Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 371 - MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY
Subchapter C - UTILIZATION REVIEW
Section 371.200 - Inpatient Hospital Utilization Review Program
Universal Citation: 1 TX Admin Code § 371.200
Current through Reg. 50, No. 13; March 28, 2025
(a) HHSC conducts the TMRP in accordance with:
(1) applicable federal regulations at 42 C.F.R. Part 456, Subparts A, B, and C, which require HHSC to operate a utilization review program that controls the utilization of inpatient hospital services and assesses the appropriateness and quality of those services; and
(2) an approved waiver under the Social Security Act, §1903(i)(4), as it relates to the use of Title XVIII utilization review procedures for Title XIX patients in acute care general hospitals other than hospitals reimbursed under TEFRA reimbursement principles.
(b) The TEFRA review process relates directly to hospitals reimbursed under the TEFRA reimbursement principles and facility-specific per diem methodology.
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