Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 421 - HEALTH CARE INFORMATION
Subchapter F - HEALTH CARE FACILITY EXEMPTIONS
Section 421.81 - Health Care Facilities Exemptions from Filing Requirements
Universal Citation: 25 TX Admin Code ยง 421.81
Current through Reg. 49, No. 38; September 20, 2024
(a) Types of Exemptions.
(1) Exemption as an exempted provider. All
health care facilities except those owned by the federal government shall
submit discharge reports to the department unless the department determines
that the hospital shall be considered an exempted provider. The department
shall make a determination of which health care facilities are entitled to this
exemption and shall notify hospitals by email or by regular United States mail.
This exemption, if granted, may be revoked by the department should the
hospital cease to meet the criteria for exemption. Health care facilities that
cease to be exempted as an exempted provider shall be responsible for
submitting discharge claims on all discharges that occur 30 days after loss of
the exemption. The initial discharge report shall not be due until 90 days
after notice is given. Subsequent discharge reports are due as specified in
§
421.3(a)
of this title (relating to Schedule for Filing Discharge Reports).
(2) Exemptions from Quarterly Filing of
Discharge Reports. Health care facilities that wish to submit discharge reports
to the department more often than quarterly may do so by requesting an
exemption to the standard submission schedule. The department may also issue
general exemptions based on the processing arrangements for data collection.
Exemption requests meeting the following criteria as shown in subparagraphs (A)
- (D) of this paragraph will normally be approved.
(A) The exemption request includes the
specific schedule on which the health care facility will make its discharge
reports, which will usually be daily, weekly or monthly.
(B) The exemption request states the medium
in which submissions will be made.
(C) The exemption request will not result in
data on any discharge being submitted to the department at a later date than it
would have been if the standard schedule had been followed.
(D) The health care facility agrees to adhere
to the schedule specified in the exemption request until the health care
facility notifies the department in writing that it wishes to end the exemption
and report according to the standard schedule, or until a new exemption letter
is issued.
(b) Requests for exemptions shall be submitted and processed using the following procedures as shown in paragraphs (1) - (4) of this subsection.
(1) A health
care facility requesting an exemption shall submit to the department a letter
requesting the exemption and providing all information necessary to establish
the hospital's entitlement to the exemption. The exemption request shall be
signed by the chief executive officer of the hospital who shall certify that
all information contained in the request is true and correct.
(2) The department shall review the request
for exemption. The department may request additional information from the
health care facility relevant to the exemption request. Within 30 days of
receipt of a request, the department shall issue a letter granting or denying
the exemption. If denied, the letter shall state in detail the reasons for the
denial.
(3) If the department
denies an exemption request the health care facility may:
(A) resubmit the request along with any
additional information or analysis the health care facility deems relevant to
the department. The resubmission shall be considered in the same manner as an
initial submission; or
(B) appeal
the department's decision to the commissioner of the department. The health
care facility may make an appeal directly to the commissioner of the
department. In making its determination, the department will consider only
those facts and issues which have been previously presented to the
department.
(4) The
department may revoke any type of exemption if facts indicate that a health
care facility no longer meets the criteria required for an exemption. The
department shall give the health care facility written notice of the revocation
at least 30 days prior to the effective date of the revocation. The notice
shall include a detailed statement of the facts on which the revocation is
based. A health care facility may challenge the revocation of its exemption by:
(A) requesting the department to reconsider
the revocation by submitting any information or analysis the health care
facility deems relevant to the department in writing at least ten days prior to
the effective date of the revocation; and
(B) by appealing to the commissioner of the
department if the department does not grant the request for reconsideration. In
making its determination, the commissioner of the department will consider only
those facts and issues which have been previously presented to the
department.
(c) Reporting loss of exemptions. Health care facilities shall notify the department in writing within 30 days of their loss of an exemption authorized by subsection (a) of this section.
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