(a) Informal review.
(1) A program provider that disputes the report of
findings described in §9.262(d) of this division (relating to
Trust Fund Monitoring and Audits) may request an informal review.
The purpose of an informal review is to provide for the informal and
efficient resolution of the matters in dispute. An informal review
is conducted according to the following procedures:
(A) DADS must receive a written request for an informal
review by United States (U.S.) mail, hand delivery, special mail delivery,
or fax no later than 15 days after the date on the written notification
of the report of findings described in §9.262(d) of this division.
(i) If the 15th day is a Saturday, Sunday, national
holiday, or state holiday, then the first working day after the 15th
day is the final day the written request is accepted.
(ii) A request for an informal review that is not received
by the stated deadline is not accepted.
(B) A program provider must submit a written request
for an informal review:
(i) by U.S. mail to DADS Trust Fund Monitoring Unit,
Attn: Manager, P.O. Box 149030, Mail Code W-340, Austin, Texas 78714-9030;
(ii) hand delivery or special mail delivery to 701
West 51st Street, Austin, Texas 78751-2321; or
(iii) by fax to (512) 438-3639.
(C) A program provider must, with its request for an
informal review:
(i) submit a concise statement of the specific findings
it disputes;
(ii) specify the procedures or rules that were not
followed;
(iii) identify the affected cases;
(iv) describe the reason the findings are being disputed;
and
(v) include supporting information and documentation
that directly demonstrates that a disputed finding is not correct.
(D) DADS does not grant a request for an informal review
that does not meet the requirements of this subsection.
(2) Upon receipt of a request for an informal review,
the Trust Fund Monitoring Unit Manager coordinates the review of
the information submitted.
(A) Additional information may be requested by DADS
and must be received in writing by U.S. mail, hand delivery, special
mail, or fax in accordance with paragraph (1)(B)(i) - (iii) of this
subsection no later than 15 days after the date the program provider
receives the written request for additional information. If the 15th
day is a Saturday, Sunday, national holiday, or state holiday, then
the first working day after the 15th day is the final day the additional
information is accepted.
(B) DADS sends its written decision to the program
provider by certified mail, return receipt requested.
(i) If the original findings are upheld, DADS continues
the schedule of deficiencies and requirement for corrective action.
(ii) If the original findings are reversed, DADS issues
a corrected schedule of deficiencies with the written decision.
(iii) If the original findings are revised, DADS issues
a revised schedule of deficiencies including any revised corrective
action.
(iv) If the original findings are upheld or revised,
the program provider may request an administrative hearing in accordance
with subsection (b) of this section.
(v) If the original findings are upheld or revised
and the program provider does not request an administrative hearing,
the program provider has 60 days from the date of receipt of the written
decision to complete the corrective actions.
(I) If the program provider does not complete the corrective
actions by that date, DADS may impose a vendor hold. If DADS imposes
a vendor hold, the program provider may request an administrative
hearing in accordance with subsection (b)(5) of this section.
(II) If the failure to correct is upheld, DADS continues
the vendor hold until the program provider completes the corrective
action.
(b) Administrative hearing.
(1) The program provider must submit a written request
for an administrative hearing under this section to: HHSC Appeals
Division, P.O. Box 149030, Mail Code W-613, Austin, Texas 78714-9030.
(2) The written request for a formal hearing must
be received within 15 days after:
(A) the date on the written notification of the report
of findings described in section §9.262(d) of this division;
or
(B) the program provider receives the written decision
sent as described in subsection (a)(2)(B) of this section.
(3) An administrative hearing is conducted in accordance
with 1 TAC Chapter 357, Subchapter I (relating to Hearings Under
the Administrative Procedure Act).
(4) No later than 60 days after a final determination
is issued as a result of an administrative hearing requested by a
program provider under §9.262(e)(2) of this division or subsection
(a)(2)(B)(iv) of this section, the program provider must complete
any corrective action required by DADS or be subject to a vendor hold
on payments due to the program provider under the provider agreement
until the program provider completes corrective action. If DADS imposes
a vendor hold, the program provider may request an administrative
hearing in accordance with paragraph (5) of this subsection. If the
failure to correct is upheld, DADS continues the vendor hold until
the program provider completes the corrective action.
(5) If DADS imposes a vendor hold under §9.262(g)
of this division, subsection (a)(2)(B)(v) of this section, or paragraph
(4) of this subsection, the program provider may request an administrative
hearing within 15 days after receiving notice of the failure to correct
and the vendor hold. The administrative hearing is limited to the
issue of whether the program provider completed the corrective action.
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Source Note: The provisions of this §261.263 adopted to be effective November 4, 2013, 38 TexReg 7724; transferred effective October 1, 2020, as published in the Texas Register August 28, 2020, 45 TexReg 6127 |