TITLE 1. ADMINISTRATION

PART 2. TEXAS ETHICS COMMISSION

CHAPTER 6. ORGANIZATION AND ADMINISTRATION

SUBCHAPTER A. GENERAL RULES

1 TAC §6.5

The Texas Ethics Commission (the commission) adopts an amendment to §6.5, relating to the Texas Ethics Commission's authority to adopt rules. The amendment is adopted without changes to the proposed text as published in the May 8, 2009, issue of the Texas Register (34 TexReg 2729) and will not be republished.

Currently under §6.5, the commission may not adopt a rule that in the opinion of the commission directly addresses the subject of pending litigation known to the commission. The amendment clarifies the term litigation by providing that it does not include the subject matter of a sworn complaint if the sworn complaint has not reached the formal hearing stage.

No comments were received regarding the proposed rule during the comment period.

The amendment to §6.5 is adopted under Government Code, Chapter 571, §571.062, which authorizes the commission to adopt rules concerning the laws administered and enforced by the commission.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 11, 2009.

TRD-200902330

Natalia Luna Ashley

General Counsel

Texas Ethics Commission

Effective date: July 1, 2009

Proposal publication date: May 8, 2009

For further information, please call: (512) 463-5800


CHAPTER 8. ADVISORY OPINIONS

1 TAC §8.3

The Texas Ethics Commission (the commission) adopts an amendment to §8.3, relating to the subject matter of an advisory opinion issued by the Texas Ethics Commission. The amendment is adopted without changes to the proposed text as published in the May 8, 2009, issue of the Texas Register (34 TexReg 2729) and will not be republished.

Currently under §8.3, the commission may not issue an advisory opinion that concerns the subject matter of pending litigation known to the commission. The amendment clarifies the term litigation by providing that it does not include the subject matter of a sworn complaint if the sworn complaint has not reached the formal hearing stage.

No comments were received regarding the proposed amendment during the comment period.

The amendment to §8.3 is adopted under Government Code, Chapter 571, §571.062, which authorizes the commission to adopt rules concerning the laws administered and enforced by the commission.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 11, 2009.

TRD-200902331

Natalia Luna Ashley

General Counsel

Texas Ethics Commission

Effective date: July 1, 2009

Proposal publication date: May 8, 2009

For further information, please call: (512) 463-5800


PART 4. OFFICE OF THE SECRETARY OF STATE

CHAPTER 73. STATUTORY DOCUMENTS

SUBCHAPTER F. DISCLOSURE STATEMENT OF CONDITIONAL GIFTS

1 TAC §73.91

The Office of the Secretary of State adopts an amendment to 1 TAC §73.91, concerning disclosure of conditional gifts. This non-substantive change corrects an outdated citation to the United States Code. The amendment is adopted without change to the text proposed in the May 8, 2009, issue of the Texas Register (34 TexReg 2731).

Two specific changes are adopted: (1) capitalization of the "f" in "Federal" in two places where the word modifies "Department of Education"; and (2) correction of an outdated citation to "20 United States Code 1145d" to "20 United States Code 1011f".

COMMENTS

The Secretary of State received no comments concerning the proposed amendment.

STATUTORY AUTHORITY

This amendment is adopted under the authority of §51.573, Texas Education Code, which provides that the secretary of state shall prescribe the form and contents of a disclosure statement of conditional gifts in accordance with federal law.

Chapter 51, Texas Education Code, is affected by the amended rule.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902300

Lorna Wassdorf

Director of Business and Public Filings

Office of the Secretary of State

Effective date: June 29, 2009

Proposal publication date: May 8, 2009

For further information, please call: (512) 463-5562


PART 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 357. HEARINGS

The Health and Human Services Commission (HHSC) adopts the repeal of Chapter 357, Subchapters A, D, E, F, G, and H and adopts new Chapter 357, Subchapter A. Specifically, HHSC repeals: Subchapter A, §§357.1, 357.3, 357.5 - 357.7, 357.9, 357.11 - 357.13, 357.15, 357.17, 357.19, 357.21, 357.23, 357.25, 357.27 and 357.29, concerning Medicaid Fair Hearings; Subchapter D, §§357.301 - 357.305, concerning Fair Hearings; Subchapter E, §§357.351 - 357.360, concerning Appeals Process; Subchapter F, §§357.401 - 357.417, concerning Hearing Procedure; Subchapter G, §357.441 and §357.442, concerning Social Service Appeals, and Subchapter H, §§357.461 - 357.463, concerning Medicaid Services Appeals. HHSC replaces the repeal with new Subchapter A, §§357.1, 357.3, 357.5, 357.7, 357.9, 357.11, 357.13, 357.15, 357.17, 357.19, 357.21, 357.23 and 357.25, concerning Uniform Fair Hearing Rules. HHSC also adopts the amendments to Subchapter R, §357.702 and §357.703, concerning Judicial and Administrative Review of Hearings. New §§357.1, 357.3, 357.9, 357.11, 357.13, 357.17, 357.19, 357.21, 357.23 and 357.25 are adopted with changes to the proposed text as published in the January 16, 2009, issue of the Texas Register (34 TexReg 309). The text of the rules will be republished. The repeal of §§357.1, 357.3, 357.5 - 357.7, 357.9, 357.11 - 357.13, 357.15, 357.17, 357.19, 357.21, 357.23, 357.25, 357.27, 357.29, 357.301 - 357.305, 357.351 - 357.360, 357.401 - 357.417, 357.441, 357.442, and 357.461 - 357.463, new §§357.5, 357.7, and 357.15 and the amendments to §357.702 and §357.703 are adopted without changes to the proposed text and will not be republished.

Background and Justification

The Health and Human Services Commission (HHSC) is required to have procedural rules that direct the conduct of client fair hearings. At consolidation of the human services agencies, the fair hearing rules at Texas Department of Human Services were transferred to HHSC. At that time, only fair hearing rules for Medicaid appeals already existed at HHSC.

