been provided and all other contract requirements are met;

(10) the DHS claims processor receives a complete and accurate claim for services for which the provider agency is entitled to payment within 12 months after the date of services.

(A) In the event that Medicaid eligibility for benefits is established after the provision of services, the 12-month period for the submission of claims will start on the date of eligibility.

(B) DHS's claims processor must receive adjustments to claims during the applicable 12-month period. Claims and adjustments rejected or denied during the 12-month period through no fault of the provider agency may be paid upon approval by DHS.

(C) The requirement to submit claims within 12 months of the date of service does not prohibit a provider agency from re-billing in the case of state-generated retroactive adjustments;

(11) the client is eligible for Medicaid benefits (if services are provided through Medicaid); and

(12) the client is not an inpatient of a hospital (unless otherwise specified in contract terms or program rules), intermediate care facility, skilled nursing facility, state hospital, state school, or intermediate care facility for persons with mental retardation or related conditions (except when a provider agency is authorized to receive payment for an assessment used to determine eligibility).

§49.42.Method of Payment.

(a) The Texas Department of Human Services (DHS) uses either the cost reimbursement or the unit rate method of payment to purchase Community Care services.

(b) The cost reimbursement method of payment is payment directly related to the allowable reimbursable costs incurred by the provider agency.

(c) The unit rate method of payment is payment according to each unit of service provided. The Texas Health and Human Services Commission sets either a fixed unit rate or a unit rate ceiling for the unit rate method of payment. For unit rates with a ceiling, DHS and provider agency staff negotiate a unit rate up to the established ceiling. The unit rate is negotiated according to policies DHS establishes. The negotiated rate then becomes the unit rate for that particular contract. The unit rate may not be increased during a contract period unless DHS determines that circumstances dictate a need for change.

§49.43.Expedited Payments System.

(a) The Texas Department of Human Services (DHS) offers an expedited payments system (EPS) to qualifying Community Based Alternatives/Home and Community Support Services and Primary Home Care providers for Personal Assistance Services only.

(b) To be eligible to participate in the EPS, the provider agency must have:

(1) billed for services for 12 consecutive months before the provider agency's application to participate; and

(2) delivered and received payment, after line item rejections, for 80% of the authorization for claims processed for the three service months preceding the month of application.

(c) To continue participation in the EPS when there is a contract assignment, the assignee must meet the requirements in subsection (b) of this section, unless the assignee is already participating in the EPS; in this case, the assignee may continue to participate.

(d) A provider agency that is participating in the EPS must:

(1) submit expedited payment claims on or before the 20th day of the service month; and

(2) reconcile the previous month's expedited payment by the 25th day of the current month.

(e) All requests to participate in the EPS are considered on a contract-by-contract basis. To participate in the EPS, the provider agency must submit a written request. The request should include the following information:

(1) when the provider agency began providing services to DHS clients;

(2) the name of a contact person in the provider agency; and

(3) the specific reasons for the request.

(f) A provider agency has the following billing options:

(1) a provider agency billing electronically before enrolling in the EPS must continue to bill electronically after enrollment in the EPS; and

(2) a provider agency that is not billing electronically before enrolling in the EPS may bill by paper or may bill electronically after enrolling in the EPS.

(g) A provider agency that does not comply with the reconciliation requirements does not receive an expedited payment for at least one month.

(h) DHS may cancel a provider agency's EPS participation when the provider agency does not reconcile the expedited payment for the previous month by the 25th of the current month.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304610

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Subchapter E. AUDITS, MONITORING, AND REVIEWS

40 TAC §§49.51 - 49.54

The new sections are proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The new sections affect the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.51.Audits.

(a) The Texas Department of Human Services (DHS) Internal Audit Department may conduct an audit/compliance review to:

(1) test the provider agency's existing system of internal controls; and/or

(2) review or examine the provider agency's service delivery and financial records to verify that payments DHS made to the provider agency were appropriate.

(b) The DHS Internal Audit Department may perform desk and on-site audits/compliance reviews associated with claims the provider agency submits under a contract. DHS recovers improper payments when DHS verifies that the provider agency has been overpaid because of improper billing or accounting practices or failure to comply with the contract terms.

(c) The provider agency must provide the detailed information DHS requests that supports the claims information the provider agency reported. If the provider agency fails to provide the requested information, DHS may take adverse action against the provider agency's contract.

(d) The DHS Internal Audit Department may identify the following types of errors during the audit/compliance review that may cause the provider agency's claims to be rejected or identified for recoupment:

(1) Administrative errors. Administrative errors result from discrepancies in the provider agency's service delivery documentation. Administrative errors may result in different outcomes depending on the exact nature of the error.

(A) An administrative error is applied to the administrative portion of the unit of services.

