Texas Register
TITLE 1 ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER CUTILIZATION REVIEW
RULE §371.208Appeals Related To Utilization Review Department Review Decisions
ISSUE 05/12/2006
ACTION Proposed
Preamble Texas Admin Code Rule
If a hospital receives notification from the Texas Health and Human Services Commission (HHSC) Utilization Review Unit [Department ] of an adverse decision regarding medical necessity of admission, days of stay, diagnosis related group (DRG) validation, or a final technical denial, the hospital may appeal to [the] HHSC [Resolution Services, Medical/Administrative Appeals Unit]. The written notification of adverse decision will set out the responsible area and time frame within which the appeal must be received by [the] HHSC. The Texas Medicaid Policy and Procedure Manual provides additional information on the appeal process. [Resolution Services, Medical/Administrative Appeals Unit.]

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on May 1, 2006

TRD-200602408

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: June 11, 2006

For further information, please call: (512) 424-6576

 

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