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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER CUTILIZATION REVIEW
RULE §371.220Exit Conferences

(a) For onsite reviews:

  (1) OIG conducts an onsite, and subsequent telephone, exit conference after the onsite review is complete.

  (2) The nurse reviewer communicates preliminary findings to the nursing facility staff during the onsite exit conference.

  (3) OIG conducts a telephone exit conference after the onsite exit conference.

(b) For desk reviews, OIG conducts a telephone exit conference after the desk review is complete.

(c) For onsite and desk reviews, OIG provides the following information in writing to the nursing facility staff prior to the telephone exit conference:

  (1) a list of reviewed assessments with proposed RUG changes;

  (2) a preliminary statement of findings;

  (3) the notification of potential RUG changes letter;

  (4) the estimated recovery amount; and

  (5) the requirements for submission of a reconsideration request.


Source Note: The provisions of this §371.220 adopted to be effective February 9, 2023, 48 TexReg 503

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