Revision 23-1; Effective July 31, 2023

Fair hearing activities are based on federal and state statutes, rules and regulations. Statutes provide an outline of all requirements, while the rules and regulations provide more detail on how to apply the statute.

1110 Statutes and Regulations

Revision 23-1; Effective July 31, 2023

1111 Federal Statutes and Regulations

Revision 23-1; Effective July 31, 2023

• Section 1396a of the Social Security Code relates to Medicaid requirements in the State Plan.
• Title 7, USC Section 2020(e)(10) relates to Supplemental Nutrition Assistance Program (SNAP) requirements.
• Regulations concerning fair hearings for Temporary Assistance for Needy Families (TANF) are in 45 CFR Section 205.10.
• Regulations concerning fair hearings for Medicaid are in 42 CFR Section 431.205.
• Regulations concerning fair hearings for SNAP assistance are in 7 CFR Section 273.15.
• Regulations concerning fair hearings for skilled nursing facilities, nursing facilities, and PASARR are in 42 CFR Section 483.204.

1112 Texas Statutes and Regulations

Revision 23-1; Effective July 31, 2023

1112.1 Texas Human Resources Code

Revision 23-1; Effective July 31, 2023

• Section 31.034 of the Texas Human Resources Code provides the right to appeal to an applicant for or recipient of financial assistance in TANF.
• Section 32.035 of the Texas Human Resources Code makes the provisions of Section 31.034 applicable to applicants for medical assistance. 

1112.2 Texas Administrative Code (TAC)

Revision 23-1; Effective July 31, 2023

Pursuant to 1 TAC Section 357.3, 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, SNAP (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 conduct fair hearings.

HHSC Appeals Division is responsible for publishing fair hearing rules, processing appeals, conducting fair hearings and issuing decisions.

1120 Reserved for Future Use

Revision 23-1; Effective July 31, 2023

1130 Burden of Proof - 1 TAC Section 357.9

Revision 23-1; Effective July 31, 2023

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, overall, favors that party, as determined by the hearings officer. Depending on the type of hearing, the following apply:

• The agency or its designee bears the burden of proof in benefit or service reduction, suspension, termination, or denial hearings.
• The nursing facility bears the burden of proof in transfer and discharge hearings.

1140 Private (Ex Parte) Communication - 1 TAC Section 357.5

Revision 23-1; Effective July 31, 2023

The hearings officer is prohibited from engaging in private (ex parte) communication, whether oral or written, with a party or the party's representative or witness relating to matters to be adjudicated in the hearing, unless both parties are notified. 

An agency representative, the appellant or the appellant's representative may contact the hearings officer to determine if a particular case has been decided or if an appeal has been received. If the contact is limited to this type of question, it is not considered ex parte communication. This is procedural communication, as it is strictly limited to uncontested procedural issues.

Additional information submitted by either party after or outside of the hearing is not considered ex parte communication if it is shared with the other party. A hearings officer must distinguish between procedural and ex parte communication.

1150 Judicial Notice

Revision 23-1; Effective July 31, 2023

Judicial notice, for the purpose of fair and fraud hearings, is the authority of a hearings officer to introduce known policy, rules, or regulations into the hearing record. 

Judicial notice is taken by the hearings officer, as a last resort, only when the hearings officer is aware of a policy, rule or regulation which:

• when not applied by the agency, will have an adverse effect on the appellant; or
• is needed to fully develop the record and write the hearing decision; and
• has not been provided or introduced by any party of the hearing.

1160 Obtaining a Legal Opinion or Clarification

Revision 23-1; Effective July 31, 2023

When necessary, a hearings officer may request legal clarification or opinion on the relevance or significance of policy, legal documents or other evidence being considered in the hearing, including allegations that agency policy conflicts with federal rule or statute.

The legal clarification request and response must be shared with all parties once the response is received. After the response is received, each side must have an opportunity to provide comment or rebuttal of the opinion; if necessary, the hearings officer may ask for additional clarification of issues raised during the rebuttal. The hearings officer must reconvene the hearing to permit discussion of the clarification by all parties. Non-case specific legal opinions or clarifications are not shared with the parties, and it is not necessary to reconvene the hearing.

1170 Requesting a Case File - 1 TAC Section 357.13(b)(7)(A)

Revision 23-1; Effective July 31, 2023

Appellants have a right to view their case files to prepare for the hearing. Form H4805, Fair Hearing Procedures, advises the appellant of this right and to contact the hearings officer if the appellant wishes to view the entire case file, not just the documents provided for the hearing. Form H4805 is included in the hearing packet mailed to the appellant.

Requests for case files must include the appeal ID, appellant’s name, and the type of program. If requested by an authorized representative who is not included in the record at the time of the request, the authorization from the requestor to represent the appellant must be included. Once a request is received, FFH will route the request to the corresponding party for completion.

1180 Records and Confidential Information

Revision 23-1; Effective July 31, 2023

1181 Privileges - 1 TAC Section 357.25(e)

Revision 23-1; Effective July 31, 2023

No party to a fair hearing is required to disclose information that is deemed privileged by law. This includes communications between a lawyer and a client, a husband and wife, and a clergyperson and a person seeking spiritual advice. Likewise, the name of an informant or other information protected from disclosure by federal or state substantive law may not be shared with an appellant.

1182 Public Access to Decisions - 1 TAC Section 357.25(c)

Revision 23-1; Effective July 31, 2023

1182.1 Confidential Information

Revision 23-1; Effective July 31, 2023

• HHSC Appeals Division records and decisions are available for public inspection and copying but are subject to federal and state rules and statutes relating to confidentiality.
• Names, addresses and other identifying information about the household, medical information and the status of pending criminal prosecutions are confidential.
• Fair and Fraud Hearings decisions can be found online, here.

1182.2 Disclosure of Hearings Recordings and Records

Revision 23-1; Effective July 31, 2023

• An appellant or representative may record the hearing, either by audio or visual means, or request a copy of the hearing recording, at no cost, from the hearings officer.
• All other public access to hearings records and decisions is subject to the Texas Public Information Act.
• The agency will redact all confidential information from the hearings decision and make the decision available to the public, without cost, within 30 calendar days of the date of the hearing decision in all acute care appeals for clients less than 21 years old.
• Fair and Fraud Hearings decisions can be found online, here.

1183 Official Record - 1 TAC Section 357.25(a)

Revision 23-1; Effective July 31, 2023

The official record of the hearing includes the fair hearing request summary, correspondence, including notices of hearing (initial, reschedule, and reconvene), reschedule requests, requests for the record to remain open, requests to reopen the record, statements of good cause, requests for additional information, withdrawal requests, letters of representation, exhibits admitted by the hearings officer, the recording of the hearing, any briefs or memoranda filed in connection with the hearing, the hearings officer’s decision and any correspondence concerning administrative review or procedural review.

1184 Record Retention - 1 TAC Section 357.25(b)

Revision 23-1; Effective July 31, 2023

The official record of all hearings is retained by the HHSC Appeals Division according to the HHSC Records/Retention Schedule.

1185 Prohibition of Use of Information Regarding Alien Status

Revision 23-1; Effective July 31, 2023

HHSC shall not disclose any of the information about a client to the U.S. Citizenship and Immigration Services or any government agency, except as required by law.

1190 Decision Reviews

Revision 23-1; Effective July 31, 2023

Hearings managers have the responsibility and duty to ensure correct decisions are issued to the extent possible. Hearings managers conduct quarterly readings of decisions issued by each hearings officer. 

The senior counsel, hearings director or hearings manager may designate mandatory readings of specific types of decisions prior to issuance.

In critical or emergency situations, including when the hearings officer is unavailable, the hearings manager has the authority to act on behalf of staff and issue or re-issue decisions and orders. 

Revision 23-1; Effective July 31, 2023

1210 Hearings Officer

Revision 23-1; Effective July 31, 2023

1211 Hearings Officer's Powers, Duties and Responsibilities - 1 TAC Section 357.5

Revision 23-1; Effective July 31, 2023

The hearings officer conducts the fair hearing as an informal proceeding, not as a formal court hearing, and is not required to follow the Texas Rules of Evidence or the Texas Rules of Civil Procedure.

A fair hearing is conducted by an impartial hearings officer who:

• does not have a personal involvement in the case;
• was not involved in the initial determination of the action that is being contested; and
• was not the agency representative who took the action or the immediate supervisor of that representative at the time the action was taken.

The hearings officer’s manager, at their discretion, may reassign the fair hearing to another officer.

Prior to the hearing, the hearings officer:

• determines whether a client requested a fair hearing in a timely manner or had good cause for failing to do so;
• schedules a pre-hearing conference to resolve issues of procedure, jurisdiction or representation, if necessary;
• requires the attendance of an agency representative to explain and defend the agency action. The hearings officer may notify other parties of the hearing but cannot subpoena witnesses;
• is prohibited from engaging in ex parte communication, whether oral or written, with a party or the party's representative or witness relating to matters to be adjudicated; and
• arranges for reasonable accommodations for disclosed disabilities.

During the hearing, the hearings officer:

• makes the official recording of the hearing;
• ensures that the appellant's and agency's rights are protected;
• contacts an interpreter when needed;
• limits the number of people in attendance at the hearing if space is limited;
• controls the use by others of cameras, videos or other recording devices to the extent possible. The hearings officer's recording is the official recording of the hearing.
• administers oaths and affirmations;
• ensures consideration of all relevant points at issue and facts pertinent to the appellant's situation at the time the action was taken, with attention to issues of particular concern to the appellant;
• considers the appellant's changed circumstances, when appropriate and possible;
• requests, receives and makes part of the record all relevant evidence;
• regulates the conduct and course of the fair hearing to ensure due process, an orderly hearing, and a clear record of the hearing; and
• conducts the hearing in a way that makes the appellant feel most at ease but meets state and federal requirements.

1212 Limitation of Authority of Hearings Officers

Revision 23-1; Effective July 31, 2023

A hearings officer does not have the authority to determine if policy is contrary to law or unconstitutional. When an appellant or their legal representative alleges a policy is contrary to law or unconstitutional, the hearings officer should state that the hearing decision will be based on agency policy in effect at the time of the agency action. If a challenge is made that an action was contrary to law, or the basis for the action is unconstitutional, the hearings officer will seek a legal opinion as outlined in 1160, Obtaining a Legal Opinion or Clarification.

1220 Agency

Revision 23-1; Effective July 31, 2023

1221 Agency Responsibilities - 1 TAC Section 357.7

Revision 23-1; Effective July 31, 2023

The agency must:

• accept and submit any appeal within five days of receipt;
• notify the hearings officer, within five days of the notice of hearing date, of any scheduling conflicts;
• ensure that copies of documents used to determine the agency action are provided to both the hearings officer and the appellant within 10 days of the date the appeal is received;
• appear at the scheduled hearing at the designated time; 
• explain and defend the decision or action taken regarding the appellant, including the internal appeal; and
• explain the decision made at the External Medical Review (EMR), if applicable. 

Additionally, for managed care cases, the agency must: 

• notify the hearings administrator if a managed care organization is submitting an appeal which has been determined to be expedited; and
• ensure that copies of documents used to determine the agency action are provided to both the hearings officer and the appellant immediately for expedited cases.

1230 Appellant

Revision 23-1; Effective July 31, 2023

1231 Appellant’s Rights - 1 TAC Section 357.13(d)

Revision 23-1; Effective July 31, 2023

The appellant and their representative have the right to: 

• examine evidence to be used in the fair hearing before the fair hearing begins;
• examine or request copies (at no cost) of all documents and records used at the hearing;
• present the case personally or with the aid of others, including, but not limited to, the appellant's representative; 
• bring witnesses; 
• present information about all pertinent facts and circumstances; 
• present arguments or address anything about the case without undue interference; 
• confront and cross-examine adverse witnesses; and 
• submit documentary evidence to the hearings officer before, during, or after the hearing as allowed by the hearings officer.

1232 Appellant’s Responsibilities - 1 TAC Section 357.13(e)

Revision 23-1; Effective July 31, 2023

The appellant or the appellant’s representative is responsible for:

• notifying any witnesses they would like to participate, unless they notify the hearings officer of additional witnesses when the hearing is requested;
• providing written authorization for someone they want to represent them in the hearing;
• notifying the hearings officer, prior to the hearing, if they will be unable to attend or would like to reschedule;
• submitting any evidence to the hearings office which they would like to offer, in accordance with the instructions on the notice of hearing;
• participating in the fair hearing; and
• informing the hearings officer before the fair hearing that the appellant needs an interpreter or other accommodation due to a disability.

1240 Attorney- Involved Hearings

Revision 23-1; Effective July 31, 2023

For an attorney to take any action on behalf of an appellant, the attorney must first demonstrate, either through verbal authorization or written documentation, that the appellant agrees to the representation. Evaluating a case to determine if legal representation will be provided does not grant an attorney authority to take any action on behalf of the appellant or to request the release of information.

From the initiation of the fair hearing request:

The hearings officer will email the attorney, or attorneys, involved, providing them with three potential dates, corresponding timeslots, and initial hearing length. The attorney(s) will have three business days to provide a response. If a response is not provided within this timeframe, the hearings officer will schedule the hearing based on their docket availability. 

After the initial hearing has been scheduled:

The hearings officer will automatically grant a continuance and email the attorney, or attorneys involved, providing them with three potential dates, corresponding timeslots, and initial hearing length. The attorneys will have two business days to provide a response. If a response is not provided within this timeframe, the hearings officer will schedule the hearing based on their docket availability. 

Regardless of when attorneys become involved in a hearing, once the hearings officer provides the initial outreach with the three potential dates for the hearing, it is the attorney’s responsibility to agree to a date and time and provide a response to the hearings officer. Additionally, the parties must exchange evidentiary documents and provide copies to the hearings officer by a certain date. 

If the attorneys cannot agree upon a date for the hearing, the hearings officer will set one for them.

Even after receiving an agreed upon date, the hearings officer may receive requests for continuances because the attorneys have conflicts or are trying to resolve the issue appealed. Depending on the circumstances, it may be appropriate for the hearings officer to grant these requests and provide a new letter with additional dates for the parties to consider and a time limit for notifying the hearings officer of the mutually agreed upon date for the hearing.

Continuances may be granted when good cause exists. However, continuances should not lead to postponing a hearing for an unreasonably long period of time.

It is strongly encouraged that attorneys provide their evidence to the other party and the hearings officer at least 20 days before the hearing. Failure to comply may be grounds for granting a continuance or for the evidence to be excluded from the hearing.

Attorneys acting in a non-legal capacity should be placed under oath when testifying. Attorneys acting in a legal capacity are not sworn in.

1250 Media

Revision 23-1; Effective July 31, 2023

Media representatives, including television, radio, and newspaper reporters, may not attend hearings, regardless of whether invited by the appellant.

If a media representative appears at a hearing, the hearings officer should instruct them to leave. Hearings officers should notify management if this occurs.

1260 Interpreters - 1 TAC Section 357.21

Revision 23-1; Effective July 31, 2023

1261 Right to Request an Interpreter

Revision 23-1; Effective July 31, 2023

When an appellant requests a fair hearing, agency staff create an appeal in the Texas Integrated Eligibility Redesign System (TIERS) Hearings and Appeal module, which generates Form H4800, Fair Hearing Request Summary. This form includes a space to indicate whether an interpreter is needed for the hearing.

Form H4805, Fair Hearing Procedures, accompanies the appointment notice and instructs the appellant to contact the hearings officer at least two business days before the hearing date if an interpreter is needed for the hearing.

The hearings officer informs the appellant on the record that he or she will be provided an interpreter at no cost if the appellant demonstrates that the appellant or required participants are not able to participate in the hearing because of a communication barrier.

The hearings officer should not serve as interpreter during a hearing.

1262 Determination of Necessity for Interpreter

Revision 23-1; Effective July 31, 2023

The hearings officer determines the need for an interpreter on a case-by-case basis.

No interpreter is required if the hearings officer determines that all participants are sufficiently able to communicate so that no barrier is present. The basis of the hearings officer’s decision must be stated on the record.

However, if all parties request for or agree that an interpreter is needed, it is the hearings officer’s responsibility to accommodate the request.

1263 LEP Interpreters

Revision 23-1; Effective July 31, 2023

HHSC provides an interpreter to applicants, clients and witnesses who have bona fide language barriers to ensure that they will be able to participate in the hearing. People with language barriers may include people who are unable to understand or communicate in English or whose ability to understand or communicate in English is limited.

Certified interpreters are required for SNAP appellants who have limited English proficiency and speak Spanish.

A certified interpreter is one who is certified by one of the following entities:

• American Translators Association;
• Federally Certified Court Interpreter through the Federal Court Interpreter Certification Examination;
• Interpreter Certification offered through a four-year college or university;
• State Certification Programs;
• U.S. Department of State (Escort, Seminar or Conference level); or
• any other nationally recognized certification program. 

If an appellant wants a family member or friend to interpret, the hearings officer explains that a trained interpreter is needed to provide interpretation for the hearing record to ensure accuracy. The family member or friend may assist the appellant as needed and may assist the appellant in the presentation of their case.

1264 Sign Language Interpreters - 1 TAC Section 357.21(b)

Revision 23-1; Effective July 31, 2023

HHSC Appeals Division provides a qualified sign language interpreter for a person who is hearing impaired and requests the service. If the appellant needs a sign language interpreter for the hearing, the hearings staff submit Form HHSC-OPS004, HHSC Request for Sign Language and Oral Interpreting Services, at least 48 hours before the hearing appointment.

1265 Requirements for Interpreters

Revision 23-1; Effective July 31, 2023

When an interpreter participates in a hearing, the interpreter must interpret in the first person and not the third person.

Interpreters must give complete and accurate interpretations and document translations without changing, omitting, or adding anything to what has been spoken or written.

The interpreter must maintain the confidentiality of client records. Information obtained during a hearing must not be disclosed outside the hearing or at a later hearing.

An interpreter must not initiate communication unless it is necessary to seek assistance when interpreting, as when speech is not understood, speech needs to be repeated, speakers need to speak more slowly or clearly, or to correct an interpretation error. In these instances, the interpreter must make it clear that the communication is not an interpretation but is needed for clarification.

