Texas Register, Volume 49, Number 7, Pages 805-932, February 16, 2024 Page: 828
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CHAPTER 371. MEDICAID AND OTHER
HEALTH AND HUMAN SERVICES FRAUD
AND ABUSE PROGRAM INTEGRITY
SUBCHAPTER G. ADMINISTRATIVE
ACTIONS AND SANCTIONS
DIVISION 3. ADMINISTRATIVE ACTIONS
AND SANCTIONS
1 TAC 371.1723
The Executive Commissioner of the Texas Health and Human
Services Commission (HHSC), on behalf of the Office of Inspec-
tor General (OIG), proposes in the Texas Administrative Code,
Title 1, Part 15, Chapter 371, Subchapter G, Division 3, new
371.1723, concerning Recoupment of Overpayments Identified
by Retrospective Payment Review.
BACKGROUND AND PURPOSE
The purpose of the proposal is to describe OIG's retrospective
payment review procedures related to records requests, review
processes, notices, and due process.
Texas Government Code 531.102 authorizes OIG to conduct
reviews related to the provision and delivery of all health and
human services in Texas to identify fraud, waste, or abuse.
SECTION-BY-SECTION SUMMARY
The proposed new 371.1723(a) identifies the types of retro-
spective payment reviews - data reviews and record reviews -
performed by OIG and states that OIG may recoup an overpay-
ment identified in a retrospective payment review.
The proposed new 371.1723(b) describes the procedures re-
lated to a retrospective payment review records request, includ-
ing the time deadline required to submit records in response to
a records request. The proposed new 371.1723(b) also states
that failure to timely produce requested records may result in an
OIG enforcement action.
The proposed new 371.1723(c) describes the review proce-
dures related to a retrospective payment review, including the
dollar limit of overpayment recoveries resulting from retrospec-
tive payment reviews and the ability of a person to produce
records to address a review finding.
The proposed new 371.1723(d) specifies the notices OIG
sends during a retrospective payment review, which includes
any finding of an overpayment amount and instructions for filing
an appeal.
The proposed new 371.1723(e) outlines the first and second
level appeal options available to a person subject to a retrospec-tive payment review.
The proposed new 371.1723(f) specifies the timing and circum-
stances under which results of a retrospective payment review
become final.
FISCAL NOTE
Trey Wood, Chief Financial Officer, has determined that for each
year of the first five years that the rule will be in effect, enforcing
or administering the rule does not have foreseeable implications
relating to costs or revenues of state or local governments.
GOVERNMENT GROWTH IMPACT STATEMENTHHSC has determined that during the first five years that the rule
will be in effect:
(1) the proposed rule will not create or eliminate a government
program;
(2) implementation of the proposed rule will not affect the number
of HHSC employee positions;
(3) implementation of the proposed rule will result in no assumed
change in future legislative appropriations;
(4) the proposed rule will not affect fees paid to HHSC;
(5) the proposed rule will create a new rule;
(6) the proposed rule will not expand, limit, or repeal existing
rule(s);
(7) the proposed rule will not change the number of individuals
subject to the rule; and
(8) the proposed rule will not affect the state's economy.
SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COM-
MUNITY IMPACT ANALYSIS
Trey Wood, Chief Financial Officer, has also determined that
there will be no adverse economic effect on small businesses,
micro-businesses, or rural communities. The rule does not
impose any additional costs on small businesses, micro-busi-
nesses, or rural communities that are required to comply with
the rules.
LOCAL EMPLOYMENT IMPACT
The proposed rule will not affect a local economy.
COSTS TO REGULATED PERSONS
Texas Government Code 2001.0045 does not apply to this new
rule because it does not impose a cost on regulated persons; is
necessary to receive a source of federal funds or comply with
federal law; and is necessary to implement legislation that does
not specifically state that 2001.0045 applies to the rule.
PUBLIC BENEFIT AND COSTS
Frank Bryan, OIG Senior Counsel, has determined that for each
year of the first five years the rule is in effect, the public benefit
will be the identification and review of fraud, waste, and abuse
in the provision and delivery of health and human services in the
state of Texas.
Trey Wood, Chief Financial Officer, has also determined that for
the first five years the rule is in effect, there are no anticipated
economic costs to persons who are required to comply with the
proposed rule because the new rule does not require a change
to business practices and does not create additional costs tocomply with the rule.
TAKINGS IMPACT ASSESSMENT
OIG has determined that the proposal does not restrict or limit
an owner's right to his or her property that would otherwise exist
in the absence of government action and, therefore, does not
constitute a taking under Texas Government Code 2007.043.
PUBLIC COMMENT
Written comments on the proposal may be submitted to HHS
Office of Inspector General - Chief Counsel Division, P.O.
Box 85200, Austin, Texas 78708, or street address 4601 W.
Guadalupe St., Austin, Texas 78751-3146; or by email to
IG_Rules_Comments_Inbox@hhsc.state.tx.us.49 TexReg 828 February 16, 2024 Texas Register
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Texas. Secretary of State. Texas Register, Volume 49, Number 7, Pages 805-932, February 16, 2024, periodical, February 16, 2024; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1657764/m1/24/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.