Texas § GV.544.0304 - INFORMAL RESOLUTION

§ GV.544.0304. INFORMAL RESOLUTION

INFORMAL RESOLUTION. (a) The executive commissioner, in consultation with the office of inspector general, shall adopt rules that allow 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, to seek an informal resolution of the issues the office identifies in the notice provided under Section 544.0302 . (b) A provider must request an initial informal resolution meeting under this section not later than the deadline prescribed by Section 544.0303 (a) for requesting an expedited administrative hearing. (c) On receipt of a timely request, the office of inspector general shall: (1) decide whether to grant the provider's request for an initial informal resolution meeting; and (2) if the office decides to grant the request, schedule the initial informal resolution meeting and give notice to the provider of the time and place of the meeting. (d) A provider may request a second informal resolution meeting after the date of an initial informal resolution meeting. On receipt of a timely request, the office of inspector general shall: (1) decide whether to grant the provider's request for a second informal resolution meeting; and (2) if the office decides to grant the request, schedule the second informal resolution meeting and give notice to the provider of the time and place of the second meeting. (e) Before a second informal resolution meeting is held, a provider must have an opportunity to provide additional information for the office of inspector general to consider. (f) A provider's decision to seek an informal resolution under this section does not extend the time by which the provider must request an expedited administrative hearing under Section 544.0303 (a). The informal resolution process shall run concurrently with the administrative hearing process, and the informal resolution process shall be discontinued when the State Office of Administrative Hearings issues a final determination on the payment hold. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.