Section 277.91 - Utilization Review(a) HHSC conducts utilization review of a service delivery plan and supporting documentation at any time to: (1) determine the appropriateness of services;(2) validate a service provision; or(3) evaluate the quality of services.(b) A provider, consumer directed services employer, and FMSA must submit documentation supporting the service delivery plan to HHSC as requested by HHSC .(c) If HHSC determines that one or more of the tasks specified in a service delivery plan do not meet the requirements described in Subchapter D of this chapter (relating to Service Plan Development) or Subchapter E of this chapter (relating to Service Requirements), HHSC denies or reduces the hours or tasks, modifies the service delivery plan effective from the date of the utilization review, and sends written notification of the denial or reduction to the individual and provider.(d) In addition to the utilization review conducted in accordance with subsection (a) of this section, HHSC may conduct utilization reviews of providers and services based on utilization patterns and trends.26 Tex. Admin. Code § 277.91
Transferred from 40 TAC § 47.91 Texas Register, Volume 49, Number 24, June 14, 2024, TexReg 4436, eff. 7/1/2024