Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 266 - MEDICAID HOSPICE PROGRAM
Subchapter B - UTILIZATION REVIEW
Section 266.225 - Informal Review
Universal Citation: 26 TX Admin Code ยง 266.225
Current through Reg. 49, No. 38; September 20, 2024
(a) Before HHSC issues a notice of proposed recoupment amount under 40 TAC § 49.533(c) (relating to Recoupment), HHSC gives a hospice:
(1) a description of the alleged rule
violation warranting the proposed recoupment;
(2) the amount of the proposed recoupment;
and
(3) the option to:
(A) request an informal review to demonstrate
that the hospice did not commit the alleged violation; or
(B) accept the proposed recoupment.
(b) A hospice's request for an informal review must:
(1) be received
by HHSC within 10 calendar days after the hospice receives the description of
the alleged violation and amount of the proposed recoupment from HHSC;
and
(2) contain documentation that
refutes the alleged violation.
(c) HHSC conducts the informal review by reviewing the hospice's written response and supporting evidence.
(d) HHSC provides the hospice with official notice of the outcome of the informal review.
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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