(a) A prospective provider who meets the criteria to provide fee-for-service (FFS) oral health treatment services, as described in Title 25, Part 1, §49.10 (relating to Provider Participation Requirements to Provide FFS Oral Health Treatment Services), is eligible to contract with the Department of State Health Services to provide oral health treatment benefits. To apply for program participation, a prospective provider must, after receiving information on the program including the schedule of current fees, sign a contract with DSHS. After the contract is properly executed, the prospective provider will be provided written notice of approval to participate in the FFS program and a copy of the program manual.
(b) The contract between the provider and DSHS may be terminated without cause by either party with a 30-day written notice. DSHS may modify, suspend, or terminate the contract of any provider for due cause. Due cause includes but is not limited to:
  (1) breach of contract;
  (2) suspension or revocation of the provider's license by the Texas State Board of Dental Examiners (TSBDE);
  (3) disciplinary action(s) taken by the TSBDE;
  (4) submission of false or fraudulent claims;
  (5) amendment or judicial interpretation of federal or state laws or other requirements in a way that would make it infeasible or impossible for either party to fulfill the agreement, or if either party is unable to agree on changes necessary for continuation of the agreement;
  (6) any violation of policies, procedures, rules, or requirements; or
  (7) any other reason authorized by rule, regulation, statute, or contract.
(c) An administrative review and due process hearing is available to any provider for the resolution of conflict between DSHS and the provider.
(d) DSHS may not terminate a contract during the pendency of a hearing. DSHS may withhold payments during the pendency of a hearing, but DSHS must pay the withheld payments and resume contract payments if the final determination is favorable to the provider.
(e) Subsections (c) and (d) of this section do not apply if a contract is canceled by DSHS because of exhaustion of funds, expires according to its terms, or is otherwise voided by law.

Source Note: The provisions of this §392.603 adopted to be effective June 17, 2015, 40 TexReg 3638