Revision 15-4; Effective October 1, 2015

All Programs

A request for a hearing is a clear expression, oral or written, by the household or its representative that indicates that the household wishes to appeal a decision. The freedom to make a request for a hearing must not be limited or interfered with in any way.

If any member of a household or the household's representative expresses dissatisfaction with a decision regarding benefits or services, the advisor takes the following actions:

• Explain the basis for the decision and the applicable policies;
• Provide the household an opportunity to have a conference with the supervisor;
• Provide the household an opportunity to request a fair hearing;
• Provide the individual with copies of all documents before the hearing that will be entered into evidence during the fair hearing; and
• Consult with the supervisor if the individual requests information the advisor considers confidential. Note: The individual is entitled to any information that was used to determine suspension, reduction or termination of benefits. See B-1210, Disclosure of Information, for information that is considered to be confidential.

The household or the household's representative must make a request to withdraw an appeal in writing. Staff must fax the written withdrawal request to the designated hearings office. If a written withdrawal request is not obtained, staff must notify the hearings officer via email. If email is not an option, staff must notify the hearings officer via fax or phone.

SNAP

If the household requests a conference with the supervisor after a denial for expedited service, the advisor must schedule the conference within two workdays of the request, unless the household prefers a later date. The advisor must document that the household requested a later date.

Revision 15-4; Effective October 1, 2015

All Programs

Individuals have the right to appeal within 90 days from the effective date of any Texas Health and Human Services Commission (HHSC) action. The individual's request may be oral or in writing.

Advisors may not prevent an individual from filing an appeal, even if the appeal was not requested within 90 days from the effective date of the action. Only the hearings officer has the authority to decide the timeliness of filed appeals and can accept untimely filed appeals in order to determine whether there was good cause for the delay in filing the appeal.

SNAP

The household may appeal the denial of a request to restore benefits that were lost within one year before the request. In addition, a household may appeal its current level of benefits during a certification period.

Revision 15-4; Effective October 1, 2015

All Programs

All fair hearing requests are processed in the State Portal. The local office staff (including Customer Care Center [CCC] staff) and Centralized Representation Unit (CRU) staff have separate responsibilities and must follow the following procedures when processing fair hearing requests and appeals.

B—1031 Local Office Procedures for Hearing Requests

Revision 15-4; Effective October 1, 2015

When any member of a household or the household's representative expresses dissatisfaction with a decision regarding benefits or services, the local office staff takes the following actions:

• Review the Eligibility Determination Group (EDG) to determine accuracy of the action;
• Take action to correct any agency error that results in an increase in benefits;
• Clearly document any discovered error and the action taken to correct the error;
• Explain the basis for the decision and the applicable policies to the individual;
• Provide the individual an opportunity to have a conference with the supervisor (including a conference within two workdays for an individual who wants to contest an expedited services decision); and
• Provide the individual an opportunity to request a fair hearing.

The same day a fair hearing request is received:

• in person, over the telephone or in writing — the advisor/supervisor enters the fair hearing request with the Add New Appeal tab in the State Portal Appeals/RFR (Request for Revision). These entries automatically create an Appeal Request for (Program/TOA) for CRU staff.
• by fax or mail — the advisor/supervisor faxes or mails the appeal using the fair hearing cover sheet to the expedited fax line (1-866-559-9628) for processing. The advisor must not:
  • complete and submit Form H4800, Fair Hearing Request Summary;
  • enter the fair hearing request in State Portal; or
  • enter the fair hearing request through left navigation in the Texas Integrated Eligibility Redesign System (TIERS).
• advisors must consult with the supervisor if the individual requests information staff considers confidential.

