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 371.220 - Exit Conferences
Universal Citation: 1 TX Admin Code § 371.220
Current through Reg. 50, No. 13; March 28, 2025
(a) For onsite reviews:
(1) OIG conducts an onsite, and subsequent telephone, exit conference after the onsite review is complete.
(2) The nurse reviewer communicates preliminary findings to the nursing facility staff during the onsite exit conference.
(3) OIG conducts a telephone exit conference after the onsite exit conference.
(b) For desk reviews, OIG conducts a telephone exit conference after the desk review is complete.
(c) For onsite and desk reviews, OIG provides the following information in writing to the nursing facility staff prior to the telephone exit conference:
(1) a list of reviewed assessments with proposed RUG changes;
(2) a preliminary statement of findings;
(3) the notification of potential RUG changes letter;
(4) the estimated recovery amount; and
(5) the requirements for submission of a reconsideration request.
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