The adopted rules will repeal the existing sets of fair hearing rules and provide a much clearer picture in new §§357.1 - 357.21 of the rules that govern client appeals at HHSC. They will provide more streamlined procedures for the conduct of these hearings. In addition, the proposed rules conform to Commission practice and fulfill the purpose intended by Government Code §531.0055: that performance of administrative support services for health and human services agencies, including legal support, is the responsibility of HHSC.

The adopted changes to §357.702 and §357.703 clarify the definition of "notice" and that the administrative review is limited to the record considered by the hearing officer. The adopted changes also provide an exception to the 30-day timeframe for requesting an administrative review.

Comments

The 30-day comment period ended February 16, 2009. Since February 16, 2009 was a holiday, comments were accepted through February 17, 2009. During this period, HHSC received comments from Advocacy Incorporated and the Texas Legal Services Center. A summary of the comments relating to the proposed rule and HHSC's responses follows. It should also be noted that references to the "Food Stamp Program" have been changed to "Supplemental Nutrition Assistance Program" (SNAP) in order to track the new federal name of the program.

Comment: Advocacy Incorporated noted that proposed §357.1(2) defines "Action Effective Date" as "the date the agency action becomes effective." They would prefer HHSC use the "Date of Action" used in the federal regulations.

Response: Those terms defined in the rules are those that are included throughout and are necessary for a common understanding of the appeals process. These include "Action Effective Date," which is the date the agency's action becomes effective, and "Date of Notice of Agency Action," which is the date that appears on the written notice informing the client of the action. These terms are specific and important when calculating time limits in the appeal process. "Date of Action" is not used in these rules. There is no requirement that every specific term defined in federal regulations be used and defined in a State's rules so long as they do not conflict with federal hearing rules. No changes were made in response to this comment.

Comment: Advocacy Incorporated argues that the definition of "Across the Board Reduction of Services" in §357.1 does not strictly comply with federal regulations and limits the beneficiary's right to a fair hearing. Specifically, they note that the definition of "Across-the-Board Reduction of Services," found in proposed §357.1(1) (which is related to proposed §357.3(b)(4)), is not in compliance with 42 C.F.R. §431.220(b), which only allows the agency to not grant a hearing "if the sole issue is a Federal or State law requiring an automatic change adversely affecting some or all recipients." (Emphasis added).

Response: The rule is changed to track the federal rules in order to reflect the comment.

Comment: The commenters believe that a fuller statement that includes all of the various federal program requirements should be used in lieu of proposed §357.1(3), the definition of "adequate notice." Texas Legal Services Center and Advocacy Incorporated stated the current definition for adequate notice is not comprehensive enough to comply with federal regulations and should be changed. They believe that the wording in the current fair hearing rules is informative and useful to the applicants and recipients to understand why an action was taken and be aware of the right to appeal. They also note that, besides the content-of-notice requirements found in various federal regulations, the First Agreement in Alberto N., et al. v. Hawkins, et al. set out, with specificity, the requirements of adequate notice and that the relevant language of this agreement should also be included in the rule.

Response: While agreeing about the importance of notice to recipients, the Commission disagrees with the suggestion that the hearing rules are the place to address all of the many program requirements of adequate notice, whether from federal rules or settlements in various lawsuits. The federal requirements for the required notices vary depending on the program and the purpose of the notice. The proposed HHSC program rules require these notices to be consistent with each program's laws, rules and regulations; they are the responsibility of the dozens of program areas that involve fair hearings. The rule language was not changed in response to this comment.

Comment: Advocacy Incorporated stated that proposed definition of "Agency Action" in §357.1(6) fails to comply with federal regulations, in that it limits the right to appeal an agency's decision to "reduce, suspend, terminate, or deny benefits," which would deny applicants or beneficiaries who are challenging a termination, suspension, or reduction of Medicaid eligibility. The federal regulations use the terms "eligibility" and "services."

Response: It has always been the practice of the Appeals Division to interpret "denial of benefits" as including "eligibility." However, the proposed rule language was changed to add "eligibility" in response to this comment to ensure clarity.

Comment: Texas Legal Services Center and Advocacy Incorporated stated that proposed §357.1(9) regarding the designation of a representative at the hearing should not be required to be "in writing." The commenter believes this requirement limits applicants for or recipients of assistance right to be assisted by whomever they choose.

Response: The purpose of the "in writing" requirement is to ensure that vendors or providers are not able to act on behalf of an appellant who has not approved their actions. This has been a serious problem in Medicaid. However, HHSC hearing officers will accept designations when the appellant confirms on the record that he or she has an authorized representative or designates someone else to speak on his behalf. Rule language was changed to specify this practice in response to the comment.

Comment: Advocacy Incorporated stated that proposed definition of a "Fair Hearing" in §357.1(19) fails to account for or otherwise allow appeals for "inaction."

Response: The failure of an agency to act upon a request for services has always been subject to appeal. The failure to "act upon a request with reasonable promptness" is covered under the Right to Appeal section (§357.3) of the rules. The rule was not changed in response to the comment.

Comment: Advocacy Incorporated stated that proposed §357.1(36) states that THSteps was "formerly known as EPSDT." The commenter noted that HHSC calls the EPSDT benefit THSteps.

Response: The rule language was not changed in response to the comment because HHSC believes the rule already reflects this point.

Comment: Advocacy Incorporated stated that the proposed definitions are missing a definition for "Adverse Determination" which should be included.

Response: A definition for "adverse determination" was not included because the term is not used in these rules. The rule language was not changed in response to the comment.

Comment: Advocacy Incorporated stated that the proposed rule regarding the "Right to Fair Hearing," §357.3(b), fails to comply with federal law since it limits the right to appeal to actions that "reduce, suspend, terminate or deny benefits," which does not include "eligibility".