(B) If the provider agency fails to comply with the corrective action plan or fails to correct the identified problems and errors, then the error is applied to the total amount paid for the unit(s) of service.

(2) Financial errors. Financial errors result when the provider agency does not have documentation to support reimbursements from DHS. The error is applied to the total amount paid for the unit(s) of service.

(3) Both administrative and financial errors. The error is applied to the total amount paid for the unit(s) of service.

(e) Administrative and financial errors are determined using the same formula. DHS takes the total number of administrative errors found in the audit and develops a statistical projection to determine the total amount of claims paid to the provider agency during the audit period. DHS then repeats this procedure using the total number of financial errors.

(f) DHS may pay the provider agency for underpayments identified by the audit/compliance review once the provider agency submits a proper and correct claim, provided the claim can be submitted in accordance with requirements as described in §49.41 of this chapter (relating to Billings and Claims Payment). If the provider agency fails to submit a proper and correct claim within the time limits set by DHS, DHS cannot pay the underpayment.

(g) DHS may withhold the provider agency's payments and apply them to the audit/review exception for any payments the provider agency owes DHS.

(h) DHS may require corrective action for any finding of the DHS Internal Audit Department.

§49.52.Fiscal Monitoring.

(a) Fiscal monitoring is the review of documentation that supports the provider agency's billing, as it exists at the time Texas Department of Human Services' (DHS) staff arrive to conduct the review. DHS may recoup payment if the service delivery documentation does not support the provider agency's billing.

(b) DHS may conduct a fiscal monitoring review:

(1) in conjunction with a compliance monitoring review;

(2) independently of a compliance monitoring review;

(3) when a contract is terminated; or

(4) as a result of conducting a complaint investigation.

(c) When DHS identifies fiscal monitoring errors, DHS recovers the funds without extrapolation.

§49.53.Compliance Monitoring.

(a) Texas Department of Human Services (DHS) conducts monitoring reviews of the provider agency's services to determine if the provider agency is in compliance with the contract and with program rules and requirements. These reviews are conducted at the location where the provider agency is providing the services unless DHS specifies a different location. DHS offers the provider agency an orientation and/or training on the use of the monitoring form(s) at least once before the provider agency is subject to a compliance monitoring review. This orientation/training is optional, as the provider agency may accept it or reject it.

(b) At the conclusion of the review, DHS scores the provider agency's cumulative level of compliance and the provider agency's compliance level on each standard reviewed. If the provider agency's overall compliance score is 90% or above, DHS considers the provider agency in substantial compliance with the contract and with program rules and requirements. If the provider agency's overall compliance score is less than 90%, DHS considers the provider agency out of substantial compliance with the contract and with program rules and requirements, and the provider agency is subject to corrective action and may be subject to sanctions. Even if the provider agency's overall compliance score is 90% or above, the provider agency is subject to corrective action for each individual standard that falls below 90% compliance.

(c) During the monitoring review, the provider agency must provide:

(1) adequate working space for reviewing the records;

(2) every record DHS requests for review; and

(3) copies or access for DHS staff to make needed copies of documents during the course of the review.

(d) During the monitoring review, DHS may:

(1) review a sample of client records to determine the provider agency's compliance with contract requirements;

(2) review consumer satisfaction surveys the provider agency conducted;

(3) interview clients and staff;

(4) observe clients and staff;

(5) consult with others, as appropriate; and

(6) conduct other activities, as appropriate.

(e) DHS may conduct follow-up compliance monitoring reviews to determine if the provider agency has corrected the deficiencies identified at the preceding formal monitoring review(s). These reviews may:

(1) be focused reviews using targeted samples; and

(2) focus only on those standards that DHS determined to be out of compliance at the immediately preceding formal monitoring review(s);

(f) DHS may expand a compliance monitoring review period or the review sample at any time.

§49.54.Administrative Review.

(a) The provider agency may request an administrative review of the review team's methodology when the provider agency suspects a formal compliance monitoring or an audit/compliance review may not have been conducted according to established rules and procedures.

(b) The provider agency's request for an administrative review must:

(1) be in writing;

(2) identify the rules and procedures the provider agency believes the Texas Department of Human Services (DHS) failed to follow;

(3) state the basis for believing the review was not conducted according to established rules and procedures; and

(4) be received by DHS within 10 calendar days of the provider agency's receipt of the written review findings.

(c) DHS gives the provider agency written notice of the results of the administrative review via certified mail.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304611

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Subchapter F. SANCTIONS AND TERMINATION

40 TAC §§49.61 - 49.63

The new sections are proposed under the Human Resources Code, Chapters 22 and 32, which authorizes DHS to administer public and medical assistance programs, and under Government Code, §531.021, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds.

The new sections affect the Human Resources Code, §§22.0001 - 22.038 and §§32.001 - 32.053.

§49.61.Sanctions.

