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 G - ADMINISTRATIVE ACTIONS AND SANCTIONS
Division 1 - GENERAL PROVISIONS
Section 371.1615 - Appeals
Universal Citation: 1 TX Admin Code ยง 371.1615
Current through Reg. 49, No. 38; September 20, 2024
(a) A person who is served with final notice of a sanction may appeal the imposition of the sanction.
(b) Request for hearing.
(1) A request for an administrative hearing
at HHSC Appeals Division or at SOAH on a final notice of overpayment, must be
received in writing by the OIG no later than 30 days after the date the person
is served the final notice.
(2) A
request for an administrative hearing at HHSC Appeals Division on a Final
Notice of Contract Cancellation, Final Notice of Exclusion, or Notice of Final
Assessment of Administrative Penalties must be received in writing by the OIG
no later than 15 days after the date the person is served the notice.
(3) A request for an expedited administrative
hearing at SOAH on a payment hold must be received in writing by the OIG no
later than ten days after the date the person is served the notice.
(4) A written request for an administrative
hearing must:
(A) be sent by certified mail to
the address specified in the notice letter;
(B) timely arrive at the address specified in
the final notice; and
(C) be signed
by the person or an attorney for the person. No other person or party may
request a hearing for or on behalf of the subject of the sanction.
(5) Other than a final notice of
overpayment or payment hold, an administrative hearing for a final notice of a
sanction is held at the HHSC Appeals Division.
(6) The costs for an administrative hearing
held at SOAH is borne by the OIG, but a provider is responsible for the
provider's own costs incurred in preparing for the hearing.
(7) All other costs incurred by either party,
including attorney's fees, transcript copies, expert fees, and deposition
costs, is the responsibility of the party incurring those costs.
(8) The OIG contacts the HHSC Appeals
Division or SOAH to request that the hearing be docketed. The OIG files a
docketing request for a payment hold hearing with SOAH not later than the third
day after the hearing is requested.
(c) If a person who has been served notice of a final sanction or notice of a payment hold fails to timely request an administrative hearing, the sanction becomes final and unappealable.
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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