Section 360.529 - Voucher Reimbursement(a) Not later than the 45th calendar day after the date ODHHS receives the voucher and all required supporting documentation from the STAP vendor, or the date the vendor has claimed the voucher in the ODHHS STAP claiming system, whichever date occurs later, the ODHHS will pay the STAP vendor from TUSF the lesser of the: (1) ODHHS established equipment value; (2) STAP vendor's advertised purchase price; or(3) voucher value established by ODHHS for the voucher category of the equipment or service exchanged.(b) Vouchers will not be reimbursed for partial exchanges. All equipment must be exchanged as authorized on the voucher.(c) STAP vendors will not be reimbursed for voucher exchanges that are made during any time the STAP vendor is barred, debarred, suspended, proposed for debarment, declared ineligible, or excluded from participation in STAP by HHSC or any federal or Texas state agency.(d) STAP vendors seeking reimbursement for the sale of STAP equipment from an additional source (such as Medicare, Medicaid, or private insurance) in conjunction with a voucher exchange may not receive more than the total price of the equipment from all sources.(e) A STAP vendor that exchanges a STAP voucher in person for the purchase of approved equipment or services in accordance with STAP requirements may request reimbursement from ODHHS. ODHHS will reimburse the STAP vendor from TUSF for a voucher exchanged in accordance with this subchapter and STAP policy when the STAP vendor claims the voucher in the ODHHS STAP claiming system, exchanges the voucher for equipment with the customer, and provides ODHHS with the following documentation: (1) a voucher documenting equipment or service exchanged and signed by both the voucher recipient, and vendor's registered signature authority on file with ODHHS certifying that the equipment or service was new, unused, and not reconditioned or obsolete and has been delivered to the voucher recipient; and(2) a receipt or invoice that contains: (A) a description of the equipment or service exchanged for the STAP voucher;(B) manufacturer and model number;(D) the total price charged to the voucher recipient, including the amount to be reimbursed by ODHHS for the equipment or service exchanged.(f) A STAP vendor that exchanges a STAP voucher by mail for the purchase of approved equipment or services in accordance with STAP policies and this subchapter may request reimbursement from ODHHS. ODHHS will reimburse a voucher (exchanged in accordance with this subchapter and STAP policies) upon receipt from the STAP vendor of: (1) proof of delivery of the equipment or service to the voucher recipient; and(2) a receipt or invoice that contains: (A) a description of the equipment or service exchanged by mail for the STAP voucher:(B) manufacturer and model number;(D) the total price charged to the voucher recipient, including the amount to be reimbursed by ODHHS for the equipment or service exchanged.(g) STAP vendors shall claim a voucher in the ODHHS STAP claiming system and submit voucher reimbursement requests, along with supporting documentation, to ODHHS within 120 calendar days after the date of the voucher exchange or the date shown on the proof of delivery.(h) Vouchers exchanged in violation of STAP requirements that are not corrected, and vouchers or supporting documentation submitted or claimed after 120 calendar days from the date of the voucher exchange will not be reimbursed.(i) Vouchers submitted that do not have supporting documentation, as required by this subchapter will not be reimbursed.(j) ODHHS may investigate whether the presentation of a voucher for payment represents a valid transaction for equipment or service under STAP.(k) If there is a dispute regarding the amount or propriety of the payment or whether the equipment or service is appropriate or adequate to meet the needs of the voucher recipient, ODHHS may: (1) delay or deny payment of a voucher to a STAP vendor until the dispute is resolved; or(2) provide payment of a voucher, conditional upon the return of the payment if the equipment is returned to the STAP vendor or if the service is not used by the voucher recipient.(l) Reimbursements may also be subject to other limitations or conditions determined by ODHHS to be just and reasonable, including investigation of whether the presentation of a STAP voucher represents a valid transaction for equipment or services under STAP.(m) If a dispute arises as to whether the submitted documentation is sufficient to create a presumption of a valid STAP sales transaction, ODHHS will make the final determination on the sufficiency of the documentation.26 Tex. Admin. Code § 360.529
Adopted by Texas Register, Volume 46, Number 13, March 26, 2021, TexReg 2024, eff. 3/30/2021