(a) The Texas Department of Human Services (DHS) may impose a sanction when the provider agency fails to follow the terms of the provider agency's contract and/or the provider agency fails to comply with program rules, policies, and procedures. DHS may impose sanctions for reasons including:

(1) DHS's determination that client health and safety are jeopardized;

(2) the provider agency's failure to comply with its corrective action plan;

(3) the provider agency's failure to follow an agreed-upon audit resolution payment plan;

(4) the provider agency's failure to submit an acceptable cost report;

(5) the provider agency's failure to provide services according to the contract and/or program requirements;

(6) the provider agency's failure to maintain a current required license or the provider agency allowing the expiration of any required license;

(7) the provider agency's relocation to a new facility address that does not have the appropriate license;

(8) the provider agency's exclusion from contracting with DHS or with a contracted program;

(9) validated report(s) of abuse, neglect, or exploitation when the perpetrator is an owner, employee, or volunteer who has direct access to clients;

(10) the provider agency's solicitation of clients from another provider agency; or

(11) the provider agency's failure to deliver Community Care services for six consecutive months.

(b) Types of sanctions include:

(1) Recoupment. DHS collects money the provider agency owes as the result of overpayments and/or other billing irregularities.

(2) Vendor hold. DHS withholds the provider agency's contract payments. DHS may put one or all of the provider agency's contracts on vendor hold. The vendor hold is released when DHS determines the provider agency has resolved the reason(s) for the hold. In addition to the reasons listed in subsection (a) of this section, DHS may place a vendor hold on provider agency's contract(s):

(A) for failure to comply with program requirements;

(B) to recoup overpayments made to the provider agency; or

(C) to recover any audit exceptions assessed against the provider agency.

(3) Involuntary contract termination. DHS may terminate the provider agency's contract for cause by citing the provider agency's failure to comply with the terms of the contract or with DHS program rules, policies, and procedures.

(4) Suspension. DHS may temporarily suspend the provider agency's right to conduct business with DHS. The causes for and conditions of suspension are described in §69.277 of this title (relating to Causes for and Conditions of Suspension). A suspension is in effect until an investigation, hearing, or trial is concluded and DHS can make a determination about the provider agency's future right to contract. DHS may impute the conduct of an individual, corporation, partnership, or other association to the contractor.

(5) Debarment. DHS may choose to not allow a provider agency to conduct business with DHS, in any capacity, for a certain period of time. The causes for and conditions of debarment are described in §69.276 of this title (relating to Causes for and Conditions of Debarment). DHS debars a provider agency for a specific period of time, with the maximum period of debarment being six years. DHS may impute the conduct of an individual, corporation, partnership, or other association to the contractor.

(c) The provider agency may appeal any adverse action DHS takes against its contract. To appeal an action:

(1) the provider agency must request the appeal in writing in accordance with Chapter 79 of this title (relating to Legal Services); and

(2) the DHS Hearings Division must receive the provider agency's request for an appeal within 15 calendar days after the provider agency receives the adverse action notice letter from DHS.

(d) An appeal does not delay any adverse action except contract termination. If the provider agency appeals the termination of a contract, DHS reinstates the provider agency's contract. However, DHS may continue to transfer the provider agency's clients. In addition, DHS may place a vendor hold on the contract under appeal, and DHS does not refer any new clients to the provider agency while the appeal is pending. If the provider agency prevails on appeal, DHS allows:

(1) the provider agency's contract to remain in effect;

(2) client referrals to resume; and

(3) the provider agency's former clients an opportunity to return to the provider agency.

(e) If DHS prevails on the appeal, the original date of termination is re-imposed.

§49.62.Contract Termination Without Cause.

The Texas Department of Human Services may terminate the provider agency's contract without stating cause by giving the provider agency written notice, as stated in the contract, of the impending termination.

§49.63.Recontracting.

(a) If the Texas Department of Human Services (DHS) involuntarily terminates the provider agency's provisional Primary Home Care/Family Care, Community Based Alternatives/Home and Community Support Services, or Consolidated Waiver Program contract, the provider agency, except as provided under subsection (b)(1) of this section, may not recontract for any Community Care program for at least 24 months after the effective date of termination.

(b) The provider agency may not recontract with DHS for at least six months after the effective date of termination when:

(1) DHS involuntarily terminates the provider agency's contract(s) because the provider agency failed to provide services to any DHS clients for a period of six consecutive months; or

(2) DHS involuntarily terminates any non-provisional Community Care contract.

(c) If DHS does not renew the provider agency's provisional contract due to the provider agency's noncompliance with program-specific rules, the provider agency cannot enter into another contract for the same Community Care program for at least 24 months after the effective date of expiration.

(d) If the provider agency chooses to voluntarily withdraw from a provisional contract, the provider agency cannot enter into another contract for the same Community Care services for at least 12 months after the effective date of voluntary termination.

