(a) The nursing facility provider may submit a request
to OIG for reconsideration of the results of the onsite or desk utilization
review.
(b) A complete reconsideration request must:
(1) be in writing;
(2) clearly identify the specific minimum data set
(MDS) assessment errors for which reconsideration is requested;
(3) contain a detailed description of the basis for
each objection to the MDS assessment errors for which reconsideration
is requested;
(4) include any documents the nursing facility provider
believes are necessary to support each objection to the identified
MDS assessment errors for which reconsideration is requested, including
the documents the nursing facility provider provided during the review;
(5) when requested, include a signed and notarized
OIG-approved records affidavit, for each record, that properly authenticates
the documents described in paragraph (4) of this subsection as business
records pursuant to Texas Rules of Evidence Rule 803(6) and Rule 902(10);
(6) be sent to the OIG Utilization Review unit at the
electronic or physical address indicated on the formal notification
of RUG changes, or successor notification; and
(7) be electronically submitted or postmarked on or
before the 15th calendar day after the telephone exit conference;
or, if the 15th calendar day falls on a Sunday or national holiday
as defined in Texas Government Code §662.003(a), the following
business day.
(c) Untimely or incomplete reconsideration requests
are denied. MDS assessment errors not specifically identified in the
reconsideration request are not reconsidered. MDS assessment errors
that do not result in a RUG change are not reconsidered.
(d) If, as part of the reconsideration request, the
nursing facility provider submits documents that were not provided
to OIG prior to the telephone exit conference, these documents must
be accompanied by:
(1) when requested, a signed and notarized OIG-approved
records affidavit, for each record, that properly authenticates the
documents as business records pursuant to Texas Rules of Evidence
Rule 803(6) and Rule 902(10); and
(2) a signed and notarized affidavit, for each record,
specifying why the record was not previously produced and the circumstances
under which the documents were found, including the date found, the
person who found the documents, and the location of the documents
when found.
(e) At the conclusion of the reconsideration review,
OIG Utilization Review issues written results of the review to the
nursing facility provider.
|