Response: It has always been the practice of HHSC and its predecessor agencies to allow appeals of eligibility issues, as a logical interpretation of "denial of benefits" encompasses that term. However, the rule language was changed to specify "eligibility" in response to this comment.

Comment: Advocacy Incorporated stated that there is no need to change the wording related to a "Hearings Officer's Responsibility," §357.5(c). They assert a preference to keep the current fair hearing rule language, which does not mention the Rules of Civil Procedure.

Response: The proposed rule expands the language of the current rule in order to better preserve the informal nature of the fair hearing, by stating that the Texas Rules of Evidence and the Texas Rules of Civil Procedure are not followed. The proposed rule was not changed in response to this comment.

Comment: Advocacy Incorporated stated that the proposed rules do not require the attendance of the medical director in appeals related to the denial or reduction of nursing services as required in the Second Partial Settlement Agreement in the Alberto N. lawsuit.

Response: The agreement in Alberto N. applies only to cases involving appellants who are under the age of 21 and seeking private duty nursing. The Medical Director, in appropriate circumstances, serves as an agency representative, attends hearings, and provides testimony in support of the decision to deny or reduce nursing services - but this requirement is limited. The rule language was not changed in response to this comment.

Comment: Advocacy Incorporated stated that proposed §357.5(c)(2)(D), which allows the hearing officer to limit the number of persons in attendance at a hearing, is unnecessary. They assert that the hearings officer should have sufficient phone lines and/or space to accommodate all participants and that the appellant's right to present testimony through witnesses may not be compromised due to a lack of phone capacity or office space.

Response: This rule follows current HHSC hearing rules and federal regulations which permit limiting the number of attendees at a hearing when space limitations exist. The hearings officer applies the same considerations to telephone hearings when appropriate, since telephone lines are likewise not unlimited. However, despite restrictions, hearing officers are able to ensure that all witnesses are heard. The rule language was not changed in response to the comment.

Comment: Advocacy Incorporated stated that proposed §357.5(c)(3)(D) should be re-written to include the same requirements of proposed §357.5(c)(3)(E), as the federal regulations require the same specificity. See, e.g., 42 C.F.R. §431.244(d) and (e) (decision must "summarize the facts"; "specify the reasons for the decision").

Response: All fair hearing decisions include Findings of Fact, which summarize the facts that were proven and which are pertinent to the appeal, and Conclusions of Law, which state the hearings officer's decision and the legal basis for that decision. The rule language was not changed in response to the comment.

Comment: Advocacy Incorporated notes that proposed §357.7(d) states that if advance notice is provided and if a hearing is requested within ten days of the mailing of the notice, and "the operating agency or its designee determines that the action resulted from something other than the application of federal or state law or policy, the operating agency or its designee will reinstate and continue an individual's services until a hearing decision is rendered." They believe that this proposed rule violates 42 C.F.R. §431.230 (Maintaining services), in that "the agency may not terminate or reduce services until a decision is rendered after the hearing unless - (1) It is determined at the hearing that the sole issue is one of Federal or State Law . . . ." Pursuant to federal law, services must be maintained unless it is determined at the hearing that the sole issue is one of federal or state law. They argue that the proposed rule, however, improperly lets the agency or its designee determine, prior to the hearing, whether the action was caused by the "application of federal or state law" (which is also different than "sole issue is one of Federal or State Law").

Response: The proposed rules do not contain a §357.7(d). However, assuming the comment refers to §357.3(b)(4)(B), that rule is changed to allow this determination at a preliminary hearing conference.

Comment: Advocacy Incorporated disagreed with that portion of proposed §357.9 requiring the appellant to bear the burden of proof to prove an affirmative defense. The commenter stated the rule allows the agency to "unlawfully flip the burden of proof to the beneficiary."

Response: HHSC disagrees that requiring an appellant to bear the burden of proof on an affirmative defense is improper or illegal. However, HHSC has concluded that the affirmative defense concept is possibly too confusing for informal hearings, especially when so few appellants have legal representation. The rule requiring an appellant to bear the burden of proof in these special circumstances has been changed as a result of this comment.

Comment: Texas Legal Services Center stated that in regard to continuation of benefits, addressed in part by §357.11(a)(7), due process may require continuation of benefits by virtue of the state or federal constitution, judicial decisions (whether reported or not, and whether in the form of a decision by the court or a decision by the court to approve a consent decree), and/or policies that provide a reasonable expectancy of continuation of benefits. The commenter requested these additional sources be added to the rule.

Response: HHSC agrees that continued benefits may be affected in the instances cited by the commenter but believe that the reference to "law" in the proposed rule covers those circumstances. Given the great variety of HHSC programs which are the subject of fair hearings, and varied circumstances under which benefits are continued, the proposed rule language was clarified in response to this comment to specify that benefits should be continued in accordance with the requirements of the program at issue.

Comment: Advocacy Incorporated stated that §357.13 should be revised to require the hearing officer or the agency or it's designee to provide the case file and copies of all documentation and evidence to be used in the fair hearing, at no cost. The commenter believes the beneficiary should, as a matter of course, receive his or her case file and evidence to be used at hearing, without having to request it.

Response: HHSC understands the point of this comment to be that the entire case file should be provided automatically whenever an appellant requests a fair hearing. The documents program staff used to make the decision being appealed are furnished at no cost to the appellant and to the hearings officer prior to the hearing. Automatically copying and forwarding the entire case file to the appellant is not required by Federal regulations, nor is it cost-effective. In addition, automatically furnishing the complete file would seldom be beneficial to an appellant, since it is rare that an entire case file would be relevant to the issue on appeal. The rule language was not changed in response to this comment.

Comment: Advocacy Incorporated stated that, according to the First Settlement Agreement in the Alberto N. lawsuit and federal regulations, an appellant has the right to request and expect an in-person hearing. The commenter suggested revising §357.13 to allow an in-person hearing upon the request of the appellant.