If an interpreter has reservations about the ability to interpret competently, the interpreter must bring it to the attention of the hearings officer. The interpreter must also tell the hearings officer if there are circumstances making it difficult to interpret, such as too much noise, more than one person speaking at the same time, or witnesses speaking too rapidly or too long.

1266 Procedures for Hearings Officers Related to Interpreters

Revision 23-1; Effective July 31, 2023

1266.1 The Role of the Interpreter

Revision 23-1; Effective July 31, 2023

The hearings officer must explain the role of the interpreter to all parties before the hearing. The explanation is provided in English and the appellant’s primary language.

The hearings officer must establish on the record that the interpreter:

• communicates effectively with all parties and witnesses;
• takes the interpreter's oath (the hearings officer administers the oath to the interpreter in the presence of all parties), to reinforce everyone's awareness of the interpreter's role; and
• is a neutral party and has nothing to gain or lose due to the hearing decision on the appeal.

1266.2 Interpreter Oaths or Affirmations

Revision 23-1; Effective July 31, 2023

The hearings officer will administer the interpreter oath to the interpreter during the hearing. The interpreter must affirm the oath to continue interpreting the hearing.

1266.3 Curing Inaccuracies

Revision 23-1; Effective July 31, 2023

The hearings officer has the responsibility to remedy inaccuracies in the interpretation if they are brought to the hearings officer's attention. The hearings officer must halt or reset the hearing if it is necessary to obtain a qualified interpreter.

1267 Complaints Regarding Quality of Interpretation

Revision 23-1; Effective July 31, 2023

If a party or representative makes a legitimate objection concerning the quality or accuracy of the interpretation by an interpreter, the hearings officer:

• addresses the objection or complaint concerning the quality of the interpretation including a request to rehear the case; and
• may provide a new interpreter.

Revision 23-1; Effective July 31, 2023

1310 Notice of Proposed Adverse Action - 1 TAC Section 357.11

Revision 23-1; Effective July 31, 2023

Whenever an adverse action is taken, agencies are required to send an adequate notice to the client. The HHS agency follows notice requirements set forth in the appropriate state or federal law or regulations for the individual program.

A notice must:

• be sent to the client when a denial or reduction in services or eligibility action is taken.
• advise the client of: 
  • the right to a fair hearing; 
  • how to appeal; 
  • the right to be represented by others, including legal counsel; 
  • available legal services in the community; and 
  • an explanation of the circumstances when continued benefits may apply. 

1320 Content of Notice

Revision 23-1; Effective July 31, 2023

Notice requirements vary for different programs. Notice requirements for the various programs are listed below.

1321 Medicaid

Revision 23-1; Effective July 31, 2023

According to 42 CFR Section 431.210, relating to notice requirements for Medicaid-funded programs, “a notice required under §431.206(c)(2), (c)(3), or (c)(4) of this subpart must contain: 

• a statement of what action the agency, skilled nursing facility or nursing facility intends to take and the effective date of such action; 
• a clear statement of the specific reasons supporting the intended action; 
• the specific regulations that support, or the change in federal or state law that requires, the action; 
• an explanation of: 
  • the individual's right to request an evidentiary hearing if one is available, or a state agency hearing; or 
  • in cases of an action based on a change in law, the circumstances under which a hearing will be granted; 
• an explanation of the circumstances under which Medicaid is continued if a hearing is requested." 

1322 Alberto N. Settlement

Revision 23-1; Effective July 31, 2023

In addition, in cases involving denials or reductions of services provided to Medicaid clients under age 21, the Alberto N. settlement requires an explanation of why the request for services was denied and where appropriate, how to obtain services through other programs.

1323 Nursing Facility Discharge

Revision 23-1; Effective July 31, 2023

26 TAC Section 554.502 specifies requirements for the notice on a nursing facility discharge action: 

“Contents of the notice. For nursing facilities, the written notice specified in subsection (d) of this section must include the following: 

1. the reason for transfer or discharge; 
2. the effective date of transfer or discharge; 
3. the location to which the resident is transferred or discharged; 
4. a statement of the resident’s appeal rights, including: 
   1. the resident has the right to appeal the action as outlined in HHSC's Fair and Fraud Hearings Handbook by requesting a hearing within 90 days after the date of the notice; 
   2. if the resident requests the hearing before the discharge date, the resident has the right to remain in the facility until the hearing officer makes a final determination unless failure to transfer or discharge would endanger the health or safety of the resident or individuals in the facility. The facility must document the danger failure to discharge would present; and 
   3. information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request; 
5. the name, address, email address, and telephone number of the managing local ombudsman and the toll-free number of the Ombudsman Program; 
6. in the case of a resident with mental illness, the address, email address, and phone number of the state mental health authority; and
7. in the case of a resident with an intellectual or developmental disability, the authority for individuals with intellectual and developmental disabilities, and the phone number, address, and email address of the agency responsible for the protection and advocacy of individuals with intellectual and developmental disabilities.”

1324 SNAP

Revision 23-1; Effective July 31, 2023

According to 7 CFR Section 273.13, relating to notices required for SNAP, "The notice of adverse action shall be considered adequate if it explains in easily understandable language: 

• the proposed action; 
• the reason for the proposed action; 
• the household's right to request a fair hearing; 
• the telephone number of the SNAP office (toll-free number or a number where collect calls will be accepted for households outside the local calling area) and, if possible, 
  • the name of the person to contact for additional information; 
  • the availability of continued benefits; and 
  • the liability of the household for any over issuances received while awaiting a fair hearing if the hearing official's decision is adverse to the household. If there is an individual or organization available that provides free legal representation, the notice shall also advise the household of the availability of the service." 

1325 TANF

Revision 23-1; Effective July 31, 2023

According to 45 CFR Section 206.10 (4), adequate notice shall be sent to applicants and recipients to indicate that assistance has been authorized (including the amount of financial assistance) or that it has been denied or terminated. Under this requirement, adequate notice means: 

• a written notice that contains a statement of the action taken;
• the reasons for and specific regulations supporting such action; and 
• an explanation of the individual's right to request a hearing.

1330 Agency Action Notice Issues

Revision 23-1; Effective July 31, 2023

1331 When Appellant Raises a Notice Issue

Revision 23-1; Effective July 31, 2023

The appellant has the right to receive adequate notice. If the appellant raises an issue at the hearing questioning the sufficiency of the notice, or if the hearings officer identifies an issue with the notice, the hearings officer must address the issue on the record at that time.

If the hearings officer determines that the notice is not adequate, the hearings officer must instruct the agency representative to prepare a new notice and provide it to the appellant. After the new notice is provided, the hearings officer will reconvene the hearing.

If the hearings officer determines that the notice is adequate, they will inform all parties and proceed with the hearing.

If the hearings officer requires additional time or escalation of the notice to determine if it is sufficient or not, the hearings officer can recess the hearing and escalate the notice to their management. Once a response has been received regarding the adequacy of the notice, the hearings officer will reconvene the hearing and provide a response.

Nursing Facility Discharge

Notices are of particular importance in nursing facility discharge hearings. Regardless of the issue listed as the basis for appeal, the hearings officer must also address adequacy of the notice to show that it complies with policy. In these hearings, if the notice issue is not raised by the appellant, the hearings officer must develop the record to include information to determine the legal adequacy of the notice.

1340 Receipt of Agency Notices

Revision 23-1; Effective July 31, 2023

An appellant may testify at the hearing that an agency notice, such as an appointment notice or a request for additional information, was not received.

The hearings officer should address this issue by asking questions and taking testimony from both the appellant or the appellant’s representative and the agency representative.

If a letter is sent and not returned, the sender may presume the letter was received.

The decision should include findings of fact regarding the determinations used in reaching the decision on whether the agency notice letter was received.

Revision 23-1; Effective July 31, 2023

1410 Right to a Fair Hearing - 1 TAC Sections 357.3, 357.7, and 357.19(b)(3)

Revision 23-1; Effective July 31, 2023

What Can be Appealed

Clients of Medicaid-funded services, TANF, SNAP and other agency programs in which state or federal law or rules provide a right to a fair hearing, are entitled to appeal the following actions:

• an action to reduce, suspend, terminate or deny benefits or eligibility;
• a failure to act with reasonable promptness on a client's claim for benefits or services;
• a decision to transfer or discharge a resident from a skilled nursing facility or nursing facility;
• an adverse determination made regarding Preadmission Screening and Resident Review;
• the denial of a prior authorization request;
• the failure to receive a service authorization request; 
• the failure to reach a service authorization decision within the period specified by federal law; and 
• an action taken to recoup benefits previously paid to a recipient.

A client may appeal more than one action at the same time, in writing or orally, unless specified in program rules or notices.

Exceptions:

• A SNAP household can contest the SNAP benefit amount by requesting a fair hearing when it is aggrieved by a mass change in benefits.
• A client may appeal the application to him of an across-the-board reduction in benefits or services on the grounds that the mass change does not apply to him.
• Under all programs, the agency is not required to grant a hearing if the sole issue is a federal or state law requiring an automatic mass change adversely affecting some or all clients. This may be determined at a pre-hearing conference.

What Cannot be Appealed

The hearings officer does not have jurisdiction when the repayment of an overpayment is court-ordered. The hearings officer will schedule a pre-hearing conference to review documents supporting a claim that the repayment is court-ordered.

Issues related to non-payment of a claim to a provider are not appealable.

Note: HHS agency staff may not prevent a client from filing an appeal because staff believe that the item, service or benefit is not subject to appeal. The hearings officer determines if an issue is appealable.

1420 Period for Requesting a Fair Hearing - 1 TAC Sections 357.3 and 357.7

Revision 23-1; Effective July 31, 2023

The appellant has a right to file an appeal within 90 calendar days from the effective date of the action or from the notice of adverse action date, whichever is later. 

Exceptions: 

• Pursuant to 7 CFR Section 273.15(g), a client may appeal their current level of SNAP benefits at any time during a certification period. A SNAP client may also appeal the denial of a request to restore benefits that were lost within one year prior to the request.
• According to program rules at 1 TAC Section 386.408, a participant in the Disaster Assistance program has 60 days from the date on the reconsideration decision letter to request a fair hearing.
• On overpayment claims, a client must file an appeal within 90 days of the date the overpayment claim was sent.
• For MCO-related appeals, appellants have 120 days from the date of the MCO’s final determination, to request a fair hearing.

Note: HHS agency staff may not prevent a client from filing an appeal because staff believe that the appeal was not requested within the required number of calendar days. The hearings officer is the final authority regarding the timeliness of filed appeals and may accept appeals filed after the time limit to determine whether there was good cause for the delay in filing.

If a request for a hearing is not received within the required time frame, and the hearings officer determines good cause was not established for the failure to file timely, the individual has forfeited the right to a fair hearing and the agency action becomes final.

1430 Determining Good Cause for Appealing Past 90-Day Time Frame

Revision 23-1; Effective July 31, 2023

If an appellant appeals after the 90-day time frame, the hearings officer must determine if the appellant had good cause for failing to appeal timely.

The hearings officer may schedule a pre-hearing conference or schedule a regular hearing and determine good cause at the beginning of the hearing.

Exception: If the hearings officer receives a request for an over payment claim hearing past the 90-day time frame, a pre-hearing conference will be scheduled to determine good cause for the appellant's failure to request the fair hearing in a timely manner.

1440 Creating and Submitting a Fair Hearing Request - 1 TAC Section 357.7

Revision 23-1; Effective July 31, 2023

The agency must accept a request for a fair hearing for one or more actions and create an appeal in the TIERS Hearings and Appeals module. The request must be created and submitted in TIERS within five calendar days from the date the fair hearing was requested. This includes requests made after the 90-day time frame. 

Example: If the client requests a fair hearing on Tuesday, the 5th calendar day is Sunday. Agency staff need to submit the request no later than close of business on Friday.

1450 Continued Benefits - 1 TAC Section 357.11

Revision 23-1; Effective July 31, 2023

After an HHSC agency or designee takes an action that affects a client’s benefits or services, the client is entitled to receive, under certain circumstances, continued benefits or services until a hearing decision is issued. Whether a client is entitled to continued assistance is based on requirements set forth in appropriate state or federal law or regulation of the affected program. 

Revision 23-1; Effective July 31, 2023

1510 Notice of Fair Hearing - 1 TAC Section 357.15(a)

Revision 23-1; Effective July 31, 2023

Form H4803, Notice of Hearing, serves as notification to all participants of the hearing and meets all requirements of state and federal law. Hearings staff send Form H4803 to the appellant to acknowledge that a request for a fair hearing has been received and to provide a time, date and place for the hearing. Form H4803 is sent to all parties listed on Form H4800, Fair Hearing Request Summary, at least 14 calendar days in advance of the date the hearing is to be held unless all parties agree to waive the 14-day notice requirement.

1520 Expedited Hearings

Revision 23-1; Effective July 31, 2023

HHSC conducts expedited hearings for situations involving transients or individuals whose health would be jeopardized by waiting.

1521 Expedited Hearings for Transient Appeals - 1 TAC Section 357.17(b)(1)

Revision 23-1; Effective July 31, 2023

Transient appeals are either SNAP or TANF appeals that are submitted by an appellant who plans to move from the jurisdiction of the hearings officer before the hearing decision normally would 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:

• the appellant agrees to the reduced notice of the time, date and place of the hearing; and
• the hearings officer has sufficient information available to decide without requesting additional information.

1522 Expedited Hearings for Individuals Whose Health is Jeopardized - 1 TAC Section 357.17(b)(2)

Revision 23-1; Effective July 31, 2023

An appellant, appellant's authorized representative or appellant's provider may request an expedited fair hearing if the appellant's health is in jeopardy. An expedited hearing may be granted for an appellant when it is determined that taking the time for a standard hearing could seriously jeopardize the appellant's life, physical or mental health, or ability to attain, maintain or regain maximum function.

Note: The managed care organization must notify the hearings administrator if they are submitting an appeal which they have determined to be expedited. The managed care organization may submit documentation to demonstrate an urgent need on behalf of a managed care appellant.

If the need for an expedited hearing is demonstrated, an expedited hearing must be held, and a decision made within:

• five working days from the date the hearings officer receives the hearing request for Medicaid cases; or
• three working days from the date the hearings officer receives the agency's evidence for managed care cases if:
  • the appellant agrees to a reduction of the usual advance notice requirement; and
  • the hearings officer has sufficient information available from the appellant to decide without requesting additional information.

If either condition is not met, the hearing will transition into a standard fair hearing time frame.

If the hearings officer schedules the hearing as an expedited hearing, but during the development of the hearing record determines that additional evidence is needed to make the decision, the hearings officer should:

• explain on the record the additional evidence that is needed;
• determine if the needed evidence can be read into the record during the hearing to permit immediate consideration;
• determine from the appellant the time that will be required to obtain the additional evidence if it is not immediately available;
• schedule a time for the additional evidence to be submitted and a date for the hearing to be reconvened;
• explain and obtain agreement that the hearing decision can no longer be issued in an expedited manner;
• determine a date that a decision can be expected to be rendered. The hearings officer must keep in mind the seriousness of the issue for the well-being of the appellant.

1530 Hearing Setting - 1 TAC Section 357.17(a)

Revision 23-1; Effective July 31, 2023

Fair hearings are conducted by conference call. All parties call into a toll-free number at a designated date and time provided on the Form H4803, Notice of Hearing.

An appellant may request a face-to-face hearing if there is good cause. The hearings officer determines if good cause exists.

1540 Attendance at Hearing - 1 TAC Sections 357.5 and 357.25(c)(3)

Revision 23-1; Effective July 31, 2023

The agency representative must appear at the scheduled hearing and be prepared to explain and defend the decision or action taken against the appellant. Failure to appear will result in a reversal of the agency decision.

The appellant or their authorized representative must appear at the scheduled hearing. Failure to appear without good cause will result in dismissal of the appeal.

For additional information on who should attend the hearing to represent the agency and who may appear as witnesses or other participants, see Appendix IX.

The hearings officer does not have the power to subpoena witnesses.

The fair hearing is not open to the public, but friends and relatives of the appellant may attend if the appellant chooses. All people attending the hearing must have an interest in the rights of the appellant, and opportunity to provide information pertinent to the issues under consideration, if called by the appellant or agency representative, unless the hearings officer determines the testimony would be unduly repetitious. 
For an in-person (face-to-face) hearing, all parties must appear unless other arrangements are made with the hearings officer.

The hearings officer has the authority to limit the number of people attending the fair hearing if space or equipment issues make conducting an orderly hearing difficult.

The appellant may record the hearing or request a copy of the recording from the hearings officer, at no cost. The hearings officer controls the use by others of cameras, videos or other recording devices.

1550 Group Hearings - 1 TAC Section 357.17(c)

Revision 23-1; Effective July 31, 2023

The HHSC Appeals Division must grant a group hearing if recipients request a group hearing and the sole issue involved in the cases is one of federal or state law or policy. In all cases except SNAP cases, the request for a group hearing must be in writing, signed by each appellant and state the common issues. Requests for group hearings in SNAP appeals may be either oral or written. An appellant may withdraw from a group hearing at any time before a final decision is issued. If an appellant wishes to withdraw, he must make the request in writing and sign it. Group hearings follow the same procedures as individual hearings.

1560 Continuances or Postponements - 1 TAC Section 357.19(a)

Revision 23-1; Effective July 31, 2023

The hearings officer considers a request to postpone a hearing only if the appellant, their representative, the agency or the agency's representative contacts the appropriate hearings officer before the scheduled hearing is to occur. In SNAP cases, the appellant is entitled to receive one postponement of up to 30 calendar days. In all other hearings, the hearings officer may postpone a fair hearing if the hearings officer determines that good cause exists. 

Except for one continuance for a SNAP appellant, a party is not entitled to a continuance. A continuance is granted at the discretion of the hearings officer for good cause. Good cause must be substantive and not for convenience. Good cause exists when there is a circumstance or excuse that is beyond the reasonable control of the parties. The hearings officer may consider whether the appellant is receiving continued benefits in deciding whether to grant a continuance. 

A request for continuance or postponement by the agency must be made within five calendar days of the date of the notice or alert. 

A rescheduled appointment notice, Form H4803, Notice of Hearing, acknowledges a hearings officer's agreement to postpone and is sent to the appellant and agency.

