SECTION 730.1313. Retroactive Payments or Restored Benefits or Services

(a) If the hearing officer finds that the decision appealed was erroneous, the hearing officer authorizes the worker to process retroactive or supplemental assistance or services to correct the error.

(b) The appellant is also eligible for retroactive assistance between the date of the adverse action and the hearing officer's decision if benefits were not continued during that period. Except in AFDC cases, reimbursement or retroactive benefits are limited to 12 months preceding the month the error or underpayment is discovered. The hearing officer must specify the months of entitlement.

(c) If the hearing officer reverses a decision, he directs the worker to authorize any restored payments, benefits, or services. If the hearing officer reverses a decision involving:

(1) services--the service usually is provided from the time of the decision instead of retroactively. If the appellant had to spend money or has unpaid bills for services incorrectly reduced or denied, then he or the provider is entitled to the retroactive reimbursement.

(2) Title XIX medical assistance--retroactive reimbursement may be made only to the Title XIX provider, not the appellant. This is true even if the appellant has already spent his own money to purchase assistance.

Source Note: The provisions of this §730.1313 adopted to be effective April 3, 1987, 12 TexReg 954; duplicated effective September 1, 1992, as published in the Texas Register September 11, 1992, 17 TexReg 6279.