Response: HHSC receives approximately 33,000 fair hearing requests per year. Scheduling hearings by telephone allows them to be heard much more quickly than if all hearings were conducted face-to-face, and federal regulations permit hearings to be conducted in this manner. In-person hearings must be coordinated between appellants, hearings officers, program representatives, and often attorneys and witnesses. Hearings staff often learn that appellants prefer to have their hearing by telephone, as this fits their schedules better. Hearings officers are provided extensive training on conducting telephone hearings, to ensure that appellants' due process rights are preserved and in-person hearings provided where required.

The settlement agreement in the Alberto N. lawsuit requires an in-person hearing when requested, for certain appellants 21 years of age or younger, and HHSC complies with this requirement in all respects. Rule language was not changed in response to this comment.

Comment: Advocacy Incorporated notes that proposed §357.17(b)(2)(A) states that "expedited hearings are granted if the health plan or health plan provider determines that taking the time for resolution of a fair hearing could seriously jeopardize the individual's life or health . . . ." The commenter believes that this determination should be made by the hearings officer, the appellant or the appellant's physician.

Response: The portion of the rule in question is derived from federal regulations regarding the appeals process of managed care organizations; this federal provision is confusing in the context of the hearing rules. The rule is amended to remove references to the federal process and to make it clear that any Medicaid patient whose health is threatened by a delay in the fair hearings process may request and be promptly granted an expedited hearing.

Comment: Texas Legal Services Center stated that the scope for review of TANF decisions should be expanded to include constitutional provisions, regulations, statutes, judicial decisions, policies and consent decrees.

Response: Section 357.19(f)(3) addresses the scope of attorney reviews provided for TANF decisions. If an appellant disagrees with a decision in a TANF case, a procedural review is available to him, since TANF decisions by statute are not accorded administrative or judicial review rights. HHSC believes that the proposed scope is so wide as to be inappropriate for an administrative review of an agency decision. The rule language was not changed in response to this comment.

Comment: Advocacy Incorporated stated that, with regard to §357.21(a), the hearings officer should be allowed to make a determination as to whether an interpreter is needed before the hearing begins. They believe that this is more practical since, especially in rural areas, an interpreter may not be so easily obtained in time if the hearing is scheduled.

Response: Appellants are given an opportunity to request an interpreter when they make a request for a fair hearing. Information on how to request an interpreter is included with the Appointment Notice sent to the appellant. If a hearings officer knows in advance that an interpreter is needed, he will be free to makes necessary arrangements. Despite being provided this information, appellants often do not notify the hearings officer that they need an interpreter until the hearing begins. At that time, the hearings officer makes needed arrangements and may have to reschedule the hearing. If the hearing is held by telephone and requires an interpreter, the hearings officer includes the interpreter in the conference call before officially beginning the hearing. The rule language was clarified in response to this comment.

Comment: Advocacy Incorporated stated that proposed §357.21(a)(2) should contain more clarification regarding how a hearing office determines whether deaf or hard of hearing participants are "sufficiently fluent" in the same language so that no barrier is present.

Response: The fair hearing rules are consistent with laws, statutes, regulations and agency agreements. More detailed information is provided to the hearings officers during training on how to determine whether all participants are able to communicate clearly, in order that there are no barriers to their participation in the hearing. The rule language was clarified in response to this comment by adopting "able to communicate" in lieu of "sufficiently fluent."

Comment: Advocacy Incorporated stated that proposed §357.21(a) should include language that requires the hearing officer to use the primary consideration standard in evaluating the needs of a deaf or hard of hearing participant. They also state that the proposed rule be amended to be consistent with the terms used in other Texas state laws concerning the certification or licensing of interpreters, which includes for spoken languages and sign language. They suggest that HHSC provide a BEI or RID certified sign language interpreter. Moreover, the commenter stated that a deaf or hard of hearing appellants should be allowed to request another form of auxiliary aid or services other than an interpreter.

Response: HHSC agrees that clear communication is necessary between all parties to a fair hearing. HHSC contracts for interpretation services for fair hearings, and these contracts require all interpreters to be BEI or RID certified at a minimum of level III or IV, as appropriate.

All hearings participants are provided form H4805, Fair Hearing Procedures, which informs them of what to do if they need special accommodations. If, at the time of the hearing, it becomes evident that special accommodations are needed, the hearings officer makes necessary arrangements to ensure that all parties are able to communicate effectively. Greater detail in terms of the form of the assistance is appropriate for training and the Fair Hearings Handbook but not for rules as it may be subject to frequent change. The rule has been changed in subsection (b) to emphasize that the hearing officer will use all available means required by law to provide assistance to those requiring it at the hearing.

Comment: Advocacy Incorporated stated with regard to §357.23(a)(3) there is nothing in federal law which allows the agency to extend the ninety day time limit on issuing the hearing decision. The commenter suggested an additional clause requiring a written notice to the appellant advising them of the new deadline. They believe that it might be acceptable for the proposed rule to be revised by the addition of a further clause, namely, "the appellant will be sent notice of any such extension at least ten days prior to the time limit that would otherwise obtain and the notice will inform the appellant of the revised date by when the decision will be issued."

Response: HHSC allows an appellant to request a 30-day postponement of his hearing. The time limit to issue a decision in the hearing may be extended by the number of days the hearing was postponed at the appellant's request. The settlement agreement reached in the Villarreal lawsuit provides for this extension.

The hearings officer may also allow a hearing record to remain open to receive additional information, and granting the extension will be clearly stated on the record during the hearing. Leaving the record open benefits the appellant as it allows him to reschedule the hearing and/or provide additional evidence if he wishes. Requiring staff to send another notice each time an appellant requests an extension for this purpose is not necessary, as the appellant made the request and participated in the hearing where the extension was granted. The proposed language was not changed in response to this comment.

