25 TAC §§41.101-41.105, 41.107-41.113
Senate Bill 30, §1.07, 75th Legislative Session transferred
the responsibility for utilization review in the state Medicaid program from
the Texas Department of Health and the Texas Department of Human Services
to the Texas Health and Human Services Commission. In accordance with this
transfer, Title 25, Part 1, §§41.101-41.105 and 41.107-41.113 concerning
utilization review will become Title 1, Part 15, §§371.200-371.211,
effective September 1, 1997. Title 40, Part 1, §§19.1812, 19.2411,
and 19.2412 will become Title 1, Part 15, §§371.212-371.214, effective
September 1, 1997. The rule conversion chart is published in the Tables and
Graphic section.
Figure: 1 TAC Chapter 371.
§41.101.Inpatient Hospital Utilization Review Program.
§41.102.Case Selection Process.
§41.103.Contracting for Texas Medical Review Program (TMRP) or Tax Equity and Fiscal Responsibility (TEFRA) Services.
§41.104.Texas Medical Review Program (TMRP) Review Process.
§41.105.TMRP Hospital Screening Criteria for TMRP and TEFRA Reviews.
§41.107.Acknowledgment of Penalty Notice.
§41.108.Denials and Recoupments for Texas Medical Review Program (TMRP) and Tax Equity and Fiscal Responsibility Act (TEFRA) Hospitals.
§41.109.Diagnostic Related Group (DRG) Changes and Adjustments.
§41.110.Appeals Requirements under the Texas Medical Review Program (TMRP) and Tax Equity and Fiscal Responsibility Act (TEFRA), and Hospital Notification.
§41.111.Sanctions under the TMRP and TEFRA.
§41.112.Inpatient Utilization Review for Hospitals Reimbursed under the Tax Equity and Fiscal Responsibility Act (TEFRA) Principles of Reimbursement.
§41.113.Quality of Care Review.