(e) DHS does not recontract with a provider agency if, in DHS's opinion, the provider agency may not provide acceptable services under the contract.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 29, 2003.

TRD-200304612

Paul Leche

General Counsel, Legal Services

Texas Department of Human Services

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 438-3734


Part 5. TEXAS VETERANS LAND BOARD

Chapter 175. GENERAL RULES OF THE VETERANS LAND BOARD

Subchapter A. GENERAL RULES AND CONTRACTING FINANCING

40 TAC §175.3

The Veterans Land Board of the State of Texas (the "Board") proposes an amendment to Title 40, Part 5, Chapter 175 of the Texas Administrative Code, §175.3 relating to Land Selection of the General Rules of the Veteran Land Board. This amendment will reduce the minimum acreage requirement from 5 acres to 1 acre. This amendment will also clarify some language relating to the title insurance requirement and to the purchase of land previously owned by a Veteran or the Veteran's spouse.

Section 161.281 of the Texas Natural Resources Code authorizes the Board to change the minimum acreage to no less than 1 acre. Section 161.214 authorizes the Board to accept insurable title. Section 161.503 of the Texas Natural Resources Code authorize the Board to adopt rules for the mortgage program. The Board finds that the price of land has increased. The number of applications for land loans has decreased as the price of land has increased. The Board finds that it serves the best interest of the programs if the Board's acreage minimum is adjusted to match market changes. The amendment to §175.3(a)(2) will reduce the minimum acreage amount to 1 acre. Also, the Board finds that the industry standard is to require insurable title. The change to §175.3(a)(3) will makes the Board's requirement insurable title and not marketable title. The change to §175.3(c) will clarify that the Board will not purchase an interest owned by the Veteran or the Veteran's spouse, except as indicated in the rule.

This amendment is proposed because of the amendments to §161.281 and §161.214 of the Texas Natural Resources Code in House Bill 2396, 78th Texas Legislature. The amendment will not be effective until the statutory change is effective.

Paul Moore, Executive Secretary of the Veterans Land Board, has determined that for each year of the first five years that the section as proposed will be in effect, there will be no significant fiscal implication to state or local government as a result of administering this section as amended. The Veterans Land Board is supported by the Veterans Land Fund. Though the amount of loans should increase, no appropriated funds are used to run the Veterans Land Board.

Paul Moore, Executive Secretary of the Veterans Land Board, has determined that for each year of the first five years that the section as proposed will be in effect, the public will benefit because the proposed amendment will allow the Board to increase the number of loans it makes to Veterans.

Mr. Moore has determined that the proposed amendment will have little or no significant effect on small businesses during each year of the first five years the section is in effect.

Mr. Moore has also determined that during each year of the first five years the proposed amendment is in effect, the anticipated economic cost to persons who are required to comply with the section will be insignificant. Persons who seek financing from the Board through the Program will pay the same fees to the Board, and costs to third parties, as previously required.

Paul Moore, Executive Secretary of the Veterans Land Board has determined that during each year of the first five years the proposed amendment is in effect, the anticipated impact on local employment will be beneficial. It is expected that this change will increase real estate transactions and related employment.

Comments may be submitted to Melinda Tracy, Legal Service, General Land Office of the State of Texas, 1700 N. Congress Avenue, Austin Texas, facsimile (512) 463-6311, by no later than 30 days after publication.

The amendment to this section is proposed under the Natural Resources Code, Title 7, Chapter 161, §§161.001, 161.061, 161.063, 161.218, 161.222, 161.233, 161.281, and 161.283, 161.503. These sections authorize the Board to adopt rules that it considers necessary and advisable for the Land Program.

The proposed amendment affects §§161.214, 161.281, and161.503 of the Natural Resources Code.

§175.3.Land Selection.

(a) Land selected by a veteran for purchase or financing through the program must:

(1) be situated entirely in Texas;

(2) contain at least one acre [ five acres ] (excluding, as defined by the board, inundated or submerged land, or otherwise unusable land);

(3) have insurable [ marketable and good ] title under conditions acceptable to the board ;

(4) if more than one tract of land is selected the tracts must be contiguous as defined by the board; or, if not contiguous, then one tract must meet the minimum acreage requirement, and the use, location, and value of the tracts would permit the board, in its sole discretion, to consider the combination of the tracts as one tract; and

(5) have direct access to a public road. If the tract does not directly abut a public road, a perpetual access easement appurtenant must be conveyed to the board, or other board approved access must be provided. This easement must meet the county width requirement for publicly maintained roads and, in any event, must be at least 60 feet wide. The easement must be conveyed to the board by general warranty deed or dedicated to the public or subdivision owners. If the easement is conveyed to the board by deed, it must be described by metes and bounds. This description must contain specific tie calls to both the tract and a public road. If the easement is dedicated, the deed to the board must refer to the recording information of the subdivision plat or other dedication instrument. If the board finances the transaction the tract must have similar easement rights. Easements and roads must be usable by standard automobiles during inclement weather.