Comment: Advocacy Incorporated stated a hearings officer should only be able to re-issue a decision at the request of the appellant or appellant's representative. The commenter notes that although an appellant has the right to request administrative review within 30 days of the hearing officer's decision, there is not a concept that the decision "lies in repose out of effect for some period of days after it is issued; to the contrary, the decision is effective when issued and if it is to be withdrawn, revised, or re-issued, that should only occur at the request of the appellant."

Response: Section 357.23(g) authorizes the hearings officer to promptly withdraw a decision and issue a new one when appropriate, to correct an error of fact or law - whether in favor of the agency or the appellant. Proposed §357.23(f) provides a mechanism for the appellant to request that a hearing be re-opened. Moreover, if a new decision is issued, appellant has the right to request administrative review of that decision. The rule language was not changed in response to this comment.

Comment: Advocacy Incorporated stated that proposed §357.25(a) should be revised to include various documents associated with the appeal. The commenter believes that hearings decision should be available to the public indefinitely, not just for a period of a few years.

Response: HHSC believes that the rule language regarding the items to be retained in a record of the decision includes all items required by law. Regarding the time these documents are retained, there is no law requiring state agencies to retain hearing records indefinitely. Many of HHSC's programs have amended their retention schedules to require that records be kept for six years from the date a case is closed, in order to comply with certain HIPAA requirements. The Appeals Division, including the Fair and Fraud Hearings Section, will amend its retention schedule to retain records for six years from the last action in an administrative appeal, and the rule language was changed in response to this comment.

Comment: Advocacy Incorporated stated that all decisions should be redacted and made available to the public within 30 days of the date of the decision as is the case with decisions related to the Alberto N. settlement, i.e., all fair hearing decisions, not just Texas Health Steps appeals.

Response: HHSC complies with all known rules, regulations, and settlements that relate to redacting records and making records available to the public. The provisions of the Alberto N. settlement do not apply to all Medicaid decisions and redacting those other decisions would serve no apparent purpose. The rule language was not changed in response to this comment.

Comment: Advocacy Incorporated stated that the proposed rules are missing sections on the reinstatement of services, corrective action, and Federal Financial Participation which provides for, among other things, payments for continued services, payments for corrective action, and administrative costs for the beneficiary, his or her representative, and witnesses to travel to and from the hearing. They believe that these omissions deprive beneficiaries of rights provided by federal law, and therefore, must be cured.

Response: The fair hearing rules comply with all applicable federal regulations regarding continuing benefits and complying with the hearings officers' decision. The fair hearing rules do not address Federal Financial Participation requirements or other matters included in the State Plan. Decisions involving FFP or the State Plan are not made in the Appeals Division, and HHSC has elected not to provide for paying administrative and travel costs for appellants and witnesses to and from fair hearings.

It is important to note that these rules must agree with federal regulations, but there is no requirement that they reiterate every related or tangentially related federal provision already covered in those regulations. No changes were made to this rule in response to the comment.

SUBCHAPTER A. MEDICAID FAIR HEARINGS

1 TAC §§357.1, 357.3, 357.5 - 357.7, 357.9, 357.11 - 357.13, 357.15, 357.17, 357.19, 357.21, 357.23, 357.25, 357.27, 357.29

The repeals are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902306

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER D. FAIR HEARINGS

1 TAC §§357.301 - 357.305

The repeals are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902307

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER E. APPEALS PROCESS

1 TAC §§357.351 - 357.360

The repeals are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902308

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER F. HEARING PROCEDURE

1 TAC §§357.401 - 357.417

The repeals are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902309

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER G. SOCIAL SERVICES APPEALS

1 TAC §357.441, §357.442

The repeals are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902310

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER H. MEDICAL SERVICES APPEALS

1 TAC §§357.461 - 357.463

The repeals are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902311

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER A. UNIFORM FAIR HEARING RULES

1 TAC §§357.1, 357.3, 357.5, 357.7, 357.9, 357.11, 357.13, 357.15, 357.17, 357.19, 357.21, 357.23, 357.25

The new rules are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

§357.1.Definitions.

The following words and phrases, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise:

(1) Across the Board Reduction of Services--The agency need not grant a hearing if the sole issue is a Federal or State law requiring an automatic change adversely affecting some or all recipients.

(2) Action Effective Date--The date the agency action becomes effective.

(3) Adequate Notice--Notice in accordance with applicable law, rules, and regulations of the programs.

(4) Agency--Any one of the agencies listed under the Health and Human Services Agencies.

(5) Agency Action--The agency's decision to:

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

(B) deny certification of a household; or

(C) grant a benefit in an amount less than requested.

(6) Agency Representative--An individual from an agency or its designee who is authorized to represent the agency or its designee in a fair hearing.

(7) Appeal--A request for a review of an agency action or failure to act that may result in a fair hearing.

(8) Appellant--A client who requests a fair hearing.

(9) Authorized Representative--A person designated by the appellant in writing or designated by statute, regulation, or rule or named by the appellant on the record who may act on behalf of the appellant at the fair hearing.

(10) Benefit--A service administered or assistance provided by the agencies or their designees, including determining eligibility for services in the SNAP, TANF, and Medicaid-funded programs, and other agency programs in which state or federal law or rules provide a client the right to a fair hearing.

(11) Certified Spanish/English Interpreter--An interpreter who is certified by one of the following entities:

(A) American Translators Association;

(B) Federally Certified Court Interpreter through the Federal Court Interpreter Certification Examination;

(C) Interpreter Certification offered through a four-year college or university;

(D) State Certification Programs;

(E) United States Department of State (Escort, Seminar, or Conference level); or

(F) Any other nationally recognized certification program.

(12) CFR--Code of Federal Regulations.

