This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:36 GMT

Home > Title 1 > Part 15 > Chapter 371 >Subchapter C > Rule 371.200
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 C - UTILIZATION REVIEW
SECTION/RULE §371.200 - Inpatient Hospital Utilization Review Program
Chapter Review Date 08/08/2023

(a) HHSC conducts the TMRP in accordance with:(1) applicable federal regulations at 42 C.F.R. Part 456, Subparts A, B, and C, which require HHSC to operate a utilization review program that controls the utilization of inpatient hospital services and assesses the appropriateness and quality of those services; and(2) an approved waiver under the Social Security Act, §1903(i)(4), as it relates to the use of Title XVIII utilization review procedures for Title XIX patients in acute care general hospitals other than hospitals reimbursed under TEFRA reimbursement principles.(b) The TEFRA review process relates directly to hospitals reimbursed under the TEFRA reimbursement principles and facility-specific per diem methodology.

Source Note: The provisions of this §371.200 adopted to be effective June 14, 1989, 14 TexReg 2624; transferred effective September 1, 1993, as published in the Texas Register January 28, 1994, 19 TexReg 589; amended to be effective November 22, 1995, 20 TexReg 9274; transferred effective September 1, 1997, as published in the Texas Register February 18, 2000, 25 TexReg 1308; amended to be effective March 30, 2003, 28 TexReg 2481; amended to be effective January 1, 2014, 38 TexReg 9479; amended to be effective May 1, 2016, 41 TexReg 2941.

View Official Rule