A postponement may occur only if the hearing has not taken place and a decision has not been issued. A postponement may not be applied to an appeal that is closed.

Notes: 

• The terms continuance and postponement are used interchangeably.
• More than two continuances must be reviewed and granted by the hearings manager.

Revision 23-1; Effective July 31, 2023

1610 Pre-hearing Conference – General

Revision 23-1; Effective July 31, 2023

The hearings officer may schedule a pre-hearing conference if it is necessary to resolve issues of procedure, jurisdiction or representation, or if it will expedite and simplify the hearing. 

A pre-hearing conference is required on overpayment claims appeals filed after 90 days to determine jurisdictional issues or if there was good cause for requesting the hearing past the filing time frame. The hearings officer will schedule a pre-hearing conference to review documents supporting the claim that the repayment is court-ordered. 

The hearings officer does not have jurisdiction when the repayment of an overpayment is court-ordered.

It is not necessary to conduct a pre-hearing conference to determine good cause. However, if a pre-hearing conference is held to determine good cause, it must be recorded and all participants who will testify must be placed under oath. Attorneys acting in a non-legal capacity should be placed under oath when testifying. Attorneys acting in a legal capacity are not sworn in.

1620 Special Hearing Situations

Revision 23-1; Effective July 31, 2023

1621 Hearings for Programs with Program Cost Limits

Revision 23-1; Effective July 31, 2023

The Centers for Medicare and Medicaid (CMS) is the federal agency with oversight over Texas Medicaid nursing facilities, intermediate care facilities for individuals with intellectual disabilities (ICF/IID), and the waivers associated with them. The following programs may have cost limits:  STAR+PLUS Waiver, Medically Dependent Children Program (MDCP), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), Texas Home Living (TxHmL).

If the issue on appeal is a request for an increase in services or benefits, it is prudent for the hearings officer to ask the agency representative how the increase would impact the cost limit. If it is unclear how the decision might impact the individual cost limit, the hearings officer should recess the hearing and instruct the agency to provide the necessary information. 

A hearings officer does not have the authority to hear appeals related to General Revenue.

1621.1 Exceptional Circumstances

Revision 23-1; Effective July 31, 2023

If a prior authorization request for an item of medical equipment is denied because the item is not a normally covered benefit of Texas Medicaid, the exceptional circumstances policy allows a beneficiary to request that their DME supplier re-submit the request and invoke the exceptional circumstances exception.

If exceptional circumstances exist and were not explored by the agency prior to the hearing, the hearings officer must recess the hearing to allow the agency at least 10 days to conduct a review based on exceptional circumstances. The agency’s findings must be shared with the hearings officer and the appellant. Upon reconvening the hearing, the agency should present its findings and the appellant must have an opportunity to ask questions and respond to the agency’s findings.

1622 Hearings Concerning Overpayments

Revision 23-1; Effective July 31, 2023

A SNAP or TANF client may receive an overpayment as the result of client error, agency error, or an intentional program violation. If an appellant is notified of an overpayment, they may appeal either the existence of or the amount of the overpayment.

Once a claim has been established clients may receive collection notices or have an income source, such as an IRS tax refund, garnished. These collection efforts are not subject to appeal. The appellant may contact the IRS directly regarding a garnished tax refund. The appellant must appeal the notification of an overpayment claim rather than a collection effort. However, an appellant may allege that they did not become aware of the overpayment claim until a collection effort occurred. The hearings officer should consider this when determining if the appellant had good cause for appealing more than 90 days after the notification of the overpayment claim. A pre-hearing conference is required on overpayment claims appeals filed after 90 days to determine jurisdictional issues.

If a claim is the result of an intentional program violation, an administrative disqualification hearing must be held either before or at the same time as the overpayment hearing as described in Section 4246, Consolidation of Administrative Disqualification Hearings and Fair Hearings. The administrative disqualification decision must be rendered before an overpayment decision can be rendered.

Compromising a claim means that the agency waives part or all of an overpayment claim because of the client's inability to repay the claim. Although HHSC has discretionary authority to compromise and settle SNAP over issuance claims, a hearings officer has no authority to determine whether HHSC should compromise a claim or the amount for which a claim should be settled. A client does not have a right to appeal an HHSC decision whether to compromise an over issuance or the settlement amount.

1630 Discovery, Evidence and Exhibits

Revision 23-1; Effective July 31, 2023

1631 Discovery - 1 TAC Section 357.13(b)(7)

Revision 23-1; Effective July 31, 2023

All parties in the hearing have the right to examine the documents, before the hearing, that will be considered at the hearing and used to make a decision.

Before the hearing, the agency representative sends copies of all documents to be used in the hearing to the hearings officer and the appellant. The packet includes, but is not limited to:

• the agency action notice that prompted the appeal;
• application form and worksheets relevant to the appealed action;
• verifications used to make the decision that is being appealed;
• forms, notices and other correspondence sent to and received from the client concerning the appealed action;
• assistance authorization documents;
• all other materials relating to the appealed action; and
• appropriate policy on which the agency is relying.

If the appellant or the appellant’s representative submits documents to be considered at the hearing, the hearings officer will share them with the agency representative before the hearing. The hearings officer ensures that all evidence admitted onto the record has been uploaded to TIERS.

1632 Written Interrogatories - 1 TAC Section 357.13(c)

Revision 23-1; Effective July 31, 2023

An appellant or an appellant's representative or legal counsel may send written interrogatories. 

The written interrogatories must:

• be clear and concise;
• contain no more than 30 questions; and
• be submitted no less than 20 business days before the hearing.

If a party offers the interrogatories at the hearing, they may be admitted as evidence. The hearings officer will determine if they are relevant to the issue on appeal and will be given the appropriate evidentiary weight during the decision writing process.

The hearings officer does not have a role in the interrogatory process except in the hearing itself.

The hearings officer does not have the authority to compel either party to respond to interrogatories.

1633 Evidence - 1 TAC Section 357.5

Revision 23-1; Effective July 31, 2023

The hearings officer is not required to follow the Texas Rules of Evidence or the Texas Rules of Civil Procedure.

Evidence includes any relevant documents or testimony provided by the appellant, the appellant's representative, the appellant’s witness, the agency representative or the agency witness.

Hearsay evidence may be considered by the hearings officer and given the appropriate weight. Hearsay evidence is a statement made by a third party and repeated by one of the hearing participants during the hearing.

Note: When both the appellant and the agency have an attorney, the attorneys are required to share their evidence with each other, the agency representative and the hearings officer as soon as possible. It is highly recommended that evidence be shared at least 20 days before the hearing appointment date. Rebuttals or responses to such submittals may be submitted up until the 10th day before the hearing appointment date. Failure to share evidence may be grounds for a postponement at the request of the side not notified.

The hearings officer ensures the appellant has an opportunity to review any evidence to be used in the hearing before the hearing. In the case of an appeal involving a secondary agency, such as the Texas Workforce Commission, the secondary agency representative sends the hearings officer and appellant a copy of the secondary agency’s case evidence.

It is not appropriate to allow a party or witness to talk about a document that has not been offered into the evidence.

If the appellant has not received the evidence, the appellant should be given the option of proceeding with the hearing without the evidence or rescheduling the hearing in order to receive the evidence.

If no evidence is offered into the record at the hearing or provided to either the hearings officer or the appellant before the hearing, the hearings officer should inform the appellant of their rights when the agency fails to provide the exhibits or documents in advance.

All exhibits admitted by the hearings officer are part of the record, and the hearings officer must ensure that each exhibit is properly labeled and clearly addressed on the record. An exhibit is not admitted into evidence until the hearings officer states as such.

1633.1 Exhibits Admitted

Revision 23-1; Effective July 31, 2023

For an exhibit to be admitted into evidence by the hearings officer, several activities must occur. First, the party must offer the exhibit into evidence. This may be accomplished by the party clearly stating they would like to offer the document as an exhibit. It also may be accomplished by the hearings officer asking the party if they want a particular document to be considered by the hearings officer.

After an exhibit is offered, the hearings officer must decide either to admit the exhibit or not. The hearings officer asks if there are any objections to the exhibit being admitted. If there are no objections the hearings officer admits the exhibit.

The agency representative may offer the full evidence packet as an exhibit. It is permissible for a hearings officer to admit the full packet as one exhibit. If multiple documents are submitted as one exhibit, the pages should be numbered to allow the documents to be identified as they are discussed.

1633.2 Handling Objections

Revision 23-1; Effective July 31, 2023

The formal rules of evidence do not apply to HHSC fair hearings. Most exhibits offered will be admitted, even when objections are raised.

When a document is offered as an exhibit and there is an objection to its admission, the hearings officer should clarify the basis for the objection to the document.

The hearings officer may state, "I've noted your objection. I'll give the appropriate weight to this document when it is time to consider it, but I'll go ahead and admit it."

If a hearings officer sustains the objection and refuses to admit a document for any reason, they should state the reason they are not admitting the document into evidence.

1633.3 Exhibits Not Admitted

Revision 23-1; Effective July 31, 2023

If a party offers an exhibit that the hearings officer determines will not be admitted because it is not relevant to an issue on appeal, the hearings officer states this on the record. 

If a party submits an exhibit but does not offer it, it should be labeled in the decision as “Omitted” or “Not Admitted.”

1633.4 Labeling Exhibits

Revision 23-1; Effective July 31, 2023

There is no right or wrong way to label exhibits. The hearings officer must ensure that all exhibits are clearly labeled if they are admitted on the record.

1634 Requesting Additional Documents

Revision 23-1; Effective July 31, 2023

The hearings officer is responsible for appropriately developing the hearing record and may request additional documentation when further clarification is needed; however, the hearings officer does not have subpoena authority. The hearings officer is responsible for appropriately developing the hearing record and may request additional documentation when further clarification is needed.

If additional documents are requested the hearings officer may leave the record open. Documents are shared with all parties. Each party must be given an appropriate opportunity to review a document and evidence must be admitted and discussed on the record.

Revision 23-1; Effective July 31, 2023

1710 Starting the Hearing

Revision 23-1; Effective July 31, 2023

All hearings are recorded.

All parties, representatives and witnesses may participate by phone, in-person or a combination of the two.

At the scheduled time for the hearing, the hearings officer calls into the conference line and starts the recording. If all parties are participating face to face with the hearings officer, the conference call line should still be used to record the hearing. 

If the hearings officer is unable to use the conference call feature to record the hearing, then the hearing is recorded either by a tape recorder or a digital recording system.

The hearings officer:

• advises all parties that the hearing is being recorded.
• makes introductory remarks on the recording including the hearings officer's name, the date and time, the appeal ID, and the appellant's name. 
• determines and confirms the names, addresses, and positions of all parties. (The hearings officer waits 7 minutes to allow time for all participants to appear.)
• obtains an interpreter, if needed.
• places all participants, including interpreters, under oath. (Attorneys acting in a non-legal capacity should be placed under oath when testifying. Attorneys acting in a legal capacity are not sworn in.)
• announces the program involved, the date of agency action, the agency action taken and confirms the issue on appeal with all parties. 
• explains the hearing procedures including how the hearing will proceed, interpreter procedures, if necessary, when a decision will be rendered, and what the appellant may do if not satisfied with the decision, and the time frames for action.
• ensures that all evidence packets submitted by either party have been shared with the hearings officer and the other party or that the appellant has waived their right to have them and is willing to proceed with the hearing. The hearings officer must address this on the record.

1720 Invoking the Rule

Revision 23-1; Effective July 31, 2023

If a party requests a hearings officer to "invoke the rule" they are requesting that the hearings officer order witnesses excluded so that they cannot hear the testimony of other witnesses. The hearings officer may invoke the rule in response to the request or make the order without a request if it is necessary to limit the number of people in the room or on the phone. This rule does not authorize exclusion of the appellant, the appellant's representative, or the agency representative. When the rule is invoked, witnesses are asked to leave the room until it is their turn to testify. In a teleconference hearing, the hearings officer should arrange to call the witnesses when it is their turn to testify prior to disconnecting them.

1730 Controlling the Hearing - 1 TAC Section 357.5

Revision 23-1; Effective July 31, 2023

Hearings officers are responsible for regulating the conduct and course of the hearing to ensure due process and an orderly hearing. This includes:

• setting the tone of the hearing through the use of calm authority;
• emphasizing the requirement that only one person speak at a time; 
• explaining that each party will have an opportunity to present their side; and
• facilitating efficient presentation of evidence while limiting repetitive testimony.

When a participant behaves inappropriately and disrupts the hearing, the hearings officer may take appropriate action to correct this behavior, including but not limited to:

• issuing warnings that explain expected behavior and the consequences of noncompliance;
• offering a recess to allow time for participants to gain self-control;
• rescheduling the hearing for a future date; or
• muting the participant.

Muting a participant must only be used to control the hearing as a last resort. If used inappropriately, the parties' rights to a fair and impartial hearing could be compromised. Before muting a party:

• the hearings officer should warn the disruptive party that if they do not remain calm, their phone will be muted.
• the hearings officer should consider permitting the disruptive party an opportunity to present their testimony and evidence outside the normal order in the hearing. 
• if the party continues the disruptive behavior, the hearings officer must advise them that their phone will be muted, but that they must stay on the line as they will still be able to listen to the hearing. The hearings officer must further advise the participant that they can present their testimony when the mute function is turned off.
• the hearings officer should also explain that if the disruptive party hangs up while their phone is on mute, the hearings officer may rule that they abandoned the hearing.
• the hearings officer should also advise the party that if they disconnect, they must call back into the hearing immediately. Failure to do so may result in the hearings officer ruling that they abandoned the hearing.

1731 When a Party Disconnects from the Hearing

Revision 23-1; Effective July 31, 2023

1731.1 If All Parties Disconnect from the Hearing

Revision 23-1; Effective July 31, 2023

If all or multiple participants drop off the line, the hearing should be rescheduled to a later date unless all participants have had an opportunity to provide testimony, all questions have been answered, and there is enough information on the record to issue a decision on the case.

Known Issues

If an individual disconnects from the hearing when there are known issues with the teleconferencing system or weather-related issues in the individual’s particular area, the hearing should be rescheduled to a later date unless all participants have had an opportunity to provide testimony, all questions have been answered, and there is enough information on the record to issue a decision on the case.

1731.2 If Only the Appellant Disconnects from the Hearing

Revision 23-1; Effective July 31, 2023

If only the appellant disconnects from the hearing, there are two options:

Option 1:  The hearings officer may state on the record that they will allow five minutes for the appellant to call back in. If, after five minutes, the appellant has not called back, the hearings officer should state, “The appellant seems to have abandoned the hearing. I have allowed the appellant an opportunity to call back into the hearing. I will send a letter to the appellant advising them to contact my office within 10 days. If the appellant provides a good cause reason for disconnecting from the hearing, I will reschedule it. If they do not respond, the hearing will be dismissed." The hearings officer should then send an abandonment letter to the appellant advising them to call within 10 days if they wish to reconvene the hearing and that the appeal will be dismissed if they do not respond.

Option 2:  If the appellant does not call back and there is enough information to issue a decision either sustaining or reversing the agency’s action, the hearings officer should state that on the record.

1731.3 If Only the Agency Representative Disconnects from the Hearing

Revision 23-1; Effective July 31, 2023

If only the agency representative disconnects from the hearing the hearings officer should state on the record that they will allow five minutes for the agency representative to call back in. If, after five minutes, the agency representative has not called back in or contacted the Fair Hearings Office and there is not enough information on the record to issue a decision sustaining the agency’s action, the hearings officer should explain that they will be issuing a decision reversing the agency’s action. It is very important that the hearings officer clearly explain to the appellant that if the agency representative contacts the Fair Hearings Office and shows good cause for not calling back into the hearing, the record will be reopened, and a new hearing scheduled.

1731.4 If Only a Witness Disconnects from the Hearing

Revision 23-1; Effective July 31, 2023

If only a witness disconnects from the hearing the hearings officer should state on the record that they will allow five minutes for the witness to call back in. If, after five minutes, the witness has not called back in, the hearings officer should explain that they are going to move forward but will allow the witness to participate if they call back in.

1740 When the Agency Representative Does Not Appear for the Hearing

Revision 23-1; Effective July 31, 2023

If the agency representative does not appear for the hearing and does not submit written documentation, the hearings officer opens the record and states that the agency representative did not appear. The hearings officer states that the appellant is present and available either by phone or in person. The hearings officer will take no testimony. The hearings officer closes the record and issues a decision reversing the agency action. The hearing decision will instruct the agency to take the appropriate steps to implement the decision.

If the agency representative does not appear for the hearing but submits written documentation, the hearings officer opens the record and makes a statement to that effect. The hearings officer further states that, while the agency representative submitted documents, the absence of the agency representative prevents the documents from being authenticated or explained and prevents the appellant from cross-examining the agency concerning the documents. For these reasons, the documents will not be entered into evidence. The hearings officer will take no testimony. The hearings officer will close the hearing and issue a written decision reversing the agency action. The hearings officer will instruct the agency to take the appropriate action to implement the decision.

1750 When the Appellant Does Not Appear for the Hearing

Revision 23-1; Effective July 31, 2023

1751 Hearings Held Via Conference Call

Revision 23-1; Effective July 31, 2023

If the hearing is conducted via conference call, the hearings officer waits seven minutes from the time listed on the appointment notice to allow parties to call in to the conference call. If the appellant fails to call in at the scheduled time, the hearings officer opens the record and states that the agency representative called in, but the appellant failed to call in. The hearings officer takes no testimony but verifies the appointment notice was sent to the appellant’s current address on file with the agency. The hearings officer notes the time given on the notice and the time the record is closed. The hearings officer closes the record and issues a written decision dismissing the appeal.

1752 Face-to-Face Hearings

Revision 23-1; Effective July 31, 2023

If the appellant fails to appear at the hearing, the hearings officer waits seven minutes from the time listed on the appointment notice for all parties to appear. If the appellant fails to appear, the hearings officer opens the record and states that the agency representative appeared, but the appellant did not appear. The hearings officer takes no testimony but verifies the appointment notice was sent to the appellant’s current address on file with the agency. The hearings officer notes the time given on the notice and the time the record is closed. The hearings officer closes the record and issues a written decision dismissing the appeal. 

