1 Tex. Admin. Code § 371.200
Inpatient Hospital Utilization Review Program
Effective Nov 22, 199520 TexReg 9274Source 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.Texas Secretary of State
(a) The Texas Medical Review Program (TMRP) is the inpatient hospital utilization review system used by the Texas Department of Health (department) for hospitals reimbursed under the department's prospective payment system. The department conducts the TMRP in accordance with:
- (1) applicable federal regulations at 42 Code of Federal Regulations §456, Subpart C, which require the department to operate a utilization review program that controls the utilization of inpatient hospital services and assesses the quality of those services; or
- (2) an approved waiver under the Social Security Act, §1861(k), as it relates to the use of Title XVIII utilization review procedures for Title XIX patients in acute general hospitals other than hospitals reimbursed under the Tax Equity Fiscal Responsibility Act (TEFRA) principles of reimbursement; or
- (3) diagnostic-related group (DRG) data base that determines the DRG payment schedule, which includes psychiatric and rehabilitation admissions in the DRG payment methodology.
- (b) The TEFRA review process relates directly to hospitals reimbursed under the TEFRA principles of reimbursement.
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.