Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter J - MEDICAID THIRD PARTY RECOVERY
Division 5 - HEALTH INSURER REQUIREMENTS
Section 354.2344 - Notice and Appeal of Administrative Penalty

(a) HHSC will send the insurer a Notice of Administrative Penalty at least 30 days prior to the date that administrative penalties begin to accrue.

(b) The notice will contain the following information:

(c) If the insurer does not submit the information on or before the date on which administrative penalties begin to accrue, penalties will be assessed as stated in the notice.

(d) An insurer may request a hearing in writing within 20 days of receiving written notice from HHSC of administrative penalty.

(e) If a hearing is requested, the hearing is a contested case under the Administrative Procedure Act, Texas Government Code Chapter 2001, and HHSC's formal hearing rules in Chapter 357, Subchapter I of this title (relating to Hearings Under the Administrative Procedure Act).

(f) If an insurer fails to submit a request for hearing within 20 days from the date of the notice, or fails to appear at a scheduled hearing, the right to a hearing is waived and the amount of penalties assessed per day of non-compliance is final.

(g) The order of administrative penalty will be reported to the attorney general for collection.

(h) The enforcement of the penalty may be stayed during the time the order is under judicial review if the insurer pays the penalty assessed as of the date of the order to the clerk of the court or files a supersedeas bond with the court in the amount of the penalty. An insurer who cannot afford to pay the penalty or file the bond may stay the enforcement by filing an affidavit in the manner required by the Texas Rules of Civil Procedure for a party who cannot afford to file security for costs, subject to the right of HHSC to contest the affidavit as provided by the Texas Rules of Civil Procedure.