1760 Short Hearings

Revision 23-1; Effective July 31, 2023

If the agency representative admits early in the hearing that they are unable to defend the agency action or admits that the agency action was taken in error, the hearings officer:

• ensures that all parties are under oath;
• determines whether the appellant understands the action under appeal;
• determines whether the action the agency has taken or plans to take; and
• explains that the hearing will not continue.

If all these conditions are met, the hearings officer reverses the agency action. The hearings officer then issues the decision using the shortened decision format.

1770 Recessed Hearings - 1 TAC Section 357.19(d)

Revision 23-1; Effective July 31, 2023

Once a hearing begins, the hearings officer may recess the hearing 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.

Example: The appellant asks the hearings officer if they may leave the hearing open so they can obtain additional information to support their case. The hearings officer agrees to leave the record open and sets a deadline for the appellant to submit the additional information. The hearings officer may also recess to request a legal or policy clarification. Once that information is received, the hearings officer ensures that all parties receive the additional documents or the legal or policy clarification. Then the hearings officer schedules a date to reconvene the hearing. The reconvened hearing will focus on the additional documentation provided by the appellant or the legal or policy clarification.

If no additional information is received from the appellant by the due date, the hearings officer issues a decision based on evidence provided at the hearing.

1771 When a Party Does Not Appear at a Reconvened Hearing

Revision 23-1; Effective July 31, 2023

If a hearing is held and recessed to obtain additional information, the hearings officer must reconvene the hearing to discuss the new information or clarification with all parties. If the party that provided the additional information is not present for the reconvened hearing, the reconvened hearing does not proceed, and the hearings officer will write the decision based on the record previously developed. The hearings officer must make sure all parties understand that additional information will not be admitted to the record if the party does not appear for the hearing.

If the party that provided the additional information does appear for the reconvened hearing, the hearings officer should proceed with the hearing to have the new information offered, admitted and discussed. It is not ex parte communication if all parties were notified of the scheduled reconvened hearing and the information was shared with all parties. The hearings officer must make this clear on the record. Documents can be admitted into the record and testimony can be given when only the party that provided the additional information is present at a reconvened hearing.

Revision 23-1; Effective July 31, 2023

1810 Before Writing the Decision

Revision 23-1; Effective July 31, 2023

After the hearing, the hearings officer:

• determines if the agency's or its designee's actions were in compliance with statutes, policies or procedures;
• carefully weighs the evidence presented in accordance with the appropriate standard or proof;
• renders a decision based on the evidence presented at the hearing. 

1820 Decision Issuance Time Frames - 1 TAC Section 357.23

Revision 23-1; Effective July 31, 2023

Decision Issuance Time Frames 1 TAC Section 357.23

According to federal regulations, all hearing decisions on SNAP appeals must be issued within 60 days from the date of appeal. Hearing decisions on all other appeals must be issued within 90 days.

Exceptions:

The hearings officer must issue reversal decisions on non-SNAP appeals within 80 days. This will allow 10 calendar days for the agency representative to act on the reversal.

The issuance of some decisions may be delayed beyond these periods. For example, the appellant may make one or more requests to reschedule the hearing appointment. (See Section 1830, Delays in Issuing a Decision - 1 TAC Section 357.23(a)(3), for appropriate processing and delay procedures.)

1830 Delays in Issuing a Decision - 1 TAC Section 357.23(a)(3)

Revision 23-1; Effective July 31, 2023

Delay is a term the HHSC Appeals Division uses to allow for time extensions in individual cases when the hearings officer grants one or more continuances.

A delay cannot exceed 30 calendar days. The length of a delay is the number of days from event to event or 30 days, whichever is less. The start date of a delay is the date of the first event. The end date is the date of the new event or 30 days from the first event, whichever is less.

Delaying decisions in TANF and SNAP cases is permissible due to specific circumstances:

• Delay Beyond Agency Control - Circumstances which are beyond agency control include fire, flood and natural disasters. When using this reason, the hearings officer should document the reason for the delay in TIERS.
• Record Held Open for Additional Evidence - The record may be held open when the appellant, appellant's representative, agency or agency's representative asks that the record remain open for a specific period of time after the hearing. The hearings officer may hold the record open to allow for additional documentation needed to make a decision.
• Request by Agency - The agency or agency's attorney may ask for one or more continuances or reschedules. The hearings officer must decide if there is good cause for the request.
• Rescheduled at Client's Request - The appellant or appellant's representative may ask for one or more continuances or reschedules. The hearings officer must decide if there is good cause when more than one continuance is requested.
• Delay due to EMR – this delay may be entered when the hearing is rescheduled due to the External Medical Review (EMR) decision not being completed.

1840 Components of a Hearing Decision

Revision 23-1; Effective July 31, 2023

The hearings officer prepares a written decision which includes:

• order;
• introduction;
• purpose of the fair hearing;
• legal authority;
• procedural history;
• relevant authorities;
• summary of evidence;
• findings of fact; 
• conclusions of law; and
• exhibits.

Exception:

Short reversal decisions do not include appearances, purpose, relevant authorities, summary of evidence or exhibits.

1850 Writing the Decision

Revision 23-1; Effective July 31, 2023

A hearings officer writes a decision based on testimonial and documentary evidence presented at the hearing by the agency representative, the agency witnesses, the appellant and the appellant’s representative and witnesses. The decision should be clear and concise and explain the action taken, the relevant policy, and the hearings officer's determination as to whether the agency followed the applicable policy. 

The decision by the hearings officer must be written in English. HHSC provides a translated coversheet in Spanish for hearing decisions when a Spanish interpreter was used and when the hearing was conducted in Spanish. The cover sheet includes a short, translated statement that describes the outcome of the hearing and instructs the appellant to call the hearings office if he needs assistance to understand the decision. An appellant who indicates by phone, in person or in writing that assistance is needed to understand the decision should receive an explanation of the hearing decision from bilingual personnel within a reasonable period.

1860 Decision Formats for Certain Decisions

Revision 23-1; Effective July 31, 2023

A decision is issued for every appeal received by the hearings division. 

1861 Decisions to Dismiss -1 TAC Section 357.19(b)

Revision 23-1; Effective July 31, 2023

All dismissal formats include sections on Legal Authority and the Final Order. Dismissals can occur in the following formats:

Dismissed - 90 Day No Jurisdiction:  This is used when the hearings officer has determined that an appellant did not have good cause for filing an appeal outside of the 90-day time frame. 

Dismissed - Failure to Appear:  This is used when the appellant or the appellant's representative fail to appear at the scheduled hearing.

Dismissed - Generic:  For dismissals other than the two options above, the hearings officer should use this reason in TIERS and no decision will be generated by the system. The hearings officer must write a decision and mail or e-mail it to all participants. Examples of when to use this option include:

• when the hearings officer has determined that there is no jurisdiction for reasons other than filing outside the 90 days; 
• an appeal was added in error by the agency; or
• a decision was previously issued and incorrectly reopened.

1862 Decisions to Withdraw - 1 TAC Section 357.19(c)

Revision 23-1; Effective July 31, 2023

All withdrawal formats include sections on Legal Authority and the Final Order. Withdrawals can occur in the following formats:

Withdrawn - Favorable Action:  this is used when the agency resolved the issue on appeal in the appellant's favor. It should not be used unless the hearings officer has received proof or testimony from the agency that they resolved the issue on appeal.

Withdrawn - Sustained:  this is used when the appellant decides to withdraw the appeal without any additional action by agency staff.

1862.1 Withdrawn Appeals

Revision 23-1; Effective July 31, 2023

Once an appeal is filed, only the appellant or their representative may withdraw the appeal.

1862.2 Withdrawal Received Prior to the Hearing

Revision 23-1; Effective July 31, 2023

If an appellant withdraws the appeal prior to the hearing, a written withdrawal must be sent to the hearings officer or the local office via mail, fax or e-mail. Verbal withdrawals are recorded and accepted prior to the hearing.

Upon receipt of a written or verbal withdrawal, the hearings officer should issue a decision to show that the appeal was withdrawn. If this is done within five days of the scheduled hearing, the hearings officer should notify hearing participants the hearing has been canceled.

1862.3 Oral Withdrawal Received During the Hearing

Revision 23-1; Effective July 31, 2023

If an appellant or their representative withdraws the appeal during the hearing, the hearings officer should ensure the withdrawal is noted on the record and issue a decision to show the appeal was withdrawn.

1862.4 If an Appellant Dies During the Appeal Process

Revision 23-1; Effective July 31, 2023

If an appellant dies during the appeal process, and the legal representative of the decedent's estate does not pursue the appeal, the hearings officer may dismiss the appeal.

1863 Decisions to Reverse 1 TAC Section 357.23(c)

Revision 23-1; Effective July 31, 2023

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 in accordance with applicable statutes, policies or procedures;
• the agency representative or designee fails to appear for the scheduled hearing (see Section 1740, When the Agency Representative Does Not Appear for the Hearing); or 
• the agency or designee concedes or fails to defend the action or inaction (see Section 1863.1, Short Form for Reversed Decisions).

The agency may be instructed to issue retroactive payments or restored benefits in accordance with applicable rules, regulations and statutes.

If a hearings officer decides there is insufficient information to determine eligibility or benefit amount, they may instruct the agency to obtain additional information and make a redetermination in accordance with the hearings officer's order.

Whenever the agency is ordered to redetermine eligibility or benefit amount, the hearings officer should include in the order that the agency must notify the appellant of the results of the redetermination and that the appellant retains the right to appeal the results of the redetermination.

If changed circumstances were discussed during the hearing, the hearings officer must make a finding of fact explaining why the appellant’s changed circumstances were or were not considered. 

Reversals can occur in the following formats:

Reversed - Benefits Due:  this is used when the hearings officer orders the agency to provide or restore benefits to an appellant and the amount and type of benefits to be provided or restored is known to the hearings officer.

Reversed - Information Needed:  this is used when the hearings officer orders the agency to redetermine eligibility using information previously obtained or allow the appellant to provide additional information and then redetermine eligibility.

Reversed - No Benefits Due:  this is used when the hearings officer has determined that there was an error on a case, but the error did not result in lost benefits, or the benefits have already been restored.

1863.1 Short Format for Reversed Decisions

Revision 23-1; Effective July 31, 2023

A short reversal format may be used when the agency representative admits that the agency made a mistake in deciding to take the action being appealed. The format includes Order, Legal Authority, History, Findings of Fact and Conclusions of Law.

1864 Decisions to Sustain — 1 TAC Section 357.23(d) and (e)

Revision 23-1; Effective July 31, 2023

The hearings officer sustains a decision of the agency or designee if the action or inaction is supported by the evidence admitted at the hearing, and is in accordance with applicable statutes, policies or procedures.

If changed circumstances were discussed during the hearing, the hearings officer must make a finding of fact explaining why the appellant’s changed circumstances were or were not considered.

Sustained decisions can occur in the following formats:

Sustained – this is used for sustained and sustained with instructions decisions.

Sustained With Instructions – If the agency made a correct decision at the time of the agency action, but circumstances have changed between the action date and the hearing, the hearings officer may issue a Sustained with Instructions decision. If the hearings officer issues a Sustained with Instructions decision they must order the agency to report compliance to the hearings officer via TIERS Decision Implementation. 

1870 Signing the Hearing Decision

Revision 23-1; Effective July 31, 2023

All hearing decisions require the hearings officer's signature on the cover letter, order, and the last page of the decision. The hearings officer may sign the decision manually or electronically. Administrative assistants may sign on behalf of the hearings officer by signing the hearings officer's name followed by theirs.

1880 Decision Routing

Revision 23-1; Effective July 31, 2023

Decisions should always be sent to the appellant, the appellant's representative, the agency representative, the agency representative's supervisor and Texas Workforce Solutions, if appropriate. The hearings officer should send the decision to others listed as Other Participants on Form H4800, Fair Hearing Request, as appropriate. 

Staff are required to date, sign, e-mail to the agency, e-mail to the appellant, if requested, place in the agency mail for pick-up, and enter the decision in TIERS all on the same day. All decisions that are not generated in TIERS must be uploaded to the State Portal.

The hearings officer ensures the decision is sent to the appropriate parties to permit timely implementation. 

Appeals Division state office staff will forward reversed nursing facility discharge hearing decisions, including Form H4807, Action Taken on Hearing Decision, to appropriate nursing home regulatory staff in accordance with agency regulations.

Revision 23-1; Effective July 31, 2023

1910 Implementing the Hearing Decision - 1 TAC Section 357.7

Revision 23-1; Effective July 31, 2023

1911 Responsibility of the Agency Representative for Implementing Decisions

Revision 23-1; Effective July 31, 2023

When the hearings officer reverses the agency action on appeal, the agency representative is required to implement the order and enter implementation data, or delays, in the TIERS, Hearings and Appeals, Decision Implementation module.

The agency representative has 10 calendar days from the date the decision was issued to implement the hearing decision. If additional information is needed, the agency representative will contact the appellant and pend the implementation process. Once the additional information is received, the agency representative has three business days to complete the implementation.

The agency has 10 calendar days to report compliance to the hearings officer, via e-mail, on a Sustained with Instructions decision. Hearings officers must monitor compliance with these orders.

1912 Delays in Implementing a Hearings Decision

Revision 23-1; Effective July 31, 2023

The following delay reasons are applicable in specific circumstances and can only be used by program staff after a hearing decision has been issued and the worker is delayed in responding to the directives of the hearings officer.

Beyond Agency Control:  Circumstances beyond HHSC control, such as fire, flood or other acts of nature. 

Pending Information Needed:  Additional information or verification was needed from the appellant, and the appellant agreed to cooperate.

Client Refuses to Cooperate:  The appellant refused to cooperate in providing additional information or verification.

Agency staff enter delays in the TIERS Hearings and Appeal Module under Decision Implementation/Delays.

1920 Requests to Reopen

Revision 23-1; Effective July 31, 2023

1921 Request to Reopen Following Dismissal for Failure to Appear

Revision 23-1; Effective July 31, 2023

1921.1 Determining Good Cause for Failure to Appear

Revision 23-1; Effective July 31, 2023

Requests to reopen must be in writing. If the hearings office receives a written reopen request within 30 calendar days of the dismissal decision date, date stamp the statement and immediately route it to the hearings officer for review. The hearings officer must determine, on a case-by-case basis, whether good cause is established for the appellant’s failure to appear at the scheduled hearing.

To constitute good cause for failure to appear, the appellant must demonstrate the failure was due to circumstances beyond their control. If the good cause statement shows the appellant could have appeared but failed to do so, good cause is not established.

1921.2 Action on Reopen Request

Revision 23-1; Effective July 31, 2023

The hearings officer must initiate one of the following actions within 10 business days of receipt of the appellant’s reopen request.

When Good Cause is Established: If the written statement establishes good cause for the appellant’s failure to appear at the scheduled hearing, reopen the appeal and schedule another hearing. The reopen date will be the date the hearings office received the good cause statement.

If the appellant appears for the hearing, the hearings officer includes, in the procedural history section of the hearing decision, the detailed actions taken and that the original dismissal decision is set aside.

If the appellant fails to appear at the new hearing, dismiss the appeal. The appellant may again submit a reopen request within 30 calendar days of the dismissal decision date. The hearings officer reviews the request and again initiates action within 10 business days of receipt. There is no limit on the number of times an appellant may submit a reopen request. If the hearings officer continues to find good cause, reopen the appeal, and schedule a hearing.

When the Reopen Request is Not Clear

If the reopen request does not contain sufficient or clear information that allows the hearings officer to determine if the appellant had good cause for failing to appear at the hearing, the hearings officer may schedule a pre-hearing conference or send a letter asking the appellant to provide the reason for missing the hearing within 10 business days. The hearings officer makes the decision on good cause based on the information obtained.

If a pre-hearing conference is held, the sole issue is whether the appellant’s reason(s) for failing to appear resulted from circumstances beyond their control. If the hearings officer finds the appellant’s failure to appear was not caused by such circumstances, the hearings officer closes the hearing record and dismisses the appeal. A pre-hearing conference may be rescheduled because of extenuating circumstances and considered on a case-by-case basis.

If good cause is established and a new hearing is conducted, the hearings officer details these actions in the procedural history section of the hearing decision and sets aside the original dismissal decision. The reopen date is the date the reopen request was received by the hearings office.

When Good Cause Does Not Exist

If the reopen request does not clearly establish the appellant had good cause for failing to appear at the scheduled hearing, the hearings officer will send the good cause request for an administrative review to an HHSC Administrative Law Judge (ALJ). The ALJ will either uphold the hearings officer’s decision to not grant good cause or overturn it. If the decision is overturned, the hearings officer will reopen the record and schedule a new hearing. 

If the appellant submits a reopen request after the 30-day period, the hearings officer will send the appellant a decision letter within 10 business days of receipt by the Fair and Fraud Hearings Department. The decision informs the appellant that no further action will be taken on the appeal, because the reopen request was submitted after the 30-day period.

1922 Request to Reopen Following Sustained Decision - 1 TAC Section 357.23(f)

Revision 23-1; Effective July 31, 2023

The hearings officer may reopen an appeal and reconsider the decision if, within 12 months of the decision date, the appellant offers evidence that:

• the hearings officer decides would have affected the outcome of the original decision;
• shows the original decision was not valid; and
• the appellant did not offer at the hearing. 

The hearings officer must decide whether to reopen the appeal within 10 business days from the date of the request. If the hearings officer decides to reopen the appeal, the decision-issuance time frames apply beginning with the date of the request to reopen. See 1820 Decision Issuance Time Frames.

If the appellant offers information after the hearings officer has issued the original decision and the hearings officer decides the information is new and would have affected the outcome of the decision, the hearings officer reopens the appeal and schedules a hearing with notice to both parties. After the hearing, the hearings officer issues a new decision. 

If the hearings officer decides the information is not new, they notify the appellant in writing that they are denying the request to reopen, and that the original decision remains in effect.

If information was provided with an administrative review request, see Section 2240 New Information Received During the Administrative Review.

