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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 1. ADMINISTRATION |
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PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION |
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CHAPTER 371. MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD AND ABUSE PROGRAM INTEGRITY |
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SUBCHAPTER C. UTILIZATION REVIEW |
| § 371.200. Inpatient Hospital Utilization Review Program |
| § 371.201. Case Selection Process |
| § 371.203. TMRP Review Process |
| § 371.204. Hospital Screening Criteria for TMRP, TEFRA, and Facility-Specific Per Diem Methodology Reviews |
| § 371.206. Denials and Recoupments for TMRP, TEFRA Hospitals, and Facility-Specific Per Diem Methodology Reviews |
| § 371.208. Appeals Related to Utilization Review Department Review Decisions |
| § 371.210. Inpatient Utilization Review for Hospitals Reimbursed Under TMRP and TEFRA Principles of Reimbursement and Facility-Specific Per Diem Methodology Reviews |
| § 371.212. Utilization Review of Nursing Facilities |
| § 371.214. HHSC-Approved Online RUG or Other HHSC-Required Training Course |
| § 371.216. Nursing Facility Clinical Records |
| § 371.218. Onsite and Desk Utilization Reviews of Nursing Facilities |
| § 371.220. Exit Conferences |
| § 371.222. Reconsideration of Utilization Review Results |
| § 371.224. Appeals of Reconsideration Results |
| § 371.226. Calculation of Overpayments and Underpayments |
| § 371.228. Recoveries |
| § 371.230. Waiver of Extrapolation |