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

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 §371.208 - Appeals Related to Utilization Review Department Review Decisions
Chapter Review Date 08/08/2023

If a hospital receives notification from HHSC Utilization Review Unit of an adverse decision regarding medical necessity of admission, days of stay, diagnosis related group (DRG) validation, or a final technical denial, the hospital may appeal to HHSC. The written notification of adverse decision sets out the responsible area and time frame within which HHSC must receive the appeal. The Texas Medicaid Policy and Procedure Manual provides additional information on the appeal process.

Source Note: The provisions of this §371.208 adopted to be effective March 30, 2003, 28 TexReg 2481; amended to be effective August 1, 2006, 31 TexReg 5603; amended to be effective May 1, 2016, 41 TexReg 2941.

View Official Rule