| (a) An interested party who disputes a determination
under §355.8704(g) of this chapter (relating to Reporting and
Monitoring) may request post-determination review under this section.
(b) The purpose of a post-determination review is to
provide for the informal and efficient resolution of the matter(s)
in dispute. A post-determination review is not a formal administrative
hearing and is conducted according to the following procedures:
(1) The Texas Health and Human Services Commission
(HHSC) must receive a request for a post-determination review electronically
to PFD_LFM@hhs.texas.gov no later than 30 calendar days from the date
of a notification under §355.8704(g) of this chapter. If the
30th calendar day is a weekend day, national holiday, or state holiday,
then the first business day following the 30th calendar day is the
final day the receipt of the written request will be accepted. HHSC
will extend this deadline for an additional 15 days if it receives
a request for the extension prior to the initial 30-day deadline.
A request for a post-determination review or extension that is not
received by the stated deadline will not be accepted.
(2) An interested party must, with its request for
a post-determination review, submit a concise statement of the specific
determinations it disputes, its recommended resolution, and any supporting
documentation the interested party deems relevant to the dispute.
It is the responsibility of the interested party to render all pertinent
information at the time it submits its request for a post-determination
review. A request for a post-determination review that does not meet
the requirements of this subparagraph will not be accepted.
(3) The written request for the post-determination
review or extension must be signed by a legally authorized representative
for the interested party. A request for a post-determination review
or extension that is not requested by a legally authorized representative
of the interested party will not be accepted.
(4) On receipt of a request for post-determination
review that meets the requirements of this section, HHSC will:
(A) acknowledge receipt of the request to the requestor;
and
(B) coordinate the review of the information submitted
by the interested party and may request additional information from
the interested party, which must be received no later than 14 calendar
days from the date of the written request for additional information.
(i) If the 14th calendar day is a weekend day, national
holiday, or state holiday, then the first business day following the
14th calendar day is the final day the receipt of the additional information
will be accepted.
(ii) Information received after 14 calendar days may
not be used in the post-determination review decision unless the interested
party requests an extension and receives written approval from HHSC
staff to submit the information after 14 calendar days. HHSC must
receive a request for an extension to the 14-calendar-day due date
prior to the 14th calendar day.
(iii) HHSC may make subsequent requests for additional
information. If HHSC makes a subsequent request for additional information,
the timeframes for submission and receipt of the information apply
just as they applied to the initial request for additional information.
(5) Upon review and receipt of all requested supplemental
information, HHSC will provide a final decision no later than 180
days after receipt of the request or receipt of supplemental information,
whichever is later. An interested party may request an update on the
status of the post-determination review at any time.
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