B—1031.1 Office of Attorney General (OAG) Child Support Division Region Contacts

Revision 15-4; Effective October 1, 2015

OAG Region	Primary Contact	Secondary Contact	Physical Mailing and Centralized Email Addresses
1 Lubbock	Angelia Gregg 806-761-4715 Fax: 806-763-7579	Renee DeLaRosa 806-761-4704 Fax: 806-763-7579	4630 50th Street, Ste 500 Lubbock, TX 79414-3521 OAGarea1.FairHearing@texasattorneygeneral.gov
2 San Antonio	Vanessa Vasquez 210-804-6488 Fax: 210-930-3625	Martin Martinez 210-804-6489 Fax: 210-930-3625	3460 Northeast Parkway San Antonio, TX 78218-3304 OAGarea2.FairHearing@texasattorneygeneral.gov
3 McAllen	Anna Rangel 956-926-4524 Fax: 956-631-2451	Vacant	3331 N. McColl Road McAllen, TX 78501-5536 OAGarea3.FairHearing@texasattorneygeneral.gov
4 Dallas	Nancy Hernandez 214-915-3721 Fax: 214-915-3750	Oscar Sanchez 214-915-3720 Fax: 214-915-3750	400 South Zang Blvd. Ste. 1100 Dallas, TX 75208-6646 OAGarea4.FairHearing@texasattorneygeneral.gov
5 Tyler	Christy Cates 903-533-4005 Fax: 903-592-5732	Glen Elliott 903-533-4009 Fax: 903-592-5732	200 N. Broadway Avenue, Ste 355 Tyler, TX 75702-5747 OAGarea5.FairHearing@texasattorneygeneral.gov
6 Houston	Mark Jones 713-948-7673 Fax: 713-910-4806	Melissa Jimenez 713-787-7146 Fax: 713-789-7665	8866 Gulf Freeway, Ste 200 Houston, TX 77017-6529 OAGarea6.FairHearing@texasattorneygeneral.gov
7 Austin	Patricia Roark 512-358-3242 Fax: 512-892-8967	Annette Hernandez 512-358-3249 Fax: 512-892-8967	2512 S IH 35 Ste 200 Austin, TX 78704-5751 OAGarea7.FairHearing@texasattorneygeneral.gov
8 El Paso	Lorraine Sanchez-Rayas 915-782-4211 Fax: 915-782-4276	Barbara Ramirez 915-782-4236 Fax: 915-782-4276	6090 Surety Dr., Ste 250 El Paso, TX 79905-2062 OAGarea8.FairHearing@texasattorneygeneral.gov
9 Ft. Worth	Elizabeth House 817-834-7048 Fax: 817-834-7066	Kelly Robison 817-834-7038 Fax: 817-834-7066	2001 Beach St. Ste 700 Ft. Worth, TX 76103 Regional email not yet established

OAG – Counties Served by Each Area

 

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

B—1031.2 Providing Form H4800-A, Fair Hearing Request Summary (Addendum), to Hearings Division

Revision 17-1; Effective January 1, 2017

Form H4800-A, Fair Hearing Request Summary (Addendum), provides a method to send documents or evidence used in a hearing that were not sent with the original submission and to report changes of address or other corrections to the appropriate hearings officer.

B—1032 Centralized Representation Unit (CRU)

Revision 15-4; Effective October 1, 2015

The CRU is a staff unit within Eligibility Services Support (ESS) that represents HHSC in fair hearings and implements hearing officers' decisions.

B—1032.1 Centralized Representation Unit (CRU) Staff Responsibilities

Revision 15-4; Effective October 1, 2015

CRU staff completes the following actions:

• claim the Appeal Request for (Program/TOA) task from the Task List Manager (TLM) Global Queue;
• review the EDG to determine if any correction is needed and take appropriate action;
• prepare the evidence packet and mail to the Document Processing Center (DPC) for imaging;
• ensure the hearing procedures are explained in a language the individual understands;
• mail a copy of the evidence packet to the individual, legal representative, authorized representative and any other witnesses participating in the hearing;
• create and send a fair hearing request in TIERS;
• enter in TIERS any necessary accommodations; and
• mark the task as Task Completed.

Once the fair hearings request has been scheduled by Hearings Division staff, a Fair Hearing Appointment for a (Program) Case task will be routed to the Fair Hearings Centralized Representation Unit TLM Global Queue.

CRU will:

• assign an agency representative for each hearing;
• attend the fair hearing as the agency representative; and
• present the agency's case by explaining the action being appealed, the documents submitted and how the agency policy applies to the issue(s) on appeal.

B—1033 Appeals Related to Decisions/Actions of an Electronic Benefit Transfer (EBT) Vendor

Revision 14-2; Effective April 1, 2014

All Programs

When an EBT vendor cannot resolve an account balance dispute or error resolution related to benefits to an individual's satisfaction, the vendor refers the individual to Lone Star Business Services (LSBS) for a second review. The individual may contact LSBS staff to request a fair hearing if still not satisfied with the results of the second review. CRU processes the appeal following the policy and procedures outlined in this section.

B—1034 Appeals Related to Services for Medicaid Recipients

Revision 15-4; Effective October 1, 2015

All Programs

The Texas Department of State Health Services (DSHS) handles appeals concerning specific services for Medicaid recipients including:

• lock-in;
• medical necessity for prior authorization of services; and
• denial, termination, suspension or reduction of covered services, or payment for services rendered.