(b) The board will not purchase or finance a tract of land that was wholly owned by the veteran or his spouse, separately or jointly, within 3 years of the date of application.

(c) If the veteran or his or her spouse owns an undivided interest in the land that he or she has selected, the board may approve the application after the tract has been partitioned and a copy of the recorded partition deed is furnished to the board. The board may purchase only that interest not owned by the applicant or the applicant's spouse . If the land is not partitioned because the applicant is purchasing the remaining undivided interest not currently owned by the applicant or the applicant's spouse , the board may nonetheless approve the purchase or financing of the tract. In such cases, the purchase price or loan amount will be limited to the value of the interest not previously owned by the applicant or the applicant's spouse . Whether or not the land is partitioned however, title to the entire tract must be conveyed to the board, or the board must be in a first lien position as to the entire tract.

(d) Except as provided in subsection (c) of this section, the board will not purchase or finance land in which the seller or any prior owner is to retain any interest, other than a mineral interest or an access or utility easement.

(e) The board will not approve any application that will result in a refinancing of a prior purchase by a veteran or his or her spouse.

(f) A tract must be free and clear of all liens when the board takes title or perfects its lien.

(g) The board reserves the right to refuse to purchase or finance any tract for any reason.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 31, 2003.

TRD-200304645

Larry L. Laine

Chief Clerk, Deputy Commissioner

Texas Veterans Land Board

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 305-9129


40 TAC §175.20

The Veterans Land Board of the State of Texas (the "Board") proposes amendments to Title 40, Part 5, Chapter 175 of the Texas Administrative Code, §175.20, relating to Delinquencies and Forfeiture Procedures of the General Rules of the Veteran Land Board. These amendments require payment in full as a condition of reinstatement for an account that is forfeited for the third time. These amendments also allow the chairman to change the calculation of past due charges. These amendments also allow the Board to release an assignor of liability three years after the transfer of the contract.

The proposed change to §161.317 of the Texas Natural Resources Code allows the Board to require payment in full as a condition of reinstatement on a contract that is forfeited for the third time. The present rule does not contain the proposed change. The Board finds that some contracts are forfeited and reinstated repeatedly. The Board finds that it is in the best interest of the program to require payment in full when a contract is forfeited more than two times, to prevent repeated forfeiture and reinstatement. The proposed addition of §175.20(d)(6) will incorporate the statutory change.

The proposed change to §161.320 of the Texas Natural Resources Code allows the Board to set interest rates and charges on delinquent payments. The present rule requires an interest rate on the past due amount for the entire time that the payment is late, with a 5-day grace period. The industry standard is to charge an amount on each past due payment with a 15-day grace period. The Board finds that it is in the best interest of the program if the Board sets the terms of each loan. The amendment to §175.20(a)(5) and §175.20(a)(9) will allow the Board to set past due charges or interest on each loan.

The proposed change to §161.323 of the Texas Natural Resources Code allows the Board to release an assignor of liability after three years. The present rule does not follow the proposed statutory change. The industry standard in most mortgage loans is to release an assignor upon approval of the assignee. The Board finds that it is in the best interest of the program if it amends the rule to allow for the release of liability of an assignor as permitted by the statute. The amendment to §175.20(c)(3) will allow the Board to release an assignor upon written request and according to the statute.

These amendments are proposed because of the amendments to §§161.317, 161.320, and 161.323 of the Natural Resources Code in House Bill 2396, 78th Texas Legislature. These amendments will not be effective until the statutory change is effective.

Paul Moore, Executive Secretary of the Veterans Land Board, has determined that for each year of the first five years that the section as proposed will be in effect, there will be no significant fiscal implication to state or local government as a result of administering this section as amended.

Paul Moore, Executive Secretary of the Veterans Land Board, has determined that for each year of the first five years that the section as proposed amendments will be in effect, the public will benefit because the proposed amendments will eliminate the possibility of any confusion by changing the rules to match the changes in the statute.

Mr. Moore has determined that the proposed amendment will have no significant effect on small businesses during each year of the first five years the section is in effect.

Mr. Moore has also determined that during each year of the first five years the proposed amendment is in effect, the anticipated economic cost to persons who are required to comply with the section will be insignificant. Persons who seek financing from the Board through the Program will pay the same fees to the Board, and costs to third parties, as previously required.

Paul Moore, Executive Secretary of the Veterans Land Board has determined that during each year of the first five years the proposed amendment is in effect, the anticipated impact on local employment will be insignificant.

Comments may be submitted to Melinda Tracy, Legal Services, General Land Office of the State of Texas, 1700 N. Congress Avenue, Austin Texas, by no later than 30 days after publication.

