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 04/22/2016
ACTION Final/Adopted
Preamble Texas Admin Code Rule
If a hospital receives notification from 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 out the responsible area and time frame within which HHSC must receive the appeal. The Texas Medicaid Policy and Procedure Manual provides additional information on the appeal process.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on April 11, 2016

TRD-201601682

Karen Ray

Chief Counsel

Texas Health and Human Services Commission

Effective date: May 1, 2016

Proposal publication date: January 29, 2016

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

 

Next Page       Previous Page

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page