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 07/14/2006
ACTION Final/Adopted
Preamble Texas Admin Code Rule
If a hospital receives notification from the Texas Health and Human Services Commission (HHSC) Utilization Review Unit 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 HHSC. The written notification of adverse decision will set out the responsible area and time frame within which the appeal must be received by HHSC. The Texas Medicaid Policy and Procedure Manual provides additional information on the appeal process.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 29, 2006

TRD-200603527

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: August 1, 2006

Proposal publication date: May 12, 2006

For further information, please call: (512) 424-6900

 

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