Texas Register
TITLE 1 ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 371MEDICAID FRAUD AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER CUTILIZATION REVIEW
RULE §371.208Appeals Related To Utilization Review Department Review Decisions
ISSUE 10/04/2002
ACTION Proposed
Preamble Texas Admin Code Rule
If a hospital receives notification from the Texas Health and Human Services Commission (HHSC) Utilization Review 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 time frame within which the appeal must be received by the HHSC 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 September 23, 2002

TRD-200206174

Marina S. Henderson

Executive Deputy Commissioner

Texas Health and Human Services Commission

Earliest possible date of adoption: November 3, 2002

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

 

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