1930 Time Frames for Processing Requests to Reopen

Revision 23-1; Effective July 31, 2023

After the hearing decision is rendered, an appellant may request that the appeal be reopened. The request must be made in writing. The date the appellant contacts hearings staff, in writing, is considered the request date. The hearings officer has 10 business days from the date of the reopen request to determine whether to reopen the appeal.

If the hearings officer decides to reopen the appeal, all the time frames and delays for an initial appeal apply.

1940 Amended or Re-issued Decision - 1 TAC Section 357.23(g)

Revision 23-1; Effective July 31, 2023

The hearings officer has the authority to withdraw, revise and re-issue a decision within 20 calendar days following the original decision date if they become aware of an error of law or fact that would have affected the outcome of the decision for either side. 

If program staff or the appellant feel that the hearings officer committed an error of law or fact, they may send a letter to the hearings officer and to the other parties within five business days of the date the decision was issued to allow the hearings officer sufficient time to re-issue a decision, if necessary.

Corrected Decision

The hearings officer has the authority to revise a decision to correct an error that does not affect the outcome of the decision. The correction may be made at any time by the request of either party, the attorney conducting an administrative review, or when a hearings officer discovers the error.

Issuance of a corrected decision does not extend any timelines for filing a request for Administrative Review or a petition for Judicial Review.

The decision that is rendered, be it revised, reissued, or corrected, must be identified as an amended decision on the cover letter and the order of the decision. The procedural history should indicate the date the first decision was mailed and possibly the date the hearings officer became aware of the need to reconsider the decision.

An amended decision should be submitted to the hearings manager for review before issuance.

Revision 11-4; Effective June 1, 2011

An administrative review is the review of a hearings officer’s decision on a Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) or Medicaid appeal or an administrative disqualification hearing by HHSC Regional Legal Services. The assigned attorney reviews the testimony and evidence available to the hearings officer when the decision was issued and issues a new decision. An appellant or appellant’s representative may request an administrative review when he does not agree with the hearings officer’s decision.

2110 Appellant’s Responsibility

Revision 11-4; Effective June 1, 2011

When an appellant or appellant’s representative does not agree with a hearings officer’s decision, he may request a review of the decision within 30 days of the date on the decision. The request must be in writing and postmarked no later than the 30th day. A request for administrative review will be considered timely if filed after 30 days, when the appellant demonstrates good cause for the filing delay.

The request for a review is sent to the hearings administrator at:

Hearings Administrator
Mail Code W-613
P.O. Box 149030
Austin, TX 78714

Exception: The 30 days does not begin until a new decision is issued if the appellant or appellant’s representative is working with the hearings officer to reopen or reschedule the hearing.

2120 Receipt of the Administrative Review Request

Revision 14-2; Effective August 6, 2014

Appellants submit administrative review requests by fax, mail and email.

Upon receipt of the request, the hearings administrator’s assistant:

• enters the request into the appropriate database,
• creates a tracking sheet with pertinent information,
• scans the request, and
• emails it to the appropriate hearings manager.

The hearings officer reviews the request to determine whether to reopen the appeal. If the original appeal was dismissed because the appellant failed to appear for the hearing, the hearings officer needs to determine if the appellant had good cause for failing to appear. If the hearings officer determines the appellant did have good cause, the hearings officer reopens the appeal. If the hearings officer determines the appellant did not have good cause, the appeal is sent to administrative review. If the appeal is being reopened, the hearings manager sends an email to the hearings administrator.

The database is updated to reflect the decision to reopen the appeal.

If the appeal is not reopened, the request is sent to Regional Legal Services.

The hearings administrator sends an acknowledgement letter to the appellant.

The appellant has the right to submit a brief. The brief should be no more than five pages. For the brief to be considered, the appellant must submit it with the request for administrative review filed with the hearings administrator. The brief must address only the issues that were addressed in the appeal hearing.

2130 Assigning the Administrative Review Request

Revision 11-4; Effective June 1, 2011

The scanned request and any other documents submitted by the appellant are e-mailed to the Health and Human Services Commission (HHSC) Regional Legal Services and a request is made that an attorney be assigned. The documents are also sent to the appropriate hearings manager.

The e-mail with the scanned documents will include the appeal ID, case name, case number, program, region, hearings officer, date of request and date of decision.

HHSC's Regional Legal Services responds to the e-mail and assigns an attorney.

Hearings staff scan the hearing record and post it to the public folder notifying the assigned attorney via e-mail when it is posted and the file name. The hearing record must be received by the assigned attorney within 10 days from the date of the request.

The assigned attorney will access the hearing record from the public folder and the AVAYA recording from the FairHearAudio folder.

2140 Completing the Administrative Review

Revision 10-4; Effective July 16, 2010

 

2141 Attorney’s Responsibility

Revision 11-1; Effective June 1, 2011

Within 15 business days of receipt of the hearing record, the assigned attorney will review the hearing record and issue a new decision.

The decision format will be similar to the one used by the hearings officer. The decision will include any direction to program staff. The cover letter will include how the appellant can request judicial review, the time frames for requesting judicial review and the appropriate legal aid information.

The attorney will provide a copy of the decision to the appellant, appellant's representative and e-mail a scanned copy with all appropriate signatures to the hearings administrator, the director of appeals and the appropriate hearings manager.

If the hearing was related to a Texas Workforce Commission (TWC) sanction, the attorney will also provide a copy to TWC via mail at the following addresses:

Loretta Robertson
Texas Workforce Commission
101 E. 15th Street, Room 440T
Austin, TX 78778
512-936-6265
Fax: 512-463-7379

The attorney may choose to discuss the case with his supervisor. Ex parte communication does not include discussing the decision with supervisors in the attorney's chain of command.

2141.1 New Information Received During the Administrative Review

Revision 14-4; Effective November 14, 2014

When appeals go to administrative review, appellants often give new information (information the appellant did not offer during the hearing) that the hearings officer may not have considered. Additionally, the appellant may give information directly to the reviewing attorney after the record has gone to administrative review. If the appellant hires an attorney, the attorney may decide to submit a brief to the reviewing attorney. The brief should be no more than five pages.

In both instances, the hearings officer has a chance to decide whether the information would have altered the original decision.

If the appellant offers new information before the appeal goes to administrative review, the appeal goes back to the hearings officer for review. The hearings officer decides if the information is new and if it would have changed the original decision. After reviewing the information, the hearings officer either reopens the hearing or issues a new decision upholding the original decision.

If the hearings officer upholds the original decision, he states that the information given does not constitute new evidence. If the evidence is in fact new information, he states that it would not have altered the original decision. The appeal then goes to the reviewing attorney for administrative review.

If the appellant offers new information after the administrative review has gone to the reviewing attorney, the reviewing attorney sends the case back to the hearings officer. The hearings officer then decides whether the new information would have changed the original decision.

The reviewing attorney may not consider any information in the administrative review that was not available to the hearings officer or not included in the hearing record. The reviewing attorney decides whether the decision was correct in light of the evidence admitted at the hearing and the application of relevant policy (law) to that evidence.

The reviewing attorney may consider legal briefs the appellant submits during the administrative review process, unless they contain any information that was not available to the hearings officer or not included in the hearing record.

If the legal briefs contain new information, the reviewing attorney must send the case back to the hearings officer for consideration, and the hearings officer will make a new decision.

2142 Hearings Administrator's Responsibility

Revision 11-4; Effective June 1, 2011

Upon receipt of the attorney's decision, the database and tracking spreadsheet will be updated with the outcome and date of decision.

If the decision is a reversal and some action needs to be taken by program, the hearings administrator will direct the hearings manager to send the decision and Form H4807, Action Taken on Hearing Decision, to program and track for completion.

2143 Hearings Manager Responsibilities

Revision 10-4; Effective July 16, 2010

The hearings manager will provide the decision and Form H4807, Action Taken on Hearing Decision, to the appropriate program staff if the attorney’s decision requires program to take an action, track for completion and provide that information to the hearings administrator.

Revision 10-4; Effective July 16, 2010

If an appellant does not agree with the administrative review decision, he can file a request for a judicial review with the courts in Travis County within 30 days of the date of the administrative review decision.

2210 Preparing the File

Revision 11-4; Effective June 1, 2011

When the agency is served with process and an appellant has filed for judicial review in the courts of Travis County, the following actions are taken.

• General counsel will notify the Office of the Attorney General that HHSC has been served in a suit for judicial review of an administrative review.
• The special counsel for litigation will notify TWC's Office of the General Counsel if the suit relates to a board/contractor requested sanction. The attorney contact at TWC is:
  
  Sheri Sanders Givens
  Assistant General Counsel
  Office of General Counsel
  Texas Workforce Commission
  101 E. 15th Street, Room 608
  Austin, TX 78778
  512-463-6652
  Fax 512-463-1426
• The special counsel for appeals will be notified so that the hearings administrator can prepare a copy of the file, including a copy of the recorded hearing. The database will be updated.
• The hearings administrator will prepare the file and provide it to the director of appeals who will certify the record.
• The certified record will be provided to the agency counsel.

2220 Completing the Judicial Review

Revision 11-4; Effective June 1, 2011

HHSC Legal Division staff will notify the special counsel for appeals when the district court has issued a decision on the judicial review request.

The special counsel for appeals will notify the appeals director and the hearings administrator of the court's decision.

Upon receipt of the court's decision, hearings staff will update the database and tracking spreadsheet with the outcome and date of decision.

If the decision is a reversal and some action needs to be taken by program, the hearings administrator will direct the hearings manager to send the decision and Form H4807, Action Taken on Hearing Decision, to program and track for completion.

2230 Hearings Manager Responsibilities

Revision 10-4; Effective July 16, 2010

The hearings manager will provide the decision and Form H4807, Action Taken on Hearing Decision, to the appropriate program staff if the judge’s decision requires program to take an action, track for completion, and provide that information to the hearings administrator.

Revision 11-4; Effective June 1, 2011

The hearings officer makes the final administrative decision in all appeals not covered under Chapter 31 (TANF), Chapter 32 (Medicaid) or Chapter 33 (Nutrition Assistance Programs) in the Human Resources Code. An appellant or his representative may file a request for a procedural review. Examples of programs eligible for procedural review include Disaster Assistance, Refugee Cash Assistance and In-Home Family Support Services.

When an appellant or appellant's representative does not agree with a hearings officer's decision, he may request a procedural review of the decision within 30 days of the date on the decision. The request must be in writing and postmarked no later than the 30th day. A request for procedural review will be considered timely if filed after 30 days when the appellant demonstrates good cause for the filing delay.

A procedural review is a review of the hearing record by an HHSC Regional Legal Services attorney. The attorney reviews all documentation submitted, listens to the recorded hearing and reviews the hearings officer's decision. A procedural review does not change the outcome of the hearing.

The request for a review is sent to the hearings administrator at:

Hearings Administrator
Mail Code W-613
P.O. Box 149030
Austin, TX 78714

Exception: The 30 days does not begin until a new decision is issued if the appellant or appellant's representative is working with the hearings officer to reopen or reschedule the hearing.

2310 Receipt of the Procedural Review Request

Revision 11-4; Effective June 1, 2011

Procedural Review requests may be received by fax, mail or e-mail from appellants.

Upon receipt of the request, the hearings administrator’s assistant:

• enters the request into the tracking system,
• creates a tracking sheet with pertinent information, and
• scans the request and e-mails it to the hearings area manager and the Regional Legal Services, which assigns an attorney.

The hearings area manager scans the hearing record and posts it to the public folder notifying the assigned attorney via e-mail when it is posted and the file name. The assigned attorney must receive the hearing record within 10 days from the date of the request.

The attorney will access the hearings record from the public folder and the AVAYA recording from the AVAYA folder.

The hearings administrator sends an acknowledgement letter to the appellant.

2320 Completing the Procedural Review

Revision 11-4; Effective June 1, 2011

2321 Attorney’s Responsibilities

Revision 11-4; Effective June 1, 2011

Within 15 days of receipt of the hearing record, the regional attorney will review the applicable law, facts and regulations contained in the record developed by the hearings officer.

The regional attorney e-mails the review results to the hearings administrator and hearings manager.

2322 Hearings Administrator's Responsibilities

Revision 11-4; Effective June 1, 2011

The hearings manager reviews the attorney's opinion and takes appropriate action. A letter to the appellant is developed by the hearings manager explaining the results of the review and any actions that may be taken. The letter is signed by the hearings administrator.

Revision 10-4; Effective July 16, 2010

2410 General

Revision 14-5; Effective December 10, 2014

Although program staff may disagree with the hearings officer’s decision, they must carry out the fair hearing decision once it has been made. However, program staff have 20 calendar days from the date of the decision to ask for an exception to the fair hearing decision. The exception process exists to make sure both program staff and hearings officers consistently apply applicable policy.

When a hearings officer issues a fair hearing decision, staff must carry out the decision within the implementation time frames, including restoring benefits to which the appellant is entitled.

2420 Initial Review of the Hearing Decision

Revision 10-4; Effective July 16, 2010

If program staff disagree with the fair hearing decision and initiate the exception process, a memorandum must be sent to the manager of the fair hearings officer that rendered the decision requesting an informal review of the decision, with a copy to the fair hearings administrator.

The fair hearings manager conducts a preliminary review of the decision, with input from relevant stakeholders and provides a response to program.

2430 Memorandum to Program Policy Staff

Revision 10-4; Effective July 16, 2010

If program staff still disagree with the fair hearing decision, program staff must send a memorandum to their policy staff with a copy of the hearings officer’s decision and the outcome of the preliminary review conducted by the fair hearings manager. The fair hearings administrator, fair hearings manager and the appropriate program staff must also receive a copy of the memorandum. The memorandum must include:

• case actions taken by the worker/specialist that led to the appeal;
• a summary of the hearings officer's decision;
• points of disagreement; and
• pertinent policy citations.

2440 Response from Program Policy Staff

Revision 10-4; Effective July 16, 2010

Program policy staff contact the fair hearings administrator after the memorandum is reviewed and prepares a response to the requestor.

If policy staff agrees with the requestor, it does not change the outcome of the appeal. It does, however, provide guidance for hearings officer and staff concerning correct policy and procedures for future decisions, and allows program staff to correct the case for future benefits.

2450 Hearing Manager’s Responsibility in the Exception Process

Revision 10-4; Effective July 16, 2010

Upon receiving an exception to a hearings officer’s decision, the manager will review the case record and recording.

Revision 15-2; Effective November 20, 2015

A respondent becomes ineligible to take part in the Supplemental Nutrition Assistance Program (SNAP) and/or Temporary Assistance for Needy Families (TANF) program if a state or federal court or administrative agency finds he has committed an intentional program violation.

The Food Stamp Act of 1977, as amended in Section 6(b) by the Omnibus Budget Reconciliation Act of 1981, and Sections 403, 416 and 1102 of the Social Security Act provide for this action.

4110 Requirement for Administrative Disqualification Hearing (ADH)

Revision 15-2; Effective November 20, 2015

Federal regulations implementing the provisions of the Food Stamp Act and Social Security Act require the Texas Health and Human Services Commission (HHSC) to establish procedures for holding administrative disqualification hearings.

According to TAC, Title 1, Part 15, Chapter 357, §357.521, HHSC may initiate an administrative disqualification hearing in SNAP and TANF cases. To initiate this hearing, HHSC must have documented evidence to prove that a respondent has intentionally committed one or more of the acts described in Section 4111, Definition of Intentional Program Violation.

HHSC will combine the proceedings against a person taking part in both the SNAP and TANF programs if the factual issue arises from the same or similar circumstances.

4111 Definition of Intentional Program Violation

Revision 15-2; Effective November 20, 2015

The Code of Federal Regulations (CFR), Title 7, Subtitle B, Chapter II, Part 273, Subpart F, §273.16(c) states that a SNAP intentional program violation is one or more of the following intentional actions:

• Making a false or misleading statement, or misrepresenting, concealing or withholding facts.
• Committing any act that constitutes a violation of the Food Stamp Act; SNAP regulations; or any state statute relating to the use, presentation, transfer, acquisition, receipt, possession or trafficking* of SNAP coupons or authorization cards, or reusable documents used as part of an automated benefit delivery system (access device).

* Trafficking means:

• the buying, selling, stealing or otherwise effecting an exchange of SNAP benefits issued and accessed via Electronic Benefit Transfer (EBT) cards, card numbers and personal identification numbers (PINs), or by manual voucher and signature, for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone;
• attempting to buy, sell, steal or otherwise effect an exchange of SNAP benefits issued and accessed via EBT cards, card numbers and PINs, or by manual voucher and signature, for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone;
• the exchange of firearms, ammunition, explosives or controlled substances, as defined in Section 802 of Title 21, United States Code, for SNAP benefits;
• purchasing a product with SNAP benefits that has a container requiring a return deposit with the intent of obtaining cash by discarding the product and returning the container for the deposit amount, intentionally discarding the product, and intentionally returning the container for the deposit amount;
• purchasing a product with SNAP benefits with the intent of obtaining cash or consideration other than eligible food by reselling the product, and subsequently intentionally reselling the product purchased with SNAP benefits in exchange for cash or consideration other than eligible food; or
• intentionally purchasing products originally purchased with SNAP benefits in exchange for cash or consideration other than eligible food.

Title 45 CFR, Subtitle B, Chapter II, Part 235, §235.110(b) states that a TANF intentional program violation is determined in accordance with state law. A TANF violation occurs when a person’s action results in:

• a false or misleading statement, or misrepresentation, concealment or withholding of facts; or
• any act intended to mislead, misrepresent, conceal or withhold facts or to represent a falsehood as a fact.

HHSC may charge a respondent with an intentional program violation even if he has not actually received benefits to which he is not entitled.

4112 Initiating the Administrative Disqualification Process

Revision 15-2; Effective November 20, 2015

Office of Inspector General (OIG) investigators are responsible for starting the process to inform certain individuals accused of an intentional program violation about their right to waive an administrative disqualification hearing. If the respondent signs the waiver, see Section 4131, Waivers. When the respondent does not sign the waiver, OIG investigators send the case to a hearings officer to schedule an administrative disqualification hearing. The hearings officer decides whether or not the respondent is guilty of committing an intentional program violation.

