HHSC agrees. A. To pay the Provider for services provided under this Agreement in amounts and under conditions determined by HHSC as defined in this Agreement, the applicable provider manual, handbook, policy letter, or program rules and standards and in accordance with applicable laws and regulations for all eligible persons receiving such services under the Medical Assistance Program.
B. To pay the Provider within time limits set by HHSC and in accordance with applicable laws and regulations after a proper claim for payment is submitted and approved for payment in accordance with HHSC Claims Administrator billing guidelines.
C. To adjust payments to the Provider to compensate for prior overpayment or underpayment.
D. To give the Provider reasonable notice of any impending change in its status as a participating provider, except that nothing in this section shall be construed to deny HHSC the right, for failure to comply with this Agreement or regulations published in the Texas Register, to terminate this Agreement, suspend payments or take any other legal remedy available to HHSC.
E. To provide a hearing, in accordance with Texas Administrative Code, Title 1, Part 15, Chapter 357, Subchapter I, to the Provider in the event HHSC imposes an adverse action on the Provider under this Agreement.
F. To make available to the Provider the applicable provider manual and any changes to that manual that change the requirements for participation.
G. That a religious organization that contracts with HHSC does not by contracting with HHSC lose the exemption provided under Section 702 of the Civil Rights Act [42 USC §2000E-1(a)] regarding employment practices. A religious or charitable organization is eligible to be a provider on the same basis as any other private organization. The Provider retains its independence from state and local governments, including the Provider's control over the definition, development, practice and expression of its charitable or religious beliefs. Except as provided by federal law, HHSC shall not interpret this Agreement to require a charitable or religious organization to alter its form of internal governance or remove religious art, icons, scripture or other symbols. Furthermore, if a religious or charitable organization segregates the government funds provided under this Agreement, then only the financial assistance provided by these funds will be subject to audit. However, neither HHSC's selection of a charitable or faith-based nursing facility pr...
HHSC agrees. 4.1.1 Vendor Drug Program (VDP) Providers
4.1.1.1 HHSC agrees to pay clean claims for covered drugs paid for by VDP. HHSC will make payments to providers, in
4.1.1.2 HHSC agrees to pay clean claims in accordance with applicable federal and state laws, and regulations (see e.g., 42 U.S.C. § 1396a(a)(37) and 42 CFR § 447.45). However, HHSC will attempt to pay clean claims submitted electronically or on the VDP Pharmacy Claims Billing Request based on a weekly payment cycle, as described in the “Claims Payment” provisions of the Provider Manual. HHSC is not required to pay Provider claims that are
4.1.1.3 HHSC agrees to provide reasonable notice of any impending change in the Provider's status as a participating provider of pharmaceutical services, including notice of cancellation of this Agreement, if no claims are processed in a 12-month period.