(13) Client--A person who applies for or receives benefits from one of the HHS Agencies.

(14) Date of Appeal Request--The date on which the appellant or the appellant's authorized representative clearly expresses, in writing or orally as required, a desire to appeal.

(15) Date of Decision--The date of the hearings officer's decision, as noted on the decision document.

(16) Date of Notice of Agency Action--The date on the written notice informing the client of the agency action.

(17) Day--Calendar day, unless otherwise specified.

(18) Designee--A contractor, employee, or other agent designated to act for an agency.

(19) Fair Hearing--An informal proceeding held before an impartial HHSC hearings officer in which a client appeals an agency action. These hearings are not open to the public.

(20) Health and Human Services (HHS) Agencies:

(A) Health and Human Services Commission (HHSC);

(B) Department of Aging and Disability Services (DADS);

(C) Department of Assistive and Rehabilitative Services (DARS);

(D) Department of Family and Protective Services (DFPS);

(E) Department of State Health Services (DSHS); and

(F) A reference to an agency includes a designee.

(21) Health Plan--Includes MCO's, ICM and PCCM plans.

(22) Hearings Administrator--The administrator for fair and fraud hearings in the HHSC Appeals Division who oversees daily operations and staff conducting fair hearings.

(23) Hearings Officer--An HHSC employee designated by the Director of the Appeals Division who is responsible for conducting fair hearings and issuing decisions.

(24) Integrated Care Management (ICM) Program--A Medicaid managed care plan where an ICM Contractor manages and coordinates acute care services and long term services and supports for eligible Medicaid clients.

(25) Language Services--Any services that ensure effective communication for full participation of all parties in a hearing.

(26) Managed Care Organization (MCO)--An entity that has a current Texas Department of Insurance certificate of authority to operate as a health maintenance organization (HMO) or as an approved nonprofit health corporation under the Texas Insurance Code.

(27) Nursing Home Action--The nursing home's decision to transfer or discharge a client.

(28) Party--An appellant or his authorized representative or an agency or its representative.

(29) PASARR--Pre-Admission Screening and Resident Review Determination.

(30) Preponderance--The greater weight of the evidence required in a civil lawsuit for the trier of fact to decide in favor of one side or the other. This preponderance is based on the more convincing evidence and its probable truth or accuracy, and not on the amount of evidence.

(31) Primary Care Case Management (PCCM)--A managed care model allowed under federal regulations in which the Commission contracts with providers to form a managed care provider network.

(32) Person with Limited English Language Proficiency (LEP)--Person who does not speak English as a primary language and who has a limited ability to read, speak, write, or understand English.

(33) Prior Authorization Request--A request for services that is reimbursable only if authorization or approval for the services is obtained before services are rendered.

(34) SNAP--Supplemental Nutrition Assistance Program, formerly known as Food Stamps.

(35) TANF--Temporary Assistance for Needy Families.

(36) Texas Health Steps (THSteps)--A program under Medicaid that provides medical and dental check-ups, diagnosis, and treatment to eligible clients from birth through age 20. THSteps was formerly known as EPSDT.

§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.

(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.

§357.9.Burden of Proof in a Fair Hearing.

The burden of proof in a fair hearing regarding a specific issue is proof by a preponderance of the evidence. The party that bears the burden of proof meets the burden if the stronger evidence, on the whole, favors that party, as determined by the hearings officer. Depending on the type of hearing, the following apply:

(1) The agency or its designee bears the burden of proof.

(2) The nursing facility bears the burden of proof in transfer and discharge hearings.

§357.11.Notice and Continued Benefits.

(a) The agency must:

(1) follow the notice requirements set forth in the appropriate state or federal law or regulation for the affected program;

(2) give clients timely and adequate notice, as appropriate, of the right to a fair hearing;

(3) explain the right of appeal;

(4) explain the procedures for requesting an appeal;

(5) explain the right to be represented by others, including legal counsel;

(6) provide information about legal services available in the community;

(7) continue benefits if required to do so by state or federal law or regulations of the affected program; and

(8) not reinstate or continue SNAP benefits if a client requests a fair hearing after the date his certification period has ended.

(b) In Medicaid cases, except as specifically provided in federal regulations, the following apply:

(1) The written notice to an individual of the individual's right to a hearing must:

(A) contain an explanation of the circumstances under which Medicaid is continued if a hearing is requested; and

(B) be mailed at least 10 days before the date the individual's Medicaid eligibility or service is scheduled to be terminated, suspended, or reduced, except as provided by federal rules.

(2) If a hearing is requested before the date a Medicaid recipient's service, including a service that requires prior authorization, is scheduled to be terminated, suspended, or reduced, the agency may not take that proposed action before a decision is rendered after the hearing unless:

(A) it is determined at the hearing that the sole issue is one of federal or state law or policy; and

(B) the agency promptly informs the recipient in writing that services are to be terminated, suspended, or reduced pending the hearing decision.

§357.13.Appellant Rights and Responsibilities.

(a) Requesting an Appeal. Only the appellant or the appellant's authorized representative has the right to appeal an action by an agency.

(b) During the appeal process, the appellant has the right to:

(1) reapply for assistance;

(2) receive continued benefits if required by state or federal regulation or statute;

(3) confer with supervisory staff within the appropriate agency about the case prior to the hearing;

(4) continue with the fair hearing after a case adjustment or correction is made;

(5) request that reasonable accommodations due to disability or language comprehension be provided at the hearing at no cost;

(6) make an audio recording of the fair hearing;

(7) examine at a reasonable time before the date of the hearing and during the hearing:

(A) the content of the appellant's case file; and

(B) all documents and records to be used by the agency or the skilled nursing facility or nursing facility at the hearing;

(8) review the appeal procedures outlined in agency policy; and

(9) request a copy of the official recording at no charge after the decision is issued.