4120 Administrative Disqualification Hearings Officer

Revision 15-2; Effective November 20, 2015

 

4121 Designation of Hearings Officer — 1 TAC §357.522

Revision 15-2; Effective November 20, 2015

HHSC employs impartial officials to preside over fair and fraud hearings and to issue decisions on actions taken by HHSC and its designees, per state and federal law. A person authorized to conduct fair hearings under Section 1000, Fair Hearings, may also conduct administrative disqualification hearings.

4122 Disqualification of Hearings Officer — 1 TAC §357.523

Revision 15-2; Effective November 20, 2015

HHSC disqualifies a hearings officer if he takes part in the decision to:

• refer the case to the investigation unit, or
• recommend disqualification for intentional program violation.

HHSC may disqualify a hearings officer for any of the following reasons:

• The hearings officer took part in a case conference with the worker, investigator or the supervisor to make a referral for an intentional program violation decision. The hearings officer may not have discussed or evaluated a case or any major points at issue.
• The hearings officer reviewed the entire record or a comprehensive summary of the record to make a referral for disqualification.
• The hearings officer has a personal interest in the outcome of the hearing decision or has some other conflict of interest.
• A respondent asks that a certain hearings officer not hold the hearing or makes allegations against the fairness of the hearings officer.
• The hearings officer has supervised the worker or investigator within the past two years, although the hearings officer may not have been involved in the decision.

HHSC does not disqualify a hearings officer for answering a question about HHSC policy concerning the case if the question and answer are stated in broad terms.

4123 Alternate Hearings Officer

Revision 15-2; Effective November 20, 2015

If the hearings officer questions his qualifications, he informs the hearings manager or hearings administrator about his concerns. The hearings manager or administrator may assign the hearing to another hearings officer.

If an alternate hearings officer cannot be chosen from within the same area, the hearings administrator appoints an alternate hearings officer from another area.

When the hearings manager or administrator appoints an alternate hearings officer, the first hearings officer immediately sends all documents concerning the hearing to the alternate hearings officer.

4124 Hearings Officer's Powers and Duties — 1 TAC §357.524

Revision 15-2; Effective November 20, 2015

The hearings officer:

• administers oaths or affirmations;
• makes sure all relevant issues are considered;
• requests, receives and includes in the record all evidence determined necessary to make a decision;
• ensures an orderly hearing by regulating the conduct and course of the hearing;
• makes an administrative decision concerning the hearing in the name of HHSC; and
• requires the attendance of an HHSC representative to explain and defend HHSC’s allegation. The hearings officer may request the presence of another HHSC representative, but does not have the authority to subpoena witnesses.

4130 Referral Process

Revision 15-2; Effective November 20, 2015

The OIG investigator sends the hearings officer a referral for an administrative disqualification concerning the alleged intentional program violation. The referral must include, but is not limited to:

• a recommendation of TANF or SNAP disqualification,
• a brief statement of allegations,
• a summary of the evidence,
• the respondent's most current address and telephone number available to any division within HHSC.

Before the hearing, the OIG investigator sends the hearings officer and the respondent an evidence packet which must include, but is not limited to:

• the referral summary,
• the notice and final notice to the respondent, and
• copies of all documents necessary to support the disqualification recommendation.

The OIG investigator should send the evidence packet to the hearings officer and the respondent at least 20 calendar days before the hearing to allow sufficient time for review.

The hearings officer sets the date for the hearing and sends Form H4851-F, Notice of Administrative Disqualification Hearing, to the respondent and OIG investigator.

If two or more members of the same household are charged, the hearings officer handles each as a separate case. However, at the request of both parties, HHSC may hold a joint hearing. Even if HHSC holds a joint hearing, the hearings officer issues separate decisions and must send a separate notice to each person.

4131 Waivers

Revision 15-2; Effective November 20, 2015

OIG investigators are responsible for starting the process to inform certain individuals accused of an intentional program violation about their right to waive an administrative disqualification hearing. The respondent may waive his right to a hearing when the respondent signs and returns the waiver. If the respondent waives the administrative disqualification hearing, he will sign a Waiver of Disqualification Hearing form and a Repayment Agreement form.

The OIG investigator sends a copy of the signed waiver to the Appeals Division and to the OIG Disqualification Unit, State Office, which initiates the disqualification penalty. The Appeals Division will make sure appropriate hearings staff are informed.

4132 Definition of a Valid Waiver

Revision 15-2; Effective November 20, 2015

7 CFR §273.16(f) refers to waivers. Please see the full section for more information.

7 CFR §273.16(f) defines a valid waiver as:

"(ii) The written notification provided to the household member which informs him/her of the possibility of waiving the administrative disqualification hearing shall include, at a minimum:

(A) The date that the signed waiver must be received by the State agency to avoid the holding of a hearing and a signature block for the accused individual, along with a statement that the head of household must also sign the waiver if the accused individual is not the head of household, with an appropriately designated signature block."

4133 Processing ADH Waivers or Withdrawals

Revision 15-2; Effective November 20, 2015

Upon receipt of a valid waiver from a respondent or a request from OIG to withdraw the ADH referral, the hearings officer takes action based on the circumstances described below. A case folder will be created for each waiver/withdrawal and filed according to local office procedures.

Scenario 1: After hearings staff mail the appointment notice, the hearings officer receives a waiver, or OIG asks to withdraw the ADH request.

OIG sends an ADH case report to hearings staff asking for an ADH. Hearings staff schedule the ADH and mail the appointment letter to the respondent. After the mailing of the appointment notice, but before the hearing, OIG gives the hearings officer a valid waiver. The hearings officer sends the respondent a letter stating the hearing will not be held because the respondent waived his right to a hearing. Hearings staff generate all waiver and withdrawal notices via the Texas Integrated Eligibility Redesign System (TIERS) Hearings and Appeals Correspondence.

Scenario 2: Before hearings staff mail the appointment notice, the hearings officer receives a waiver, or OIG asks to withdraw the ADH request.

OIG sends an ADH summary to hearings staff asking for an ADH. Before hearings staff mail the appointment letter, OIG receives a valid waiver from the respondent and sends it to the hearings officer, or OIG decides it should not have asked for an ADH and sends a withdrawal to the hearings officer. If the ADH has not been assigned to a hearings officer, the waiver/withdrawal is sent to the manager for assignment. The hearings officer generates a letter to the respondent via TIERS Hearings and Appeals Correspondence.

Scenario 3: During or after the hearing, OIG asks to withdraw the ADH request, or the hearings officer receives a waiver.

OIG sends an ADH summary to hearings staff asking for an ADH. Hearings staff schedule the ADH and mail the appointment letter to the respondent. During or after the hearing, OIG decides to withdraw its request or submits a waiver. The hearings officer will issue a decision. The decision will be “did not commit” if OIG requests to withdraw the ADH request. If the hearings officer receives a waiver during or after the hearing, he will decide the case based on the evidence.

4134 Scheduling the Hearing — 1 TAC §357.525

Revision 15-2; Effective November 20, 2015

Form H4851-F, Notice of Administrative Disqualification Hearing, must be sent to the respondent within 20 calendar days from the date OIG asks for the hearing. The hearings officer must hold the hearing and issue a written decision no later than 90 calendar days from the date hearings staff mail the hearing notice to the respondent. The hearings officer schedules the hearing at a reasonable time and place. Hearings are normally held using a scan call conferencing system. A respondent may ask for a face-to-face hearing, but must show good cause for a face-to-face hearing before the hearings officer grants the request. The hearings officer decides whether good cause exists for a face-to-face hearing.

4135 Advance Notice of Hearing — 1 TAC §357.526

Revision 15-2; Effective November 20, 2015

The hearings officer sends the respondent advance notice of the hearing in sufficient time to allow receipt at least 30 calendar days before the scheduled hearing date. The notice is sent first class and certified mail, return receipt requested, to the most current mailing address available to any division within HHSC, and it is marked "return service requested." Delivery is not restricted to the addressee. The notice specifies the charges against the respondent and a summary of the evidence (including how and where it may be examined). If the notice is returned showing a new address, the hearings officer will re-send it and reapply advance notice requirements.

Form H4851-F, Notice of Administrative Disqualification Hearing, serves as a notice of the hearing for the respondent. Hearings staff generate all hearing notices via TIERS Hearings and Appeals Correspondence.

The hearings officer sends a full hearing packet to the respondent and the respondent’s representative, which includes a copy of Form H4800-ADH, Request for Administrative Disqualification Hearing; Form H4851-F; Form H4855, Statement of Household Member's Rights in Administrative Disqualification Hearing; Form H4856, Request for Another Appointment for Administrative Disqualification Hearing; Form H4861, Receipt of Notice; and an envelope addressed to the hearings officer.

The hearings officer sends a partial hearing packet to the witnesses, which includes Form H4851-F only.

TIERS generates an alert to the agency representative when the Managed Office Resource (MOR) search function is used to create the appeal. If MOR is not used, a packet containing Form H4851-F is generated.

Because the respondent must receive the notice at least 30 days before the hearing, TIERS will not allow hearings staff to enter the notice less than 40 days before the hearing if advance notice requirements apply. (See Section 4220, Time Frames, Postponements, Recesses and Delays — 1 TAC §357.533 and §357.534, for information on when advance notice requirements do not apply. If advance notice requirements do not apply, TIERS will not allow hearings staff to enter the notice less than 14 days before the hearing.)

Advance notice requirements are met when the hearings officer mails the notice to the most current mailing address available to any division within HHSC. Regardless of whether the certified or first class mail is returned, if the hearings officer mailed it per advance notice requirements, the hearing will be held.

• If the returned notice shows a new address, another notice is mailed following the procedures in the first paragraph of this section, and the 90-day time requirement for issuing a decision begins again with the date that the second notice is mailed.
• If the respondent claims non-receipt of notice of the hearing, he has one year after the date of the hearing decision to claim good cause for not appearing at the hearing. In all other instances, the respondent has 10 calendar days from the date of the hearing to claim good cause for not appearing. If the respondent is found to have committed an intentional program violation, but a hearings officer later finds that good cause existed for the respondent's failure to appear, then the previous decision shall no longer be valid, a new hearing will be held, and a new decision will be issued.

4136 Participation While Hearing Is Pending — 1 TAC §357.527

Revision 15-2; Effective November 20, 2015

HHSC may not disqualify a respondent for an intentional program violation until the hearings officer finds that the person committed an intentional program violation. A pending hearing does not affect the respondent's or the household's right to be certified and participate in the program.

HHSC reduces or terminates benefits if:

• HHSC has documentation substantiating the household is either ineligible or eligible for fewer benefits (even if these facts suggest an intentional program violation and lead to an administrative disqualification hearing), or
• the household fails to ask for a fair hearing and for continued benefits pending the hearing.

HHSC may adjust benefits if it has facts substantiating the household's failure to report a change in its circumstances. HHSC does not have to show that the failure to report was an intentional program violation before making the adjustment.

Pending the hearing, HHSC determines the eligibility and benefit level of the household per usual procedures. If the suspected action does not affect the household's current circumstance, the household:

• continues to get its allotment based on the latest certification action, or
• is recertified based on a new application and current circumstances.

HHSC terminates benefits if:

• the certification period has expired, and
• the household fails to reapply after receiving an expiration notice.

Revision 10-1; Effective January 15, 2010

4210 Conduct of Hearing — 1 TAC §357.528

Revision 15-2; Effective November 20, 2015

The hearings officer conducts the administrative disqualification hearing as an informal proceeding, not as a formal court hearing. The participants are placed under oath, but the formal rules of evidence are not followed.

At the hearing, the hearings officer must advise the respondent or his representative that he may refuse to testify or answer questions during the hearing.

The hearing is recorded.

4211 Presentation of HHSC's Case — 1 TAC §357.540

Revision 15-2; Effective November 20, 2015

OIG is responsible for presenting HHSC'S case in the administrative disqualification hearing.

4212 Respondent's Rights During Hearing — 1 TAC §357.530

Revision 15-2; Effective November 20, 2015

The hearings officer must give the respondent or his representative an adequate chance to do the following:

• Examine all relevant documents and records at a reasonable time before and during the hearing. The case record is available to the respondent or his representative, including the application form and the verification documents used to find out the household's ineligibility or eligibility and allotment amount. All open records requests should be sent to the hearings administrator. If the respondent or his representative asks for a copy of the case record, HHSC provides a free copy of the portions that are relevant to the hearing. HHSC protects confidential information from release. Confidential information may include the names of people who have disclosed information about the household without its knowledge, or information that shows the nature or status of pending criminal prosecutions. Confidential information and other documents or records that the household may not otherwise have a chance to contest or challenge are not introduced at the hearing. They do not affect the hearings officer's decision.
• Present the case or have it presented by a legal counsel or another person.
• Present witnesses.
• Present or refuse to present arguments without undue interference.
• Question or refute any testimony or evidence, including a chance to confront and cross-examine adverse witnesses.
• Submit evidence to show all pertinent facts and circumstances in the case.
• Refuse to answer any question whether it is asked by the hearings officer or the agency representative.

4213 Attendance at Hearing — 1 TAC §357.529

Revision 15-2; Effective November 20, 2015

A representative from OIG must attend the hearing to explain and defend HHSC's case.

The respondent may attend the hearing, offer evidence, present testimony, ask questions and answer questions; however, he is not required to do so. If the respondent does not attend the hearing or chooses not to testify or answer questions, the hearings officer will consider only HHSC's evidence and testimony in making a decision.

The hearing is not open to the public; however, at the respondent's request, friends and relatives may attend. If space is limited, the hearings officer may limit the number of people attending the hearing.

4213.1 Failure of OIG to Appear

Revision 15-2; Effective November 20, 2015

If the OIG representative does not appear to explain or defend HHSC’s case, the hearings officer opens the record and states that the agency representative did not appear. The hearings officer will take no testimony. The hearings officer closes the record and issues a decision finding the respondent did not commit an intentional program violation, regardless of whether the respondent appears for the hearing.

4213.2 Failure of Respondent to Appear – Notice Requirement Met — 1 TAC §357.532

Revision 15-2; Effective November 20, 2015

If advance notice requirements (as outlined in Section 4135, Advance Notice of Hearing — 1 TAC §357.526) are met and the respondent or his representative fails to attend a hearing without good cause, the hearings officer holds the hearing without the respondent. The respondent has 10 calendar days from the date of the hearing to show good cause for failing to appear.

If the hearings officer finds the respondent committed an intentional program violation, but later finds that the respondent or his representative did not receive notice of the hearing or had good cause for not appearing, a new hearing is held. The previous decision is no longer valid, and a new decision is issued. The respondent has one year from the date of the hearing decision to show good cause for failure to appear because he did not receive notice of the hearing.

4213.3 Failure of Respondent to Appear – Notice Requirement Not Met — 1 TAC §357.532(c)

Revision 15-2; Effective November 20, 2015

If advance notice requirements are not met, the hearings officer reschedules the hearing to ensure advance notice requirements are met.

4220 Time Frames, Postponements, Recesses and Delays — 1 TAC §357.533 and §357.534

Revision 15-2; Effective November 20, 2015

The hearings officer must hold the hearing and issue a written decision no later than 90 calendar days from the date that hearings staff mail Form H4851-F, Notice of Administrative Disqualification Hearing, to the respondent. 

If the initial notice is returned due to a bad address and hearings staff re-send it to a more current address, the hearings officer must issue the written decision no later than 90 calendar days from the date that hearings staff mail the second Form H4851-F. Advance notice is still required if the hearings officer reschedules a hearing for this reason. When entering the new notice in TIERS, use the delay reason "Bad Address/Unable to Locate."

Exceptions: Issuing some decisions may be delayed beyond the time periods described above. In the instances below, hearings staff may enter a delay in TIERS, and the due date will be extended by the number of delay days entered. Hearings staff should enter a delay for the number of days between the first and second hearing date or for the number of days needed to get additional information. The maximum allowable delay is 30 days.

The respondent or his representative may ask for one postponement of up to 30 calendar days. Additional postponements may be requested and approved if the respondent has good cause for asking for the postponement. Advance notice is not required for hearings rescheduled at the respondent’s request. The hearings officer must allow a minimum notice of 14 days for these hearings. When rescheduling the hearing in TIERS, enter a delay using "Rescheduled at Client's Request."  

Hearings may also be postponed at the request of OIG for business reasons if OIG makes the request no later than five calendar days after the date on Form H4851-F. Business reasons include conflicts in scheduling due to training, meetings or multiple hearings scheduled at the same time. Business reasons do not include conflicts in scheduling due to leave or flex time. If the hearings officer postpones a hearing at the request of OIG, the hearings officer must give advance notice of the postponed hearing to the respondent. When entering the new notice in TIERS, use the delay reason "Request by Agency."

Hearings may be postponed due to factors beyond the control of the hearings officer, such as inclement weather or power outages. If factors beyond the control of the hearings officer cause a postponement, the hearings officer must give advance notice of the postponed hearing to the respondent. When rescheduling the hearing in TIERS, enter a delay using "Delay Beyond Agency Control."

If the respondent asks for additional information or wants additional information considered, the hearings officer may recess the hearing to allow time to receive this information. The respondent may question or refute any additional testimony or evidence after a recess.

The hearings officer may order a recess to ask for and receive additional testimony or evidence. The hearings officer tells the respondent or his representative the reason for the recess and the nature of the requested information. The respondent may question or refute any additional testimony or evidence after a recess.

The hearings officer reconvenes the hearing after the witness, document or other evidence is available. Once the hearings officer reconvenes the hearing, it is held as any other hearing.

Advance notice of 30 days is not required for hearings held open for additional evidence. The hearings officer should allow notice of 14 days for these hearings unless all parties agree in advance upon a date and time to reconvene. When scheduling the reconvened hearing in TIERS, enter a delay using "Record Held Open for Additional Evidence."

Use the chart below to determine due dates, notice requirements, delay reasons and maximum delays allowed.

