SECTION 357.3. Authority and Right to Appeal

(a) Health and Human Services (HHS) System Authority and Responsibilities.

(1) The Health and Human Services Commission (HHSC) is authorized by law to adopt and implement rules to administer the programs it oversees. These uniform fair hearing rules apply to the TANF program, the Supplemental Nutrition Assistance Program (formerly the Food Stamp Program), all Medicaid-funded services, and all other agency programs that are required by state or federal law or rules to provide the right to a fair hearing. HHSC delegates to the Appeals Division the authority to appoint hearings officers and to hear fair hearings.

(2) HHSC Appeals Division is responsible for:

(A) publishing fair hearing rules;

(B) receiving fair hearings appeal requests;

(C) conducting fair hearings; and

(D) issuing decisions.

(b) Right to Fair Hearing.

(1) Clients of Medicaid-funded services, TANF, the Supplemental Nutrition Assistance Program, and other agency programs in which state or federal law or rules provides a right to a fair hearing, are entitled to appeal the following actions:

(A) an action to reduce, suspend, terminate, or deny benefits or eligibility;

(B) a failure to act with reasonable promptness on a client's claim for benefits or services;

(C) a decision to transfer or discharge a resident from a skilled nursing facility or nursing facility;

(D) an adverse determination made regarding preadmission screening and resident review (PASARR);

(E) the denial of a prior authorization request; and

(F) the failure to reach a service authorization decision within the time period specified by federal law.

(2) Time for Fair Hearing. The client has the right to appeal:

(A) the current level of SNAP benefits anytime within SNAP certification period; and

(B) in all other actions, within 90 days from, the date on the notice of agency action, or the effective date of the agency action, whichever is later.

(3) Manner of Requesting Fair Hearing. The client may appeal more than one action at the same time and, unless otherwise provided in program rules or notices, in writing or orally.

(4) The Right to a Fair Hearing--Exceptions:

(A) Under the Supplemental Nutrition Assistance Program the household may request a fair hearing when it is aggrieved by a mass change in benefits.

(B) Under all other programs, the agency is not required to grant a hearing if the sole issue is a federal or state law requiring an automatic change adversely affecting some or all clients. This may be determined at a preliminary hearings conference.

(C) The client can appeal the application to him of an across-the-board reduction in benefits or services on the ground that he is not in the class affected by the automatic change.

Source Note: The provisions of this §357.3 adopted to be effective June 29, 2009, 34 TexReg 4292; amended to be effective June 14, 2010, 35 TexReg 5033