The amendment to this section is proposed under the Natural Resources Code, Title 7, Chapter 161, §§161.001, 161.061, 161.063, 161.218, 161.222, 161.233, 161.283, 161.317, 161.320, and 161.323. These sections authorize the Board to adopt rules that it considers necessary and advisable for the Land Program.

The change affects §§161.317, 161.320, and 161.323 of the Texas Natural Resources Code.

§175.20.Delinquencies and Forfeiture Procedures.

(a) Definitions. The following words and terms when used in this section shall have the following meanings, unless the context clearly indicates otherwise:

(1) Account--The loan account a borrower holds with the Veterans Land Board. The account includes the obligations between the borrower and the board as evidenced by contracts and documents in the borrower's loan file as well as the accounting records of the board. This includes the amount of the unpaid principal balance of the loan, any administrative costs made a part of the loan, unpaid interest, and any delinquent amount.

(2) Borrower--The person presently obligated to make the loan installment payments set forth in the contract, including the purchaser at a forfeited land sale or the last board-approved assignee of the original veteran purchaser.

(3) Contract--The contract of sale and purchase between the board and a borrower.

(4) Current--The account is in good standing with no installments past due.

(5) Delinquent amount--The total amount needed to bring an account current. This includes all past due installments, administrative costs made part of such past due installments, and all accrued delinquent interest or penalty on all such past due installments. Delinquent interest or penalty shall accrue on any delinquent amount as set by the board from time to time by resolution [ beginning with the fifth (5th) day after the due date and continuing until the date payment of the entire delinquent amount is received. It does not include the reinstatement penalty ].

(6) Forfeiture--The action by which the board declares a borrower to be in breach of his or her contract by virtue of failing to perform a material term of the contract, including, but not limited to, timely payment of the loan installments.

(7) Installment--The amount of the periodic loan payment specified by the contract.

(8) Partial Payment Agreement--A borrower's written agreement to clear the delinquent amount on or before a designated date by making payments in addition to the installment amount on scheduled dates as described in the agreement.

(9) Delinquent interest--The interest or penalty which accrues on a loan installment which has become delinquent. The delinquent interest rate or penalty shall be set by the board from time to time by resolution. [ is 1.5 percentage points greater than the interest rate on the loan. ]

(10) Reinstatement penalty--The amount charged to a borrower (whose contract has been forfeited by the board) in order to reinstate the contract. The reinstatement penalty is in addition to the amount necessary to bring the account current.

(A) Beginning on the date of the first and any second forfeiture of the contract, each unpaid delinquent installment (of principal and interest combined) will accrue a reinstatement penalty in an amount equal to 1.5 percent per month (or 18 percent per year), until the contract is reinstated.

(B) Beginning on the date of the third instance and any subsequent forfeiture of the contract, the outstanding principal balance of the contract will accrue a reinstatement penalty in an amount equal to 1.5 percent per month (or 18 percent per year), less the accrued delinquent interest, until the contract is reinstated.

(11) Sale order date--The date on which the board meets to order a tract advertised for sale, or for lease for mineral development.

(b) Delinquencies.

(1) If a scheduled loan installment is not received by the board within the time allotted by the board [ four (4) days of the due date stated in the contract ], the account becomes delinquent. Any payments received on an account shall be first applied to the delinquent amount. The account continues in a delinquent status until the full amount of the delinquent amount has been received by the board.

(2) A partial payment agreement may be granted at the discretion of the chairman at any time prior to the date an account is forfeited. From time to time, the board may, by resolution, set guidelines for other conditions under which partial payment agreements may be approved.

(c) Forfeiture.

(1) The board is the sole judge whether any contract has been forfeited. An account shall become eligible for forfeiture if:

(A) it remains in a delinquent status for 30 or more consecutive days; or,

(B) the contract has been transferred without obtaining the board's permission; or,

(C) property taxes for all prior years shall not have been paid by May 1 of any year; or,

(D) the provisions of the Natural Resources Code, Chapter 161, the terms of the contract, or the rules of the board are not satisfied.

(2) The board must give 30 days written notice to the borrower, the original veteran purchaser (if different from the borrower) and all board approved assignees of the original veteran purchaser, if any, and must specify the reason why the contract is subject to forfeiture. This notice will be sent by certified mail to the last known address of these parties. If the reason for forfeiture is cured or corrected within 30 days the board shall not declare a forfeiture.

(3) The liability of the original veteran purchaser and any subsequent assignee or assignees is joint and several, but the original veteran purchaser is primarily liable for payment of the money under the contract. The board may release any assignor from liability if the assignor requests the release in writing and at least 3 years have passed since the assignment was approved and the assignee has paid the account in a manner acceptable to the board.