For individuals who want to appeal service-related issues, staff must refer them to DSHS. DSHS individual notification letters include an address and telephone number for requesting appeals. Individuals who do not have a notification letter should be referred to the Medicaid Hotline at 1-800-252-8263.

Note: DSHS does not allow individuals to appeal decisions made by the Health Insurance Premium Payment (HIPP) program. To obtain assistance in resolving problems or issues with the HIPP contractor:

• individuals must contact the Medicaid Hotline at 1-800-252-8263.
• staff must contact the Third-Party Resource (TPR) Unit at 1-800-846-7307.

B—1035 Appeals Related to Accounts Receivable Tracking System (ARTS)

Revision 15-4; Effective October 1, 2015

All Programs

For all individual requests for appeals related to ARTS collection notices, the advisor must make the following entries on Form H4800, Fair Hearing Request Summary:

1. In the From box, if the appeal is regarding a:
   • Claims Investigation (CI) collection notice, enter the CI unit supervisor, mail code, and phone number.
   • Treasury Offset Program (TOP) collection notice, enter ARTS Hearing Representative, 512-406-3800, at mail code E-411.

   Note: If the individual does not know if the collection notice is a result of a CI claim or TOP, enter the CI unit supervisor.

2. In Section 1, Program, check the appropriate program box.
3. In Section 2, Agency Action Resulting in a Hearing Request, check D, Not Benefit Amount Related. This will indicate to the hearing officer that the appeal does not affect current benefits.
4. In Section 8, Summary of Agency Action and Applicable Handbook Reference(s) or Rules, enter the following message: "Collection Notice - Overpayment Claim" (See B-700, Claims).

The advisor must notify the appropriate Claims Investigations Unit supervisor and ARTS supervisor of the hearing request. The advisor sends a copy of Form H4800 to the local Claims Investigation Unit supervisor or the ARTS supervisor, as appropriate, and faxes a copy of Form H4800 to ARTS at 512-438-3061.

Revision 15-4; Effective October 1, 2015

All Programs

Hearing decisions must comply with federal law and regulations and be based on the evidence and testimony of the hearing.

Once the fair hearing has been held and a decision rendered, the hearings officer records the decision in TIERS, and a TLM task is created and routed to the Fair Hearings Centralized Representation Unit TLM Global Queue for processing.

1. If the decision is reversed, a Process Fair Hearings Reversal Decision for (Program/TOA) TLM task is created and routed to the CRU TLM Global Queue.
2. If the decision is sustained, a Fair Hearings Sustain Decision for (Program/TOA) task will be created and routed to the CRU TLM Global Queue for processing.
3. A Fair Hearings Decision Issued for (Program/TOA) task will be created for issued decisions that do not typically require an agency action.

CRU will follow these procedures to timely implement the hearing officer's instructions:

If the hearing decision results in restored benefits, an increase in benefits for the current month and/or future months, and ...	then ...
no additional information or verification is needed,	ensure within 10 days from the date the decision task is received that: benefits for future months are increased, and all benefits the household is entitled to are provided. Authorize restored Temporary Assistance for Needy Families (TANF) benefits in Eligibility or by manual issuance within 10 days from the date Form H4807, Action Taken on Hearing Decision, is received.
additional information or verification is needed,	send the individual Form H1020, Request for Information or Action, within 10 days from the date the decision task is received. List on Form H1020 the specific information/verification needed in order to provide benefits.   If the individual: provides all of the requested information and verification, then increase benefits for future months and/or provide benefits for the current/past months within three workdays from receipt of the information/verification; provides part but not all of the requested information and verification, then increase benefits for future months and/or provide benefits for each month for which information/verification is provided within three workdays of receipt of the remaining information/verification; or fails to provide the requested information and/or verification, then follow the normal eligibility determination process in B-600, Changes, and complete/deny the EDG without the missing information/verification.

 

Notes:

• Upon the individual's request, CRU will offer reasonable assistance in obtaining the necessary verification. The individual's statement is acceptable as verification if no other documentary or collateral information is available.
• Restored benefits are not denied for any months solely because a person outside the household refuses to cooperate in providing verification.

SNAP

• Benefits are not restored for any months more than 12 months prior to the date a fair hearing was requested.
• If the hearing officer authorized restored benefits, TIERS sends Form H1825, Entitlement to Restored Benefits, to the household, along with a copy to the hearing officer, when benefits are approved either in Eligibility or by manual issuance.

