TITLE 1.ADMINISTRATION

Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 354. MEDICAID HEALTH SERVICES

Subchapter B. GENERAL PROVISIONS

1 TAC §354.1450

The Texas Health and Human Services Commission (HHSC) adopts new §354.1450, relating to audits of Medicaid providers. The new rule is adopted without changes to the proposed text as published in the May 5, 2006, issue of the Texas Register (31 TexReg 3655) and will not be republished.

Added by the Senate Bill 630, 79th Legislature, 2005, Regular Session, §32.070 of the Human Resources Code requires HHSC to adopt rules governing the audit of Medicaid providers. New §354.1450 implements the provisions of the statute.

New §354.1450 requires that an agency conducting an audit of a Medicaid provider must notify the provider of an impending audit not later than seven days before the field audit portion of the audit begins. If the provider is an incorporated pharmacy, the auditing agency must also notify the pharmacy's corporate headquarters. Section 354.1450 does not apply to computerized audits using the Medicaid Fraud Detection Audit System or audits or investigations conducted by the Office of the Attorney General's Medicaid Fraud Control Unit, the Office of the State Auditor, the Office of the Inspector General, or the Office of the Inspector General of the U.S. Department of Health and Human Services.

HHSC received one comment on the proposed rule. The Private Providers Association of Texas expressed support for the rule as proposed.

The new rule is adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; the Human Resources Code, §32.021 and the Texas Government Code, §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; and the Human Resources Code, §32.070, which provides the Commissioner of HHSC with the authority to adopt rules governing certain audits of Medicaid providers.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 7, 2006.

TRD-200603633

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: August 1, 2006

Proposal publication date: May 5, 2006

For further information, please call: (512) 424-6900