SECTION 910.7. Rate Review Process at State Hospitals

(a) If the individual or legally authorized representative (LAR) has provided complete financial information and the person disagrees with the fees assessed by the Texas Health and Human Services Commission (HHSC), the individual or LAR may contact the reimbursement office of the state hospital in which the individual would receive services to request a reduction and review of charges by the state hospital superintendent, or designee. The request must be made in writing within 10 business days of the date on the notification of charges letter. The individual or LAR retains the right to formally appeal the charges without using the rate review process at a state hospital.

(b) The individual or LAR will be notified of the rate review process at the time of initial rate determination and upon any subsequent rate determination.

(c) A request under this section will delay the deadline under §910.8(c)(2) of this chapter (relating to Appeal Process) for an appeal request to be submitted until a determination is made regarding a review under this section.

(d) If HHSC requests more information for a review, the request must be made within 7 business days of the original review request. An individual must submit additionally requested information within 15 business days. If the additional information is not received within 15 days, the request under this section will be considered withdrawn. If additional information is not received, HHSC must provide a notice to the individual that the request under this section is considered withdrawn and that the individual may proceed with an appeal under §910.8 of this chapter.

(e) Once HHSC receives all necessary information, HHSC must issue a review decision within seven business days and provide notice of the decision to the individual or LAR.

Source Note: The provisions of this §910.7 adopted to be effective March 24, 2022, 47 TexReg 1457