Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter L - LOCAL FUNDS MONITORING › Section 355.8705 - Post-Determination Review

Current through Reg. 49, No. 28; July 12, 2024
(a) An interested
				  party who disputes a determination under § 355.8704(g) of this chapter
				  (relating to Reporting and Monitoring) may request post-determination review
				  under this section.
(b) The purpose
				  of a post-determination review is to provide for the informal and efficient
				  resolution of the matter(s) in dispute. A post-determination review is not a
				  formal administrative hearing and is conducted according to the following
				  procedures:
(1) The Texas Health and Human
				  Services Commission (HHSC) must receive a request for a post-determination
				  review electronically to PFD_LFM@hhs.texas.gov no later than 30 calendar days
				  from the date of a notification under § 355.8704(g) of this chapter. If
				  the 30th calendar day is a weekend day, national holiday, or state holiday,
				  then the first business day following the 30th calendar day is the final day
				  the receipt of the written request will be accepted. HHSC will extend this
				  deadline for an additional 15 days if it receives a request for the extension
				  prior to the initial 30-day deadline. A request for a post-determination review
				  or extension that is not received by the stated deadline will not be
				  accepted.
(2) An interested party
				  must, with its request for a post-determination review, submit a concise
				  statement of the specific determinations it disputes, its recommended
				  resolution, and any supporting documentation the interested party deems
				  relevant to the dispute. It is the responsibility of the interested party to
				  render all pertinent information at the time it submits its request for a
				  post-determination review. A request for a post-determination review that does
				  not meet the requirements of this subparagraph will not be accepted.
(3) The written request for the
				  post-determination review or extension must be signed by a legally authorized
				  representative for the interested party. A request for a post-determination
				  review or extension that is not requested by a legally authorized
				  representative of the interested party will not be accepted.
(4) On receipt of a request for
				  post-determination review that meets the requirements of this section, HHSC
				  will:
(A) acknowledge receipt of the request
				  to the requestor; and
(B)
				  coordinate the review of the information submitted by the interested party and
				  may request additional information from the interested party, which must be
				  received no later than 14 calendar days from the date of the written request
				  for additional information.
(i) If the 14th
				  calendar day is a weekend day, national holiday, or state holiday, then the
				  first business day following the 14th calendar day is the final day the receipt
				  of the additional information will be accepted.
(ii) Information received after 14 calendar
				  days may not be used in the post-determination review decision unless the
				  interested party requests an extension and receives written approval from HHSC
				  staff to submit the information after 14 calendar days. HHSC must receive a
				  request for an extension to the 14-calendar-day due date prior to the 14th
				  calendar day.
(iii) HHSC may make
				  subsequent requests for additional information. If HHSC makes a subsequent
				  request for additional information, the timeframes for submission and receipt
				  of the information apply just as they applied to the initial request for
				  additional information.
(5) Upon review and receipt of all requested
				  supplemental information, HHSC will provide a final decision no later than 180
				  days after receipt of the request or receipt of supplemental information,
				  whichever is later. An interested party may request an update on the status of
				  the post-determination review at any time.