(c) An appellant or an authorized representative or legal counsel may send written interrogatories or request a pre-hearing conference to get additional information. The written interrogatories must be clear and concise, contain no more than 30 questions, and be submitted no less than 20 days prior to the hearing.

(d) Procedural Rights. The appellant has the right to:

(1) present the case personally or with the aid of others, including but not limited to the appellant's representative or legal counsel;

(2) bring witnesses;

(3) present information about all pertinent facts and circumstances;

(4) present arguments or address anything about the case without undue interference;

(5) confront and cross-examine adverse witnesses; and

(6) submit documentary evidence to the hearings officer before, during, or after the hearing as allowed by the hearings officer. Evidence submitted after the hearing, if accepted, must be entered into the record and shared with all parties.

(e) Appellant's Responsibilities. The appellant or the appellant's authorized representative is responsible for:

(1) participating in the fair hearing; and

(2) informing the hearings officer prior to the fair hearing that the appellant needs an interpreter or other accommodation due to a disability.

§357.17.Types of Hearings.

(a) Telephone and In-Person Hearings.

(1) The hearings officer conducts fair hearings by telephone ensuring that all parties are able to hear and respond to each other;

(2) An appellant may request that a hearing be conducted in person; and

(3) The hearings officer determines whether good cause for an in-person hearing exists.

(b) Expedited Appeals. The following hearings are expedited:

(1) Hearings for Transients--Transient appeals are SNAP and/or TANF appeals submitted by an appellant who plans to move from the jurisdiction of the hearings officer before the hearing decision would normally be issued. An example of a transient appeal is an appeal filed by a household that includes migrant farm workers. The hearing must be held and a decision made within 15 working days from the date the hearings officer receives the hearing request if:

(A) the appellant agrees to the reduced notice of the time, date, and place of the hearing; and

(B) the hearings officer has sufficient information available to make a decision without requesting additional information.

(2) Hearings for Individuals Whose Health Is Jeopardized--Any individual who believes and can demonstrate that a delay in his Medicaid hearing could seriously jeopardize his life or health may request an expedited fair hearing.

(c) Group Hearings--The hearings officer may consolidate hearings, upon request of multiple appellants, if the sole issue involved in the cases is one of Federal or State law or policy. In all cases except SNAP cases, the request must be in writing, signed by each appellant, and state the common issue(s). Requests for group hearings in SNAP cases may be made orally or in writing. An appellant may also withdraw from a group hearing at any time before a final decision is issued. If an appellant wishes to withdraw, he must submit a signed request in writing. Group hearings follow the same procedures as individual hearings.

§357.19.Other Procedures.

(a) Postponement. The hearings officer considers a postponement for a hearing only if the appellant or his authorized representative contacts the appropriate appeals office before the scheduled hearing is to occur.

(1) SNAP Fair Hearings--The appellant is entitled to receive one postponement of up to 30 days. Additional postponements may be approved if the hearings officer determines that there is good cause.

(2) All other Fair Hearings--The hearings officer may postpone a fair hearing if the hearings officer determines that good cause exists.

(3) The hearings officer must state in writing the decision on the request to postpone and send it to the appellant and agency.

(b) Dismissals.

(1) The hearings officer dismisses the fair hearing if the appellant fails to appear at the scheduled hearing.

(2) The appellant will have 30 days to submit in writing a request to re-open the hearing and the reasons that he failed to appear at the scheduled fair hearing.

(3) The hearings officer will consider the request and determine whether the appellant had good cause for missing the scheduled hearing. If the hearings officer determines the appellant had good cause for failing to appear, the hearings officer will re-open the hearing and set a new hearing date.

(4) The hearings officer documents the dismissal in writing and sends the decision to the parties.

(c) Withdrawals.

(1) Only the appellant or his or her authorized representative can withdraw the request for appeal.

(2) The appellant or his or her authorized representative must make the request to withdraw in writing to the hearings officer, an agency representative, or designee.

(3) If the appellant or his authorized representative orally requests to withdraw the appeal, he must confirm the request in writing. If a written request is not submitted, the hearings officer must notify the appellant in writing that if the written request is not received within 10 days, the appeal will be withdrawn based upon the original oral request.

(4) An oral request to withdraw during a hearing will be accepted in lieu of a written withdrawal.

(5) If an appellant dies during the appeal process, the hearings officer considers the appeal withdrawn unless the hearings officer is notified that the authorized representative or the appellant's executor intends to pursue the appeal.

(d) Recessed Fair Hearings. Once the hearing has begun, the hearings officer may recess the hearings proceedings if the hearings officer finds good cause for the recess. Following notice to both sides, the hearings officer may reconvene the hearing, if necessary.

(e) Administrative Review. Except for TANF decisions, an administrative review of a hearings decision is provided as set forth in §§357.701 - 357.703 of this chapter (relating to Purpose and Application, Definitions and Process and Timeframes).

(f) Review of TANF Decisions.

(1) An appellant or his or her authorized representative may make a timely request for a review of the decision.

(2) A request for a review of the decision must be postmarked within 30 days of the date of notice of the hearings officer's decision, and must be addressed to the hearings administrator.

(3) The scope of the review is limited to determining whether the hearings officer followed laws, procedures, and program rules introduced in the hearing.

§357.21.Interpreters in Fair Hearings.

(a) Determining the Need for Interpreters.

(1) The hearings officer informs the appellant on the record that he will be provided an interpreter at no cost if the appellant can show that the appellant or required participants are not able to participate in the hearing due to a communication barrier.

(2) No interpreter is required if the hearings officer determines that all participants are sufficiently able to communicate so that no barrier is present.

(3) The basis of the hearings officer's decision will be stated on the record.

(b) Types of Interpreters.

