SECTION 370.71. Review and Reconsideration of Disenrollment Determination

(a) A member may request a review of a suspension or termination of enrollment by contacting HHSC in writing within 30 working days from the notice of the action, or within 15 working days from the notice of the action if the member is requesting continuation of enrollment pending the review decision.

(b) Following receipt of the request for review, HHSC will complete its review within the timeframes required by federal regulation.

(c) HHSC will notify the requester in writing of the results of its review. The written notification will:

(1) explain the reason for the action;

(2) inform the requestor whether the action was reversed; and

(3) explain any applicable rights to reconsideration or review of the determination or state that the determination is final.

(d) A suspension or termination of enrollment is not subject to review if the sole basis for the decision is a provision in the State plan or in Federal or State law that affects all enrollees or a group of enrollees without regard to their individual circumstances.

Source Note: The provisions of this §370.71 adopted to be effective September 1, 2007, 32 TexReg 5359