| (a) A person who is served a notice of intent to impose
a sanction or notice of a payment hold may request an informal resolution
meeting (IRM) to discuss the issues identified by the OIG in the notice.
(b) A written request for an IRM must:
(1) be sent by certified mail to the address specified
in the notice letter;
(2) arrive at the address specified in the notice of
intent to impose the sanction no later than:
(A) for a payment hold, ten days after service on the
person of the notice of payment hold;
(B) for any sanction other than a payment hold or notice
of recoupment of overpayment or debt, 30 days after service on the
person of the notice; or
(C) for a notice of recoupment or overpayment or debt,
a person may request an IRM any time prior to the issuance of the
final notice;
(3) include a statement as to the specific issues,
findings, and/or legal authority in the notice letter with which the
person disagrees, and, in the case of a payment hold, why an IRM would
be beneficial for the resolution of the case;
(4) state the basis for the person's contention that
the specific issues or findings and conclusions of the OIG are incorrect;
and
(5) be signed by the person or an attorney for the
person. No other person or party may request an IRM for or on behalf
of the subject of the sanction.
(c) On timely request for an initial IRM:
(1) For any sanction other than a payment hold, the
OIG schedules the IRM and gives notice of the time and place of the
meeting.
(2) For a request based on a payment hold, the OIG
decides whether to grant the provider's request for an IRM and, if
the OIG decides to grant the IRM, the OIG schedules the IRM and notice
of the time and place of the meeting.
(d) A person may also submit to the OIG any documentary
evidence or written argument regarding whether the sanction is warranted.
Documentary evidence or written argument that may be submitted is
not necessarily controlling upon the OIG, however.
(e) A written request for an IRM may be combined with
a request for an administrative hearing, if a person is entitled to
such hearing, and if it meets the requirements of this subchapter.
If both an IRM and an administrative hearing have been requested by
a person entitled to both, the informal resolution process shall run
concurrently with the administrative hearing process, and the administrative
hearing process may not be delayed on account of the informal resolution
process.
(f) Upon written request of a provider, the OIG provides
for a recording of an IRM at no expense to the provider who requested
the meeting. The recording of an IRM is made available to the provider
who requested the meeting. The OIG does not record an IRM unless the
OIG receives a written request from a provider.
(g) Notwithstanding Texas Government Code §531.1021(g),
an IRM is confidential, and any information or materials obtained
by the OIG, including the OIG's employees or agents, during or in
connection with an IRM, including a recording, are privileged and
confidential and may not be subject to disclosure under Chapter 552,
Texas Government Code, or any other means of legal compulsion for
release, including disclosure, discovery, or subpoena.
|
| Source Note: The provisions of this §371.1613 adopted to be effective October 14, 2012, 37 TexReg 7989; amended to be effective April 15, 2014, 39 TexReg 2833; amended to be effective October 1, 2015, 40 TexReg 6585; amended to be effective May 1, 2016, 41 TexReg 2941 |
