If a hospital receives notification from the Texas Health and Human Services Commission (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 will set out the responsible area and time frame within which the appeal must be received by HHSC. 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.