Texas § GV.544.0303 - EXPEDITED ADMINISTRATIVE HEARING

§ GV.544.0303. EXPEDITED ADMINISTRATIVE HEARING

EXPEDITED ADMINISTRATIVE HEARING. (a) A provider subject to a payment hold imposed under Section 544.0301 (a), other than a hold this state's Medicaid fraud control unit requested, must request an expedited administrative hearing not later than the 10th day after the date the provider receives notice of the hold from the office of inspector general under Section 544.0302 . (b) On a provider's timely written request, the office of inspector general shall, not later than the third day after the date the office of inspector general receives the request, file a request with the State Office of Administrative Hearings for an expedited administrative hearing regarding the payment hold for which the provider submitted the request. (c) Not later than the 45th day after the date the State Office of Administrative Hearings receives a request from the office of inspector general for an expedited administrative hearing, the State Office of Administrative Hearings shall hold the hearing. (d) In an expedited administrative hearing held under this section: (1) the provider and the office of inspector general are each limited to four hours of testimony, excluding time for responding to questions from the administrative law judge; (2) the provider and the office of inspector general are each entitled to two continuances under reasonable circumstances; and (3) the office of inspector general is required to show probable cause that: (A) the credible allegation of fraud that is the basis of the imposed payment hold has an indicia of reliability; and (B) continuing to pay the provider presents an ongoing significant financial risk to this state and a threat to the integrity of Medicaid. (e) The office of inspector general is responsible for the costs of the expedited administrative hearing, but a provider is responsible for the provider's own costs incurred in preparing for the hearing. (f) In the expedited administrative hearing, the administrative law judge shall decide whether the payment hold should continue but may not adjust the amount or percent of the payment hold. (g) Notwithstanding any other law, including Section 2001.058 (e), the administrative law judge's decision in the expedited administrative hearing is final and may not be appealed. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.