SECTION 371.1615. Appeals

(a) A person who is served with final notice of a sanction may appeal the imposition of the sanction.

(b) Request for hearing.

(1) A request for an administrative hearing at HHSC Appeals Division or at SOAH on a final notice of overpayment, must be received in writing by the OIG no later than 30 days after the date the person is served the final notice.

(2) A request for an administrative hearing at HHSC Appeals Division on a Final Notice of Contract Cancellation, Final Notice of Exclusion, or Notice of Final Assessment of Administrative Penalties must be received in writing by the OIG no later than 15 days after the date the person is served the notice.

(3) A request for an expedited administrative hearing at SOAH on a payment hold must be received in writing by the OIG no later than ten days after the date the person is served the notice.

(4) A written request for an administrative hearing must:

(A) be sent by certified mail to the address specified in the notice letter;

(B) timely arrive at the address specified in the final notice; and

(C) be signed by the person or an attorney for the person. No other person or party may request a hearing for or on behalf of the subject of the sanction.

(5) Other than a final notice of overpayment or payment hold, an administrative hearing for a final notice of a sanction is held at the HHSC Appeals Division.

(6) The costs for an administrative hearing held at SOAH is borne by the OIG, but a provider is responsible for the provider's own costs incurred in preparing for the hearing.

(7) All other costs incurred by either party, including attorney's fees, transcript copies, expert fees, and deposition costs, is the responsibility of the party incurring those costs.

(8) The OIG contacts the HHSC Appeals Division or SOAH to request that the hearing be docketed. The OIG files a docketing request for a payment hold hearing with SOAH not later than the third day after the hearing is requested.

(c) If a person who has been served notice of a final sanction or notice of a payment hold fails to timely request an administrative hearing, the sanction becomes final and unappealable.

Source Note: The provisions of this §371.1615 adopted to be effective October 14, 2012, 37 TexReg 7989; amended to be effective April 15, 2014, 39 TexReg 2833; amended to be effective October 1, 2015, 40 TexReg 6585; amended to be effective May 1, 2016, 41 TexReg 2941