(4) A forfeiture shall be effective at the same time the board meets and adopts a resolution forfeiting the contract. At that time, the land and all payments previously made are forfeited.

(5) When the forfeiture is effective, the full title to the land shall revest in the board. Any interest in the mineral estate which the board acquired at purchase shall likewise revest in the board. The board shall recognize, and continue in force and effect, any outstanding valid oil, gas, or mineral lease and collect all rentals, royalties, or other amounts payable under the lease. The board may also lease the land on terms it considers proper. The proceeds received from a lease on a forfeited tract shall be credited to the Veterans Land Fund; however, the chairman is authorized to credit any portion of the lease proceeds to the delinquent amount and unpaid principal of a loan as part of a borrower's attempt to reinstate his or her contract.

(d) Reinstatement.

(1) From time to time, the board by resolution may set additional guidelines and reasonable requirements which must be satisfied before reinstatement may be granted (e.g., evidence that there are no delinquent taxes due as of the date and time of reinstatement, etc.).

(2) The borrower, the original veteran purchaser (if different from the borrower)[ , ] and all board approved assignees may reinstate the contract at any time before the sale order date if the reason for forfeiture was failure to keep the account current. If the contract was forfeited for any other reason, the board in its discretion may determine there is no right to reinstate the contract.

(A) Any person wishing to exercise a right of reinstatement shall submit to the board payment of the delinquent amount, the reinstatement penalty and other costs incident to the reinstatement as prescribed by the board.

(i) If there is only one person who has a right to reinstate a contract (there having been no board approved assignments of the contract), or if the last approved assignee requests reinstatement, the chairman of the board may in his or her discretion reinstate the contract immediately upon receipt of payment of the delinquent amount, the reinstatement penalty and other costs prescribed by the board.

(ii) If two or more persons, other than the last approved assignee, appear to have a right to reinstate the same contract, reinstatement shall not be granted prior to the time the board meets on the sale order date. In this event, all persons wishing to reinstate the same contract are required to submit to the board payment of the delinquent amount, reinstatement penalty and other costs prescribed by the board. Any person failing to satisfy this requirement by the sale order date may, in the chairman of the board's discretion, be deemed to have failed to exercise his or her right to reinstate the contract. Any monies and documents submitted by such persons shall be returned. If on the order for sale date, there are still two or more persons who have satisfied the requirements to reinstate the same contract, the chairman of the board may, in his or her discretion, reinstate the contract in the name of the person that has complied with the board's requirements for reinstatement and was most recently approved by the board as a purchaser or an assignee.

(B) A person who desires to reinstate a contract but is unable to submit full payment of the delinquent amount before the anticipated sale order date, may petition the chairman to postpone the sale order date for the tract. The chairman in his or her sole discretion may grant or deny such a petition.

(i) In granting such a petition, the chairman may set reasonable conditions which must be satisfied by a stated deadline. Such conditions may include, but are not limited to, the requirement that the requesting party enter into a partial payment agreement.

(ii) If the requesting party satisfies all conditions set by the chairman by the stated deadline, the account shall be reinstated.

(iii) If the requesting party fails to satisfy all conditions set by the chairman by the stated deadline, the sale order date for the tract may be reset. If the requesting party thereafter fails to pay the delinquent amount in full prior to the sale order date, all monies paid under the partial payment agreement shall be forfeited to the board.

(3) Any person failing to make a timely submission shall lose his or her right of reinstatement.

(4) The right to reinstate a contract is extinguished when the tract has been ordered advertised for sale (or for lease for mineral development). However, the borrower, the original veteran purchaser (if different from the borrower), or any board approved assignee may petition the board to permit reinstatement.

(A) The board, in its discretion, may reinstate the contract under conditions it deems appropriate, including, but not limited to, requiring that the account be paid in full simultaneously with the reinstatement.

(B) Stay of Sale.

(i) The board, in its discretion, may stay (postpone) sale of the tract. The board may set conditions which must be satisfied before reinstatement will be permitted. The chairman is authorized by the board to make a written agreement with the party seeking reinstatement setting forth all conditions for reinstatement, including a date by which each condition must be satisfied. The conditions may include, but are not limited to, the following: payment of the delinquent amount, payment of the reinstatement penalty (including costs incident to the reinstatement), and submission of tax certificates evidencing that there are no delinquent taxes on the land. When the board determines that all conditions set forth in the agreement have been satisfied, it shall reinstate the contract. Until the board's conditions have been satisfied, the contract will remain in a forfeited status, but the sale of the tract shall be stayed.

(ii) The stay may be revoked at any time by the board if the borrower fails to satisfy any of the conditions set forth in the agreement.

(iii) The board shall be the sole judge of whether the conditions of the agreement have been satisfied.

(5) The board expressly authorizes the chairman to reinstate any account at any time prior to receipt of full payment of the delinquent amount if he or she deems it to be in the best interest of the Veterans Land Program.

