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 [ To] Utilization Review Department Review Decisions
ISSUE 01/29/2016
ACTION Proposed
Preamble Texas Admin Code Rule
If a hospital receives notification from HHSC [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 sets [will set] out the responsible area and time frame within which HHSC must receive the appeal [must be received by HHSC]. The Texas Medicaid Policy and Procedure Manual provides additional information on the appeal process.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 15, 2016

TRD-201600180

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: February 28, 2016

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

 

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