Situation	Notice Requirement	Delay Reason	Maximum Delay Days	New Due Date
Form H4851-F returned, or more current address discovered	Advance notice (40 days, to allow receipt 30 days before hearing)	Bad Address/Unable to Locate	N/A	Form H4851-F date plus 90 calendar days
Respondent asks to reschedule	14 days	Rescheduled at Client's Request	30	Initial due date plus number of delay days
OIG asks to reschedule for business reasons	Advance notice	Request by Agency	30	Initial due date plus number of delay days
Inclement weather Power outage	Advance notice	Delay Beyond Agency Control	30	Initial due date plus number of delay days
Respondent asks for time to send new information Reconvene	14 days unless shorter time frame agreed upon by all parties	Record Held Open for Additional Evidence	30	Initial due date plus number of delay days

4230 Consideration of the Case and Findings by the Hearings Officer — 1 TAC §357.531 and §357.535

Revision 15-2; Effective November 20, 2015

The hearings officer must base his decision on clear and convincing evidence that the respondent committed an intentional program violation, as defined in Section 4111, Definition of Intentional Program Violation.

Clear and convincing evidence means the trier of fact must be persuaded by the evidence that it is highly probable the claim is true. The clear and convincing evidence standard is greater than the preponderance of the evidence standard but less than beyond a reasonable doubt.

The hearings officer must substantiate his decision by identifying supporting evidence and applicable regulations. He must also respond to reasonable arguments made by the respondent or the respondent's representative.

The hearings officer makes a decision about the allegation that the respondent committed an intentional program violation. The hearings officer issues a written decision within the time frames specified in Section 4220, Time Frames, Postponements, Recesses and Delays — 1 TAC §357.533 and §357.534. The decision of the hearings officer must comply with HHSC policy and federal law and regulations, and it must be based exclusively on the hearing record.

The hearings officer may not find that the respondent committed an intentional program violation unless there is clear and convincing evidence in the record to support a decision that the respondent knowingly, willfully and with deceitful intent committed an act described in Section 4111, Definition of Intentional Program Violation.

4240 The Hearing Record and Decision — 1 TAC §357.536

Revision 15-2; Effective November 20, 2015

Respondents or their representatives may inspect the hearing record during work hours. They may also ask for a copy of the hearing record.

The hearings officer sends written notice of the decision to the respondent or to the appropriate HHSC staff per Section 4243, Notice of Hearing Decision and the Effect on Remaining Household Members — 1 TAC §357.538. The hearings officer's decision:

• specifies the reasons for the decision,
• identifies the supporting evidence and regulations, and
• responds to reasonable arguments of the respondent or his representative.

The hearing record includes all exhibits admitted to the hearing record, all correspondence concerning the hearing and the audio recording of the hearing.

HHSC keeps hearing records for both SNAP and TANF administrative disqualification hearings for audit and review purposes per the records retention schedule, which is currently six years from the decision date.

4241 Effect of an Administrative Determination of Intentional Program Violation — 1 TAC §357.537

Revision 15-2; Effective November 20, 2015

• If a hearings officer finds a respondent committed an intentional program violation, the respondent is disqualified from SNAP and/or TANF for the following periods:
  • TANF. If the intentional program violation occurred on or after Sept. 1, 2003, the person is disqualified:
    • 12 months for the first intentional program violation determination, and
    • permanently for the second intentional program violation determination.
  • SNAP. The person is disqualified:
    • for a period of one year upon the first occasion of any such determination;
    • for a period of two years upon:
      • the second occasion of any such determination; or
      • the first occasion of a finding by a federal, state or local court of the trading of a controlled substance (as defined in Title 21, United States Code [USC], §802) for coupons;
    • permanently upon:
      • the third occasion of any such determination;
      • the second occasion of a finding by a federal, state or local court of the trading of a controlled substance (as defined in Title 21, USC, §802) for coupons;
      • the first occasion of a finding by a federal, state or local court of the trading of firearms, ammunition or explosives for coupons; or
      • conviction of the offense of knowingly receiving, transferring, acquiring, altering or possessing coupons, authorization cards or access devices in any manner contrary to the Food Stamp Act of 1977 involving an aggregate amount of $500 or more; or
    • for a period of 10 years if a person is convicted in a state or federal court or is found by a state administrative hearing to have made a fraudulent statement or representation with respect to the identification or place of residence of the individual in order to receive multiple benefits simultaneously under SNAP.
• The disqualification period does not depend on the amount of benefits involved. The disqualification period set at the time of the hearing is applicable regardless of current eligibility.
• If one hearing is held for several offenses, HHSC may impose only one disqualification period.
• If the hearings officer imposes a one-year disqualification for an initial violation, no further disqualifications may be imposed for violations occurring before the hearing decision that are later discovered. Although the hearings officer makes a decision about the intentional program violation, the respondent may appeal the amount of overpayment. The administrative disqualification hearing must be held and a decision issued before the fair hearing on the overpayment, unless the hearings officer holds both the administrative disqualification hearing and the fair hearing at the same time.

4241.1 Procedures for SNAP and TANF Administrative and Judicial Reviews

Revision 15-2; Effective November 20, 2015

If HHSC disagrees with the hearings officer’s decision, HHSC may ask for a review via the exception process.

If the respondent disagrees with the hearings officer’s decision, the respondent may ask for an administrative review.

An administrative review is when HHSC Regional Legal Services reviews a hearings officer’s decision on an administrative disqualification hearing. The assigned attorney reviews the hearing record and issues a new decision.

An administrative review must be requested within 30 calendar days of the date on the decision. The request for a review is sent to the hearings administrator at:

Hearings Administrator
Mail Code W-613
P.O. Box 149030
Austin, TX 78714

Exception: The 30 days does not start until the hearings officer issues a new decision if the respondent or respondent’s representative is working with the hearings officer to reopen or reschedule the hearing.

Upon receipt of an administrative or judicial review request or an exception request, follow procedures in Section 2100, Administrative Review — 1 TAC §§357.701-703, through Section 2450, Hearing Manager’s Responsibility in the Exception Process. The administrative disqualification procedures for administrative and judicial reviews and for exceptions are the same as those used for fair hearings.

4242 Effect of Nondetermination of Intentional Program Violation — 1 TAC §357.541

Revision 15-2; Effective November 20, 2015

If a hearings officer finds that the respondent did not commit an intentional program violation, the respondent will not be disqualified.

Although the hearings officer makes a decision about the intentional program violation, the respondent may appeal the amount of overpayment. The administrative disqualification hearing must be held and a decision issued before the fair hearing on the overpayment, unless the hearings officer holds both the administrative disqualification hearing and the fair hearing at the same time.

4243 Notice of Hearing Decision and the Effect on Remaining Household Members — 1 TAC §357.538

Revision 15-2; Effective November 20, 2015

The hearings officer informs the respondent of the decision in writing.

Within 15 calendar days of a hearings officer's written decision to disqualify the respondent, the HHSC Central Disqualification Unit informs the respondent of the effect of the hearings officer's decision. In dismissed cases or cases in which the hearings officer finds that the respondent did not commit an intentional program violation, the hearing decision is the final notice sent to the respondent. Except for dismissed, withdrawn and waived cases, the hearings officer informs the respondent of the decision on Form H4857, Notice of Decision, Administrative Disqualification Hearing. The hearings officer sends one copy each to the investigator and the respondent's representative. In addition, the hearings officer sends all “did commit” and “did not commit” ADH decisions (Form H4857 and order) electronically to the Central Disqualification Unit.

4244 Court Actions in Relation to Administrative Disqualification — 1 TAC §357.539

Revision 15-2; Effective November 20, 2015

A hearings officer does not have jurisdiction to hear or make a decision on a case that a court has already heard.

TANF and SNAP federal regulations allow a court of appropriate jurisdiction to order that a person be disqualified from participating in the program for the time periods described in 1 TAC §357.537, Effect of an Administrative Determination of Intentional Program Violation.

The state, a political subdivision of the state, or the United States may serve as prosecutor or plaintiff.

If the court fails to impose a disqualification period on a respondent who committed an intentional program violation, HHSC imposes one of the penalties described in 1 TAC §357.537. HHSC imposes the appropriate penalty unless the court order prohibits the penalty.

4245 Imposing a Disqualification

Revision 15-2; Effective November 20, 2015

HHSC must enforce administrative SNAP and TANF program disqualifications the first month after the month the household receives Form H4857, Notice of Decision, Administrative Disqualification Hearing. HHSC must enforce court-ordered SNAP disqualifications within 45 days of the date of the court decision.

If HHSC imposes the SNAP disqualification period after these limits, it is reduced by one month for each month or part of a month that the imposition is delinquent. Thus, a one-year disqualification period that was imposed two months late is reduced to 10 months. (However, the remaining two months are treated as overpayments due to HHSC error.)

When a SNAP and TANF respondent waives the hearing, HHSC must enforce the disqualification no later than the second month after the date the notice of disqualification was sent to the respondent.

4246 Consolidation of Administrative Disqualification Hearings and Fair Hearings — 1 TAC §357.542

Revision 15-2; Effective November 20, 2015

The hearings officer may combine a fair hearing and an administrative disqualification hearing to settle the amount of the claim at the same time as deciding whether or not an intentional program violation has occurred. To do this, the following conditions must exist:

• The factual issues arise out of the same or related circumstances, and the respondent receives advance notice that the hearings will be combined.
• Disqualification hearing procedures are adhered to.

At the respondent's request, the hearings officer must allow the respondent to waive the 30-day advance notice period that is required when a disqualification hearing and fair hearing are combined. If the respondent does not receive advance notice that the hearings will be combined, but decides to waive the advance notice requirement, the hearings officer obtains the respondent's signature on a waiver of notice. The hearings officer then proceeds with a fair hearing on the claim.

When a disqualification hearing and fair hearing are combined and the respondent does not waive the advance notice requirement, the hearings officer follows the time frames for holding disqualification hearings.

When the hearings are combined to settle the amount of the claim while deciding whether or not an intentional program violation has occurred, the respondent loses the right to a subsequent fair hearing on the amount of the claim.

When a respondent chooses to waive the advance notice requirement, the hearings officer documents in the decision (under procedural history) that the respondent waived the Notice of Administrative Disqualification Hearing.

Revision 14-1; March 31, 2014

Always file the most current material on top of the appropriate section.

Left Side of Folder	Right Side of Folder
Topmost item(s) are: Fair hearing tracking sheet or Form H4809, Update After Fair Hearing Data Entry Form	Topmost item(s) are: Decision cover letter Fair hearing decision

Use tabs to separate the remaining items:

Correspondence (most recent on top)

Administrative Review (for use as needed)

Examples include, but are not limited to: Emails regarding the fair hearing Form H4800, Fair Hearing Request Summary; Form H4803, Notice of Hearing; Form H4804, Request and Authorization for Fair Hearing Record to Remain Open; Form H4806, Request for Another Appointment - Request to Withdraw; and Form H4807, Action Taken on Hearing Decision Appellant's statement of representation Appellant's postponement request Note: If any of these documents become exhibits, label and file under Exhibits Admitted instead.

Examples include, but are not limited to: Appellant's administrative review request and any accompanying documents Hearings administrator email Email with name of attorney assigned to review Emails relating to decision and/or review Recording of hearing (tape or CD) Reopen: (for use as needed) Appellant’s request to reopen appeal and any accompanying documents

Exhibits Not Admitted: (for use as needed)	Exhibits Admitted:
Items determined irrelevant or otherwise inadmissible by the hearings officer Items provided to the hearings officer, but not offered by participants Duplicates of exhibits admitted	File exhibits in ascending numeric order

Revision 23-1; Effective July 31, 2023

A general email is assigned to each of the five areas under the Fair Hearings section.

Area	Email Address
1	appealsinfoarea1@hhsc.state.tx.us
3	appealsinfoarea2@hhsc.state.tx.us
3	FFH_appealsinfo3@hhsc.state.tx.us
4	appealsevidence@hhsc.state.tx.us
5	appealsinfoarea5@hhsc.state.tx.us
All Regions	OCC_Appeals_FairandFraudHearings@hhsc.state.tx.us

Revision 10-1; January 15, 2010

Appeals Received via TIERS

Revision 10-4; July 16, 2010

Partial Settlement Agreement, Exhibit B

Revision 11-4; June 1, 2011

Health Plan Management

Revision 23-1; Effective July 31, 2023

The hearings officer issues a decision for every appeal requested. There are several types of fair hearing decisions:

Decision Type	Definition
Dismissed – Abandonment	This decision type should be used when the appellant disconnects from the hearing and does not call back in.
Dismissed - Failure to Appear	This decision type should be used when the appellant or appellant’s authorized representative fails to appear for a scheduled hearing or pre-hearing conference.
Dismissed – Generic	This decision type should be used when:     the appeal was added in error; a decision was already issued; or in CHIP denials.
Dismissed – 90-Day No Jurisdiction (Untimely Request)	This decision type should be used when:  Non-managed care cases: appellant takes more than 90 days (without good cause) from the date of the action on appeal or the effective date, whichever is longer, to request a fair hearing.  Managed care cases: appellant takes more than 120 days (without good cause) from the date the internal appeal was completed or exhausted to request a fair hearing.
Dismissed – Want of Jurisdiction	This decision should be used when the Fair Hearings department does not have jurisdiction and the appeal is not in the 90-Day No Jurisdiction category (untimely request over 90 days for non-managed or 120 days for managed care).
Reversed – Benefits Due	This decision type should be used when the hearings officer determines the agency’s action was not appropriate according to policy and law, and the agency is ordered to approve or issue benefits or services.
Reversed – Information Needed	This decision type should be used when the hearings officer determines the agency’s action was not appropriate according to policy and law, but it is not clear whether benefits are due.
Reversed – No Benefits Due	This decision type should be used when the hearings officer determines the agency’s action was not appropriate according to policy and law but did not result in a loss of benefits or services.
Sustained	This decision type should be used when the hearings officer determines the agency’s action was appropriate according to policy and law.
Sustained with Instructions	This decision type should be used when the hearings officer determines the agency’s action was appropriate according to policy and law at the time of the initial determination; however, new information obtained during the hearing requires additional action by the agency.
Withdrawn – Favorable Action	This decision type should be used when the appellant or appellant’s representative withdraws the appeal after the agency corrects or overturns its original decision in the appellant’s favor.
Withdrawn – Sustained	This decision type should be used when the appellant or appellant’s representative withdraws the appeal, and the agency’s action was correct, or the hearings officer is unable to determine whether the agency’s action was correct.

Revision 14-1; March 31, 2014

Always file the most current material on top of the appropriate section.

Left Side of Folder	Right Side of Folder
Topmost item(s) are: ADH tracking sheet MAPPER entry screen printout AVAYA printout	Topmost item(s) are: Decision cover letter Form H4857, Notice of Decision, Administrative Disqualification Hearing ADH decision

Use tabs to separate the remaining items:

Correspondence: (most recent on top)

Administrative Review: (for use as needed)

Examples include, but are not limited to: Email requesting the ADH ADH case summary Form H4851-C, Notice of Administrative Disqualification Hearing Form H4856, Request for Another Appointment for Administrative Disqualification Hearing USPS certified mail receipt USPS domestic return receipt Respondent’s statement of representation Note: If any of these documents become exhibits, label and file under Exhibits Admitted instead.

Respondent’s administrative review request and any accompanying documents Reopen: (for use as needed) Respondent’s reopen request and any accompanying documents

Exhibits Not Admitted:	Exhibits Admitted:
Items determined irrelevant or otherwise inadmissible by the hearings officer Items provided to the hearings officer, but not offered by participants Duplicates of exhibits already admitted	File exhibits in ascending order. When items are offered independently, label them as the next logical exhibit number or letter. Example: Exhibits A through E are offered. Then an Office of Inspector General (OIG) representative offers five additional pages which are not included in A through E and are not labeled. These pages should be numbered one to five and labeled as exhibit F.

Revision 15-2; November 20, 2015

Region	Counties Serviced
Region 1: High Plains	Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum
Region 2: Northwest Texas	Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stonewall, Stephens, Taylor, Throckmorton, Wichita, Wilbarger, Young
Region 3: Metroplex	Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise
Region 4: Upper East Texas	Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood
Region 5: Southeast Texas	Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler
Region 6: Gulf Coast	Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton
Region 7: Central Texas	Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson
Region 8: Upper South Texas	Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala
Region 9: West Texas	Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler
Region 10: Upper Rio Grande	Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio
Region 11: Lower South Texas	Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

Revision 23-1; Effective July 31, 2023

The following changes were made:

Section	Title	Change
1100	Legal Base/Definitions	Updates title to Legal Basis/ Fair Hearings Policy and Procedures.
1110	Federal Statutes and Regulations	Updates title to Statutes and Regulations. Moves information to new section 1111.
1111	Federal Statutes and Regulations	Adds a new section for applicable federal and state statutes and regulations.
1112	Texas Statutes and Regulations	Adds a new section on Texas statutes and regulations.
1112.1	Texas Human Resources Code	Adds new section detailing Texas Human Resources Code.
1112.2	Texas Administrative Code (TAC)	Adds new section detailing fair hearing information in TAC.
1120	Texas Laws	Moves Texas Laws to Section 1112 and updates title to Reserved for Future Use.
1121	Financial, Medical and Social Service Assistance	Deletes section.
1130	Texas Rule and Regulation Authority	Changes title to Burden of Proof. Adds policy on burden of proof in fair hearings.
1131	Authority and the Right to Appeal	Deletes section. Moves information on HHSC authority and appeals to new section 1112.2.
1140	Definitions	Changes title to Private (Ex Parte) Communication. Removes definitions and updates and adds policy on Private (Ex Parte) Communication.
1150	Judicial Notice	Adds a new section on judicial notice.
1160	Obtaining a Legal Opinion or Clarification	Adds a new section on obtaining a legal opinion or clarification.
1170	Requesting a Case File	Adds a new section on how appellants can request a case file. Incorporates information formerly in section 1562.3.
1180	Records and Confidential Information	Adds a new section on Records and Confidential Information.
1181	Privileges	Adds a new section on privileged information.
1182	Public Access to Decisions	Adds a new section and subsections on Public Access to Decisions.
1182.1	Confidential Information	Adds new section detailing what qualifies as confidential information, incorporating information formerly in Section 1900.
1182.2	Disclosure of Hearings Recordings and Records	Adds new section detailing recordings of hearings incorporating information previously in Section 1932.
1183	Official Record	Adds a new section detailing the official record of a hearing.
1184	Record Retention	Adds a new section on hearings record retention incorporating information previously in Section 1950.
1185	Prohibition of Use of Information Regarding Alien Status	Adds a new section on alien status disclosure using information formerly in Section 1960.
1190	Decision Reviews	Adds a new section detailing hearings managers’ responsibility to review decisions.
1200	Notice	Updates title to Participant Rights, Roles and Responsibilities.
1210	Notice of Proposed Adverse Action	Updates title to Hearings Officer. Adds new section information. Deletes adverse action information and moves it to Section 1310.
1211	Hearings Officer's Powers, Duties and Responsibilities	Adds a new section on Hearings Officer's Powers, Duties and Responsibilities.
1212	Limitation of Authority of Hearings Officers	Adds a new section on Limitation of Authority of Hearings Officers.
1220	Content of Notice	Changes title to Agency and creates subsections. Moves notice requirement information to Section 1300.
1221	Agency Responsibilities	Adds a new section on agency responsibilities using information formerly in Section 1562.5.
1230	Right to a Fair Hearing	Changes section title to Appellant. Moves information on the right to a fair hearing to Section 1410.
1231	Appellant’s Rights	Adds a new section on appellant’s rights.
1232	Appellant’s Responsibilities	Adds a new section on appellant’s responsibilities incorporating information formerly in Section 1562.4.
1240	Time Period for Requesting a Fair Hearing	Updates section information and title to Attorney-involved Hearings. Moves fair hearing information to Section 1420.
1250	Media	Adds a new section on media representatives.
1260	Interpreters	Adds a new section on interpreters using information formerly in Section 1580.
1261	Right to Request an Interpreter	Adds a new section detailing an appellant’s right to request an interpreter. Incorporates information formerly in Section 1583.
1262	Determination of Necessity for Interpreter	Adds a new section on how to determination the necessity for an interpreter using information from Section 1584.
1263	LEP Interpreters	Adds a new section on interpreters for appellants with limited English proficiency.
1264	Sign Language Interpreters	Adds a new section on sign language interpreters.
1265	Requirements for Interpreters	Adds a new section on requirements for interpreters.
1266	Procedures for Hearings Officers Related to Interpreters	Adds a new section on procedures for hearings officers related to interpreters.
1266.1	The Role of the Interpreter	Adds new section on the role of the interpreter in a hearing.
1266.2	Interpreter Oaths or Affirmations	Adds new section on the oath administered to interpreters.
1266.3	Curing Inaccuracies	Adds new section on the hearings officer’s responsibility to remedy inaccuracies in the interpretation.
1267	Complaints Regarding Quality of Interpretation	Adds a new section on complaints regarding quality of interpretation.
1300	Submitting a Fair Hearing Request Summary	Updates section title to Notice. Moves fair hearing summary information to Section 1400.
1310	Forwarding the Request to the Hearing Officer	Updates section title to Notice of Proposed Adverse Action and incorporates information that was previously in Section 1210. Moves hearings request information to Section 1440.
1320	Continued Benefits	Changes title to Content of Notice and incorporates information that was formerly in Section 1220. Moves benefits information to Section 1450.
1321	Medicaid	Adds a new section on Medicaid.
1322	Alberto N. Settlement	Adds a new section on Alberto N. Settlement incorporating information formerly in Section 1722.
1323	Nursing Facility Discharge	Adds a new section on nursing facility discharge.
1324	SNAP	Adds a new section on SNAP.
1325	TANF	Adds a new section on TANF.
1330	Agency Action Notice Issues	Adds a new section on agency action notice issues incorporating information previously in Section 1565.
1331	When Appellant Raises a Notice Issue	Adds a new section on when an appellant raises a notice issue using information formerly in Section 1565.1.
1340	Receipt of Agency Notices	Adds a new section on receiving agency notices.
1400	Scheduling the Hearing	Changes title to Submitting a Fair Hearing Request Summary. Moves scheduling information to Section 1500.
1410	Notice of Fair Hearing	Changes title to Right to a Fair Hearing and adds information regarding fair hearings rights. Moves notice information to Section 1510.
1411	Date and Location	Deletes this section.
1420	Exception —Transient/Expedited Appeals	Changes title to Period for Requesting a Fair Hearing. Updates section information. Moves transient and expedited appeals information to Section 1521.
1430	When an Attorney Is Involved	Changes section information and title to Determining Good Cause for Appealing Past 90-Day Period. Moves attorney-involved information to Section 1241.
1431	Time Frames for Processing Requests to Reopen	Deletes this section and moves information to Section 1930.
1440	Continuances/Postponements	Changes title to Creating and Submitting a Fair Hearing Request, and updates information. Moves information on postponements to Section 1560.
1450	Continued Benefits	Adds new section on continued benefits incorporating information that was formerly in Section 1320.
1500	The Hearing	Changes title to Scheduling the Hearing and updates information.
1510	Hearings Officer's Powers and Duties	Changes title to Notice of Fair Hearing. Moves information on hearings officer duties to Section 1211.
1511	Responsibilities	Deletes this section and moves information to Section 1211.
1512	General Duties	Deletes this section and moves information to Section 1211.
1513	Limitation of Authority of Hearings Officers	Deletes this section and moves information to Section 1212.
1514	Preparing for the Hearing	Deletes this section.
1515	Pre-hearing Conference — General	Deletes this section and moves information to Section 1610.
1520	Group Hearings	Changes title to Expedited Hearings. Updates information. Moves group hearings information to Section 1550.
1521	Expedited Hearings for Transient Appeals	Adds new section of Expedited Hearings for Transient Appeals incorporating information formerly in Section 1420.
1522	Expedited Hearings for Individuals Whose Health is Jeopardized	Adds new section on expedited hearings for individuals whose health is jeopardized.
1530	Attendance at Hearing	Changes title to Hearing Setting. Updates section information.
1540	Burden of Proof	Updates title and section information to Attendance at Hearing. Moves burden of proof information to Section 1130.
1550	Private (Ex Parte) Communication	Updates section to Group Hearings and adds information formerly in Section 1520. Moves ex parte communication information to Section 1140.
1560	Conducting the Hearing	Changes title to Continuances or Postponements and adds information formerly in Section 1440. Moves information on conducting the hearing to Section 1700.
1561	Starting the Hearing	Deletes this section. Moves information to Section 1710.
1562	During the Hearing	Deletes this section.
1562.1	Hearings Officer's Responsibility	Deletes this section. Moves information to Section 1211.
1562.2	Appellant's Rights	Deletes this section. Moves information to Section 1231.
1562.3	Requesting a Case File	Deletes this section. Moves information to Section 1170.
1562.4	Appellant's Responsibilities	Deletes this section. Moves information to Section 1232.
1562.5	Agency Responsibilities	Deletes this section. Moves information to Section 1221.
1563	Short Hearings	Deletes this section. Moves information to Section 1760.
1564	Developing the Record	Deletes this section.
1564.1	When the Agency Representative Does Not Appear for the Hearing	Deletes this section. Moves information to Section 1740.
1562.2	When the Appellant Does Not Appear for the Hearing	Deletes this section. Moves information to Section 1750.
1564.2.1	Hearings Held Via a Conference Call	Deletes this section. Moves information to Section 1751.
1564.2.2	Face-to-Face Hearings	Deletes this section. Moves information to Section 1752.
1565	Agency Action Notice Issues	Deletes this section. Moves information to Section 1330.
1565.1	When Appellant Raises a Notice Issue	Deletes this section. Moves information to Section 1331.
1565.2	When Appellant Does Not Raise a Notice Issue	Deletes this section.
1566	Receipt of Program Notices	Deletes this section.
1566.1	Testimony and Evidence	Deletes this section. Incorporates information into Section 1633.
1566.2	Exhibits Offered and Admitted	Deletes this section. Incorporates information into Section 1633.1.
1566.3	Exhibits Offered and Not Admitted	Deletes this section. Incorporates information into Section 1633.3.
1566.4	Exhibits Provided But Not Offered into Evidence	Deletes this section.
1566.5	Duplicates of the Same Exhibit	Deletes this section.
1566.6	Labeling Exhibits	Deletes this section. Moves some information to Section 1633.4.
1566.7	Handling Objections	Deletes this section. Moves information to Section 1633.2.
1566.8	When to Admit Exhibits	Deletes this section and moves information to Section 1633.1.
1567	Closing the Hearing	Deletes this section.
1568	Requesting Additional Documents	Deletes this section and moves information to Section 1634.
1569	Obtaining a Legal Clarification	Deletes this section and moves information to Section 1770.
1570	Recessed Hearings	Deletes this section and moves information to Section 1770.
1571	Example of a Recessed Hearing	Deletes this section and incorporates information into Section 1770.
1580	Interpreters	Deletes this section. Moves interpreter information to Section 1260.
1581	Spanish/English Interpreters	Deletes this section and moves information to Section 1260.
1582	Other Interpreters	Deletes this section and moves information to Section 1260.
1583	Right to Request an Interpreter	Deletes this section and moves information to Section 1260.
1584	Determination of Necessity for Interpreter	Deletes this section and moves information to Section 1260.
1585	When an Interpreter is Not Needed	Deletes this section and moves information to Section 1260.
1586	Requirements for Interpreters	Deletes this section and moves information to Section 1265.
1587	Procedures for Hearings Officers Related to Interpreters	Deletes this section and moves information to Section 1266.
1587.1	The Role of the Interpreter	Deletes this section and moves information to Section 1266.1.
1587.2	Interpreter Oaths or Affirmations	Deletes this section and moves information to Section 1266.2.
1587.2.1	Examples of Conflicts of Interest	Deletes this section.
1587.3	Curing Inaccuracies	Deletes this section and moves information to Section 1266.3.
1588	Complaints Regarding Quality of Interpretation	Deletes this section and moves information to Section 1267.
1600	Evidence	Updates title to Prior to Conducting a Hearing. Moves evidence information to Section 1630.
1610	Discovery	Updates title to Pre-hearing Conference – General. Moves discovery information to Section 1630.
1620	Written Interrogatories	Updates title to Special Hearing Situations. Moves written interrogatories to Section 1632.
1621	Hearings for Programs with Program Cost Limits	Adds this new section.
1621.1	Exceptional Circumstances	Adds this new section.
1622	Hearings Concerning Overpayments	Adds this new section.
1630	Evidence	Updates section to Discovery, Evidence, and Exhibits. Incorporates information from former Section 1566.
1631	Discovery	Adds this new section incorporating information from former Section 1610.
1632	Written Interrogatories	Adds this new section using information previously in Section 1620.
1633	Evidence	Adds this new section.
1633.1	Exhibits Admitted	Adds this new section using information previously in Section 1566.2.
1633.2	Handling Objections	Adds this new section using information previously in Section 1566.7.
1633.3	Exhibits Not Admitted	Adds new section with information moved from Section 1566.3.
1633.4	Labeling Exhibits	Adds this new section using some information from former Section 1566.6.
1634	Requesting Additional Documents	Adds new section incorporating information from Section 1568.
1640	Additional Medical Assessment	Deletes this section.
1700	Decisions	Updates title to Conducting the Hearing. Moves decision information to Section.
1710	Decision Process	Changes title to Starting the Hearing incorporating information formerly in Section 1561.
1711	Time Frames	Deletes this section. Moves information to Section 1820.
1720	Decisions	Changes title to Invoking the Rule and adds new information. Moves decisions information to Section 1800.
1721	Components of a Hearing Decision	Deletes this section and moves information to Section 1840.
1721.1	Signing the Hearings Decision	Deletes this section and moves information to Section 1870.
1722	Hearings Covered by the Alberto N. Settlement	Deletes this section and moves information to Section 1322.
1723	Delays in Issuing a Decision	Deletes this section and moves information to Section 1830.
1724	Dismissals	Deletes this section.
1724.1	Appellant Did Not Appear Initial Dismissal	Deletes this section and moves information to Section 1750.
1724.2	Determining Good Cause	Deletes this section and moves information to Section 1921.1.
1724.3	Action on Good Cause Statement	Deletes this section and moves information to Section 1921.2.
1724.4	Past 90-day Time Frame	Deletes this section and moves information to Section 1430.
1725	Withdrawn Appeals	Deletes this section and moves information to Section 1862.1.
1725.1	Oral Withdrawal Received During the Hearing	Deletes this section and moves information to Section 1862.3.
1725.2	Reserved	Deletes this section.
1725.3	If an Appellant Dies During the Appeal Process	Deletes this section and moves information to Section 1862.4.
1726	Reversed Appeals	Deletes this section and moves information to Section 1863.
1727	Sustained Appeals	Deletes this section and moves information to Section 1864.
1728	Request to Reopen	Deletes this section and moves information to Section 1920.
1729	Amended or Re-issued Decision	Deletes this section and moves information to Section 1940.
1730	Hearing Manager Responsibilities	Changes title to Controlling the Hearing and incorporates information previously in Section 1560.
1731	When a Party Disconnects from the Hearing	Adds new section on disconnection policies.
1731.1	If All Parties Disconnect from the Hearing	Adds new section on disconnection policies.
1731.2	If Only the Appellant Disconnects from the Hearing	Adds new section on disconnection policies.
1731.3	If Only the Agency Representative Disconnects from the Hearing	Adds new section on disconnection policies.
1734.4	If Only a Witness Disconnects from the Hearing	Adds new section on disconnection policies.
1740	Decision Formats for Certain Decisions	Changes title to When the Agency Representative Does Not Appear for the Hearing and incorporates information formerly in Section 1564. Moves decision formats to Section 1860.
1741	Decisions to Dismiss	Deletes this section
1742	Decisions to Withdraw	Deletes this section
1743	Decisions to Sustain or Reverse	Deletes this section
1744	Sustained and Reversed Decisions for Albert N. or THSteps Appeals	Deletes this section
1745	Decision to Uphold the Original Decision	Deletes this section
1746	Short Form for Reversed Decisions	Deletes this section
1750	Decision Routing	Changes title to When the Appellant Does Not Appear for the Hearing. Moves information formerly in Section 1564.2. Moves decision routing information to Section 1880.
1751	Hearings Held Via a Conference Call	Adds new section incorporating information formerly in Section 1564.2.1.
1752	Face-to-Face Hearings	Adds new section using information formerly in Section 1564.2.2.
1760	Short Hearings	Adds new section using information formerly in Section 1563.
1770	Recessed Hearings	Adds this new section using information from Section 1570.
1771	When a Party Does Not Appear at a Reconvened Hearing	Adds new section incorporating information previously in Section 1564.
1800	Implementing the Hearing Decision	Changes title to Decisions.
1810	Responsibility of the Agency Representative for Implementing Decisions	Changes title to Before Writing the Decision and incorporates information from Section 1720. Moves implementation information to Section 1911.
1811	Delays in Implementing a Hearings Decision	Deletes this section and moves information to Section 1912.
1820	Responsibility of the Agency Representative's Supervisor	Updates section to Decision Issuance Time Frames incorporating information formerly in Section 1711.
1830	Delays in Issuing a Decision	Adds this new section using information formerly in Section 1723.
1840	Components of a Hearing Decision	Adds new section using information formerly in Section 1721.
1850	Writing the Decision	Adds new section incorporating information formerly in Section 1721.
1860	Decision Formats for Certain Decisions	Adds new section incorporating information previously in Section 1740.
1861	Decisions to Dismiss	Adds new section using information formerly in Section 1741.
1862	Decisions to Withdraw	Adds new section using information formerly in Section 1742.
1862.1	Withdrawn Appeals	Adds new section incorporating information formerly in Section 1725.
1862.2	Withdrawal Received Prior to the Hearing	Adds new section using information formerly in Section 1725.
1862.3	Oral Withdrawal Received During the Hearing	Adds new section using information formerly in Section 1725.1.
1862.4	If an Appellant Dies During the Appeal Process	Adds this new section incorporating information formerly in Section 1725.3.
1863	Decisions to Reverse	Adds this new section incorporating information formerly in Section 1726.
1864	Decisions to Sustain	Adds this new section incorporating information formerly in Section 1726.
1870	Signing the Hearing Decision	Adds this new section using information formerly in Section 1721.1.
1880	Decision Routing	Adds this new section using information formerly in Section 1750.
1900	Records and Confidential Information	Changes title to Post-Hearing Activities.
1910	Confidential Material	Changes title to Implementing the Hearing Decision. Move confidential materials information to Section 1180.
1911	Responsibility of the Agency Representative for Implementing Decisions	Adds new section using information formerly in Section 1810.
1912	Delays in Implementing a Hearings Decision	Adds this new section using information formerly in Section 1811.
1920	Privileges	Updates section to Requests to Reopen and moves information formerly from Section 1728. Moves Privileges information to Section 1811.
1921	Request to Reopen Following Dismissal for Failure to Appear	Adds this new section incorporating information formerly in Section 1728.
1921.1	Determining Good Cause for Failure to Appear	Adds this new section incorporating information formerly in Section 1724.3.
1921.2	Action on Reopen Request	Adds new section detailing actions taken on reopen requests.
1922	Request to Reopen Following Sustained Decision	Adds this new section incorporating information previously in Section 1728.
1930	Public Access to Decisions	Changes title to Time Frames for Processing Requests to Reopen.
1931	Confidential Information	Deletes this section and moves information to Section 1182.
1932	Disclosure of Hearings Recordings and Records	Deletes this section and moves information to Section 1182.
1940	Official Record	Changes title to Amended or Re-issued Decision incorporating information previously in Section 1729. Moves official records information to Section 1183.
1950	Record Retention	Deletes this section and moves information to Section 1184.
1960	Prohibition of Use of Information Regarding Alien Status	Deletes this section and moves information to Section 1185.
Appendix II	area Boxes and E-Mail Addresses	Updates title and updates content.
Appendix VI	Decision Issuance Codes	Changes title and updates content.
FFHH Contact Us	FFHH Contact Us	Deletes Appeals Division calling phone number.

Revision Notice 23-2; Effective April 28, 2023

The following changes were made:

Revised	Change
Frequently Asked Questions – Client	Updates the questions and answers.

Revision Notice 23-1; Effective March 22, 2023

The following changes were made:

Revised	Change
Frequently Asked Questions – Client	Updates the questions and answers.

Revision Notice 22-1; Effective February 23, 2022

The following changes were made:

Revised	Change
Frequently Asked Questions – Client	Updates the questions and answers.