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RULE §421.81Health Care Facilities Exemptions from Filing Requirements

(a) Types of Exemptions.

  (1) Exemption as an exempted provider. All health care facilities except those owned by the federal government shall submit discharge reports to the department unless the department determines that the hospital shall be considered an exempted provider. The department shall make a determination of which health care facilities are entitled to this exemption and shall notify hospitals by email or by regular United States mail. This exemption, if granted, may be revoked by the department should the hospital cease to meet the criteria for exemption. Health care facilities that cease to be exempted as an exempted provider shall be responsible for submitting discharge claims on all discharges that occur 30 days after loss of the exemption. The initial discharge report shall not be due until 90 days after notice is given. Subsequent discharge reports are due as specified in §421.3(a) of this title (relating to Schedule for Filing Discharge Reports).

  (2) Exemptions from Quarterly Filing of Discharge Reports. Health care facilities that wish to submit discharge reports to the department more often than quarterly may do so by requesting an exemption to the standard submission schedule. The department may also issue general exemptions based on the processing arrangements for data collection. Exemption requests meeting the following criteria as shown in subparagraphs (A) - (D) of this paragraph will normally be approved.

    (A) The exemption request includes the specific schedule on which the health care facility will make its discharge reports, which will usually be daily, weekly or monthly.

    (B) The exemption request states the medium in which submissions will be made.

    (C) The exemption request will not result in data on any discharge being submitted to the department at a later date than it would have been if the standard schedule had been followed.

    (D) The health care facility agrees to adhere to the schedule specified in the exemption request until the health care facility notifies the department in writing that it wishes to end the exemption and report according to the standard schedule, or until a new exemption letter is issued.

(b) Requests for exemptions shall be submitted and processed using the following procedures as shown in paragraphs (1) - (4) of this subsection.

  (1) A health care facility requesting an exemption shall submit to the department a letter requesting the exemption and providing all information necessary to establish the hospital's entitlement to the exemption. The exemption request shall be signed by the chief executive officer of the hospital who shall certify that all information contained in the request is true and correct.

  (2) The department shall review the request for exemption. The department may request additional information from the health care facility relevant to the exemption request. Within 30 days of receipt of a request, the department shall issue a letter granting or denying the exemption. If denied, the letter shall state in detail the reasons for the denial.

  (3) If the department denies an exemption request the health care facility may:

    (A) resubmit the request along with any additional information or analysis the health care facility deems relevant to the department. The resubmission shall be considered in the same manner as an initial submission; or

    (B) appeal the department's decision to the commissioner of the department. The health care facility may make an appeal directly to the commissioner of the department. In making its determination, the department will consider only those facts and issues which have been previously presented to the department.

  (4) The department may revoke any type of exemption if facts indicate that a health care facility no longer meets the criteria required for an exemption. The department shall give the health care facility written notice of the revocation at least 30 days prior to the effective date of the revocation. The notice shall include a detailed statement of the facts on which the revocation is based. A health care facility may challenge the revocation of its exemption by:

    (A) requesting the department to reconsider the revocation by submitting any information or analysis the health care facility deems relevant to the department in writing at least ten days prior to the effective date of the revocation; and

    (B) by appealing to the commissioner of the department if the department does not grant the request for reconsideration. In making its determination, the commissioner of the department will consider only those facts and issues which have been previously presented to the department.

(c) Reporting loss of exemptions. Health care facilities shall notify the department in writing within 30 days of their loss of an exemption authorized by subsection (a) of this section.

Source Note: The provisions of this §421.81 adopted to be effective July 5, 2017, 42 TexReg 3373

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