(1) Spanish/English--HHSC Appeals Division uses a certified interpreter;

(2) Other Spoken languages--HHSC Appeals Division makes every effort to use the most qualified interpreter for a person with limited English proficiency whose native language is not English or Spanish;

(3) Sign Language--HHSC Appeals Division provides a qualified sign language interpreter for a person who is hearing impaired and requests the service; and

(4) Other Methods of Interpretation--If required by the circumstances, the HHSC Appeals Division will arrange to provide other assistance in accordance with Commission policy.

(c) Effectiveness of Interpretation. If a party or authorized representative, during a fair hearing, makes a legitimate objection concerning the interpretation by an interpreter, the hearings officer:

(1) informs the authorized representative and the appellant of the right to request that the case be reheard;

(2) addresses the objection or complaint concerning the quality of the interpretation, including a request to rehear the case;

(3) finishes the hearing with the original interpreter; or

(4) provides a new interpreter at a later date.

§357.23.Hearings Officer Decision and Actions.

(a) Time Limits for Issuing Decisions.

(1) SNAP hearings--60 days from the date the appeal request is received by the agency or designee.

(2) Non-SNAP hearings--90 days from the date the appeal request is received by the agency or designee.

(3) The time limit for issuing a decision may be extended by as many days as the fair hearing is postponed or recessed at the request of the appellant.

(b) Decisions by Hearings Officer. The hearings officer issues a decision based exclusively on testimony and evidence introduced at the hearing. The hearings officer must:

(1) issue a written decision in English;

(2) provide the appellant with a copy of the decision; and

(3) provide a translated cover letter in Spanish for hearing decisions where a Spanish interpreter was used. The cover letter instructs the appellant to call the hearings officer if he needs assistance to understand the decision. An appellant who indicates by telephone, in person, or in writing that assistance is needed to understand the decision must receive an explanation of the hearing decision from bilingual personnel within a reasonable period.

(c) Sustained Decisions in THSteps Appeals--If the decision sustains the agency action reducing, suspending, denying, or terminating a requested service:

(1) on the basis that there is no federal financial participation, the decision must contain an explanation of the basis for the hearings officer's decision, applying the state and federal law to the individual's particular request; or

(2) on the basis that the service is not medically necessary, the decision must contain an explanation of the medical basis for the hearings officer's decision, applying the agency's policy or the accepted standards of medical practice to the individual's particular medical circumstances; and

(3) All THSteps decisions must contain legal authority, purpose of the hearing, procedural history, summary of evidence, relevant authorities, findings of fact, and conclusions of law.

(d) Decisions that are Reversed. The hearings officer reverses a decision of the agency or designee if the action or inaction is not supported by the evidence introduced at the hearing, and is not supported by statutes, policies, or procedures applicable at the time the action or inaction occurred. The agency may be instructed to issue retroactive payments or restored benefits in accordance with applicable rules, regulations, and statutes.

(e) Decisions that are Upheld. The hearings officer upholds a decision of the agency or its designee if the action is in accordance with statutes, policies, and procedures introduced at the hearing.

(f) Reopened Hearings--Appellant. The hearings officer may reopen an appeal and reconsider the decision if, within 12 months of the decision date, the appellant presents evidence that:

(1) the hearings officer has determined the information would have affected the outcome of the original decision;

(2) shows the original decision was not valid; and

(3) was not presented at the hearing by the appellant.

(g) Authority of the Hearing Officer to Re-issue a Decision. The hearings officer has the authority to withdraw, revise, and re-issue a decision. The hearings officer may re-issue the decision within 20 days of the date of the original decision if the hearings officer becomes aware of an error of law or fact that would have affected the outcome of the decision.

§357.25.Records and Confidential Information.

(a) Record Maintenance. The official record of the hearing includes the exhibits offered to the hearings officer, the exhibits admitted, the recording of the hearing, any briefs or memoranda filed in connection with the hearing, the hearings officer's decision, and any items filed in connection with administrative review and the decision on administrative review.

(b) Hearing Record Retention. The official record of a hearing is retained by the HHSC Appeals Division according to the HHSC Records/Retention Schedule.

(c) Public Access.

(1) HHSC Appeals Division records and decisions are available for public inspection and copying, but are also subject to federal and state rules and statutes regarding confidentiality.

(2) Names, addresses, and other identifying information about household members and other individuals who provide information about the household, medical information, and the status of pending criminal prosecutions are confidential.

(3) An appellant or authorized representative may record the hearing or request a copy of the recording, at no cost, from the hearings officer.

(4) All other public access to hearings records and decisions is subject to the Texas Public Information Act.

(5) The agency will redact all confidential information from the hearings decision and make the decision available to the public, without cost, within 30 days of the date of the hearing decision in Texas Health Step appeals.

(d) Confidential Information. Confidential information that can not be shared with hearing participants may not be considered by the hearings officer.

(e) Privileged Communication. No party to a fair hearing is required to disclose at the hearing information that is privileged from discovery by federal or state law, including communications between a lawyer and an appellant, a husband and a wife, a member of the clergy and a person seeking spiritual advice, or the name of an informant whose identity is protected from compelled disclosure.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902312

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900


SUBCHAPTER R. JUDICIAL AND ADMINISTRATIVE REVIEW OF HEARINGS

1 TAC §357.702, §357.703

The amendments are adopted under the Texas Government Code, §531.033, which provides the Executive Commissioner of HHSC with broad rulemaking authority; and Texas Human Resources Code, §31.034, which provides clients the right to appeal an action or failure to act by a local administrative unit relating to the financial assistance; Texas Human Resources Code, §32.035 makes the provisions of §31.034 applicable to applicants for medical assistance; and Human Resources Code, §35.003, provides an individual with the opportunity to request a hearing if an application for person with disabilities support services is denied.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 9, 2009.

TRD-200902313

Steve Aragón

Chief Counsel

Texas Health and Human Services Commission

Effective date: June 29, 2009

Proposal publication date: January 16, 2009

For further information, please call: (512) 424-6900