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August 2014 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3. Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.6 Utilization Review Process : 3.6.0.1 Admission Review : 3.6.0.2 Readmission Review

3.6.0.2
If a hospital admission or readmission occurs within 30 days of a discharge from the same or a different hospital for the same or closely related diagnosis, or for a condition identified during the previous admission, it may be reviewed for medical necessity, quality, and DRG validation including POA indicators.
Transfers from one facility to another and readmissions are also subject to review.

Texas Medicaid & Healthcare Partnership
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