Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter L - LOCAL FUNDS MONITORING
Section 355.8705 - Post-Determination Review
Universal Citation: 1 TX Admin Code ยง 355.8705
Current through Reg. 49, No. 38; September 20, 2024
(a) An interested party who disputes a determination under § 355.8704(g) of this chapter (relating to Reporting and Monitoring) may request post-determination review under this section.
(b) The purpose of a post-determination review is to provide for the informal and efficient resolution of the matter(s) in dispute. A post-determination review is not a formal administrative hearing and is conducted according to the following procedures:
(1) The Texas Health and Human
Services Commission (HHSC) must receive a request for a post-determination
review electronically to PFD_LFM@hhs.texas.gov no later than 30 calendar days
from the date of a notification under § 355.8704(g) of this chapter. If
the 30th calendar day is a weekend day, national holiday, or state holiday,
then the first business day following the 30th calendar day is the final day
the receipt of the written request will be accepted. HHSC will extend this
deadline for an additional 15 days if it receives a request for the extension
prior to the initial 30-day deadline. A request for a post-determination review
or extension that is not received by the stated deadline will not be
accepted.
(2) An interested party
must, with its request for a post-determination review, submit a concise
statement of the specific determinations it disputes, its recommended
resolution, and any supporting documentation the interested party deems
relevant to the dispute. It is the responsibility of the interested party to
render all pertinent information at the time it submits its request for a
post-determination review. A request for a post-determination review that does
not meet the requirements of this subparagraph will not be accepted.
(3) The written request for the
post-determination review or extension must be signed by a legally authorized
representative for the interested party. A request for a post-determination
review or extension that is not requested by a legally authorized
representative of the interested party will not be accepted.
(4) On receipt of a request for
post-determination review that meets the requirements of this section, HHSC
will:
(A) acknowledge receipt of the request
to the requestor; and
(B)
coordinate the review of the information submitted by the interested party and
may request additional information from the interested party, which must be
received no later than 14 calendar days from the date of the written request
for additional information.
(i) If the 14th
calendar day is a weekend day, national holiday, or state holiday, then the
first business day following the 14th calendar day is the final day the receipt
of the additional information will be accepted.
(ii) Information received after 14 calendar
days may not be used in the post-determination review decision unless the
interested party requests an extension and receives written approval from HHSC
staff to submit the information after 14 calendar days. HHSC must receive a
request for an extension to the 14-calendar-day due date prior to the 14th
calendar day.
(iii) HHSC may make
subsequent requests for additional information. If HHSC makes a subsequent
request for additional information, the timeframes for submission and receipt
of the information apply just as they applied to the initial request for
additional information.
(5) Upon review and receipt of all requested
supplemental information, HHSC will provide a final decision no later than 180
days after receipt of the request or receipt of supplemental information,
whichever is later. An interested party may request an update on the status of
the post-determination review at any time.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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