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Texas Statutes (Last Updated: January 4, 2014) |
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HUMAN RESOURCES CODE |
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Title 2. DEPARTMENT OF HUMAN SERVICES AND DEPARTMENT OF PROTECTIVE AND REGULATORY SERVICES |
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Subtitle C. ASSISTANCE PROGRAMS |
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Chapter 32. MEDICAL ASSISTANCE PROGRAM |
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Subchapter B. ADMINISTRATIVE PROVISIONS |
Sec. 32.0281. RULES AND NOTICE RELATING TO PAYMENT RATES
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(a) The department shall by rule describe the process used to determine payment rates for medical assistance and shall notify providers, consumers, the Legislative Budget Board, and the governor's office for budget and planning of that process.
(b) The department shall adopt rules relating to payment rates that include:
(1) a description of the process used to determine payment rates;
(2) a description of each cost of living index used in calculating inflation rates and the procedure for determining the level of inflation used in the department's calculations;
(3) the criteria for desk audits;
(4) the procedure for notifying providers of exclusions and adjustments to reported expenses, if notification is requested; and
(5) a method of adjusting rates if new legislation, regulations, or economic factors affect costs.
(c) The department shall include in the Title XIX State Medicaid Plan submitted to the federal government for approval the procedures for making available to the public the data and methodology used in establishing payment rates.
(d) The procedures for adopting rules under this section shall be governed by Chapter 2001, Government Code.
(e) An interested party may appeal an action taken by the department under this section, and an appeal of such action shall be governed by the procedures for a contested case hearing under Chapter 2001, Government Code. The filing of an appeal under this section shall not stay the implementation of payment rates adopted by the department in accordance with its rules.