(6) If a contract is forfeited more than two times, the chairman may require, as an additional condition of reinstatement, that the account be paid in full.

(e) Re-amortization.

(1) The chairman, in his or her discretion, may permit a borrower to re-amortize his or her loan to incorporate all or part of the delinquent amount into the unpaid balance.

(2) A re-amortization shall be granted only on the condition that the borrower's loan has not been previously re-amortized.

(3) The chairman's consent to re-amortize shall state the new balance and the term over which it is to be re-amortized.

(f) Restoring Eligibility to Participate after Order for Sale.

(1) A person who is ineligible to participate in loan programs because of a past forfeiture and order for sale, may make a written request to the board for a restoration of the person's eligibility. The request must detail the circumstances which led to the prior forfeiture and order for sale and justify such request. If granted, the requestor must fulfill any conditions that the board, in its sole discretion and notwithstanding any other provisions of this chapter, establishes or determines are necessary to restore such eligibility.

(2) Notwithstanding any other provisions of this chapter, the board authorizes the chairman to restore a person's eligibility to participate in board loan programs, as a veteran or non-veteran as the case may be, without further board action if the person requesting the restoration of eligibility:

(A) was not the account holder at the time the account was forfeited and ordered for sale, because the board had earlier approved a transfer of the account to a new account holder and the account was current at the time of transfer; or

(B) was the account holder at the time of forfeiture and order for sale and:

(i) the board has sold the property that was the subject of the forfeited account; and

(ii) the person requesting the restoration of eligibility pays to the board the unpaid interest, including delinquent interest, and reinstatement penalty that had accrued on the forfeited account as of the date the account was ordered for sale.

(g) Savings clause. Interest charged and collected on any contract will not exceed the maximum rate or amount of nonusurious interest that may be contracted for, taken, reserved, charged, or received under any law. Any interest in excess of that maximum amount will be credited on the principal amount of the contract or, if the principal amount has been paid, refunded to the borrower. On any acceleration or required or permitted prepayment any excess interest will be canceled automatically as of the acceleration or prepayment or, if the excess interest has already been paid, credited on the principal amount or, if the principal amount has been paid, refunded to the borrower. This subsection shall prevail over other provisions in this chapter and any instruments concerning the debt.

(h) All contracts are subject to the provisions of the constitution, statutes, and rules governing the board, as such constitution, statutes, and rules may from time to time be amended.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 31, 2003.

TRD-200304643

Larry L. Laine

Chief Clerk, Deputy Commissioner

Texas Veterans Land Board

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 305-9129


40 TAC §175.24

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Veterans Land Board or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Veterans Land Board of the State of Texas (the "Board") proposes the repeal of §175.24 relating to Enhanced Loan Amount of the General Rules of the Veteran Land Board.

Section 161.283 of the Texas Natural Resources Code allows for a maximum loan amount of $40,000.00. The Board finds that the present rule makes a distinction between standard loans and enhanced loans. This distinction is no longer necessary, as the different interest rates are blended.

Paul Moore, Executive Secretary of the Veterans Land Board, has determined that for each year of the first five years that the section is repealed, there will be no significant fiscal implication to state or local government as a result of administering this section as amended.

Paul Moore, Executive Secretary of the Veterans Land Board, has determined that for each year of the first five years that the section as proposed will be in effect, the public will benefit because the proposed repeal will eliminate confusion over an unnecessary distinction.

Mr. Oldmixon has determined that the proposed amendment will have no significant effect on small businesses during each year of the first five years the repeal is in effect.

Mr. Oldmixon has also determined that during each year of the first five years the proposed amendment is in effect, the anticipated economic cost to persons who are required to comply with the section will be insignificant. Persons who seek financing from the Board through the Program will pay the same fees to the Board, and costs to third parties, as previously required.

Paul Moore, Executive Secretary of the Veterans Land Board has determined that during each year of the first five years the proposed repeal is in effect, the anticipated impact on local employment will be insignificant.

Comments may be submitted to Melinda Tracy, Legal Service, General Land Office of the State of Texas, 1700 N. Congress Avenue, Austin Texas, facsimile (512) 463-6311, by no later than 30 days after publication.

The repeal of this section is proposed under the Natural Resources Code, Title 7, Chapter 161, §§161.001, 161.061, 161.063, 161.218, 161.222, 161.233, 161.283, and 161.503. These sections authorize the Board to adopt rules that it considers necessary and advisable for the Land Program.

The proposed repeal affects §161.283 of the Nat. Res. Code.

§175.24.Enhanced Loan Amount.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on July 31, 2003.

TRD-200304646

Larry L. Laine

Chief Clerk, Deputy Commissioner

Texas Veterans Land Board

Earliest possible date of adoption: September 14, 2003

For further information, please call: (512) 305-9129