 

B—1041 Completing and Reporting Timely Action on Fair Hearings

Revision 15-4; Effective October 1, 2015

SNAP

Once all restored and/or supplemental benefits have been issued, the advisor must:

• enter all decision implementation information in TIERS in the Decision Implementation page;
• clear any delays entered in the Implementation Delay page; and
• enter all necessary information in the Implementation Details page and submit for supervisor review.

The supervisor must:

• review the EDG information and all supporting documentation in accordance with agency procedures and time frames; and
• approve the Implementation Details page.

Revision 01-3; Effective April 1, 2001

 

 

B—1051 Continued Benefits

Revision 15-4; Effective October 1, 2015

All Programs

Households previously certified for ongoing benefits are entitled to continued benefits if they make a timely request for a fair hearing after receiving Form TF0001, Notice of Case Action. A request is timely if it is made within 13 days of the adverse action notice (including a mailed request postmarked during the 13-day period). If a household fails to make a timely request for a hearing, but has good cause for the failure, benefits are reinstated at the previous level if the household did not waive its right to continue benefits.

TANF and Medical Programs

Households receiving an adequate notice of adverse action are not entitled to continued benefits when benefits are lowered or denied because of reasons listed in A-2344.1, Form TF0001 Required (Adequate Notice).

Exception: If the household received a notice of adverse action based on noncompliance with child support or Choices, continued benefits are allowed if the individual timely requests a fair hearing.

SNAP

Households receiving a notice of adverse action are not entitled to continued benefits when benefits are lowered or denied because of:

• a verbal request to voluntarily withdraw, conducted in the advisor's presence;
• verification provided by the household that was previously postponed during expedited services;
• the household's failure to provide verification postponed during expedited services; or
• the expiration of the certification period.

 

B—1052 Waiver of Continued Benefits

Revision 13-3; Effective July 1, 2013

All Programs

The household may waive its right to continued benefits by providing a signed and dated statement to this effect. If the household waives this right, TIERS will reduce or deny benefits when the 13-day notice period (plus 2 days mail time) expires in advance notice situations.

 

B—1053 Reducing or Ending Benefits Before the Hearing Decision

Revision 15-4; Effective October 1, 2015

All Programs

Continued or reinstated benefits must not be reduced or denied during the appeal period before the official hearing decision unless:

• another change adversely affects the household and the household does not appeal the adjustment for the later change. Benefits are reduced based on the change, and the advisor sends Form TF0001, Notice of Case Action.
• a mass change affects the household's eligibility. Benefits should be adjusted accordingly.

SNAP

When a certification period expires and the household reapplies, the EDG is certified at the appropriate level of benefits.

If the hearing officer determines the only issue being appealed is federal law or regulation and there are no computation errors or misapplied law, the hearing officer instructs the advisor to reduce or deny benefits as required by the policy change.

 

B—1054 Time Frame to Stop Providing Continued Benefits

Revision 15-4; Effective October 1, 2015

All Programs

When a hearing officer’s decision sustains the agency action, CRU must take action to stop continued benefits and file a claim for any overpayment within 10 days of receiving the hearing decision and order. Advance notice is not provided. If the hearing decision and order are received within 10 days before cutoff, CRU must make every attempt to process the EDG action before cutoff to prevent issuing continued benefits in the next month.

Revision 15-4; Effective October 1, 2015

All Programs

Fair hearings may be conducted by telephone. However, an appellant may still request a face-to-face hearing. Upon requesting a face-to-face hearing, the appellant is notified of the date, time and location of the hearing using Form H4803, Notice of Hearing.

There are two versions of Form H4803 that indicate how a fair hearing is conducted:

If the fair hearing is scheduled using ...	then ...
Form H4803-T/H4803-TS, Notice of Hearing,	the hearing officer calls the appellant, the agency representative and all other fair hearing participants at the time, date and telephone number indicated on the form.
Form H4803-P, Notice of Hearing,	the appellant, agency representative and all other fair hearing participants must call the Fair Hearing 1-800-Call-In number, using the toll-free number and access code at the scheduled time indicated on the form.

Revision 15-4; Effective October 1, 2015

All Programs

Effective September 1, 2007, if an individual expresses dissatisfaction with a decision rendered by the fair hearings officer, the individual may have the right to have the decision reviewed. The types of review to which the individual may be entitled are an administrative review and a judicial review, depending on which program is appealed.

If the individual or individual's authorized representative is dissatisfied with a …	then the individual is entitled to an administrative review.	then the individual is entitled to a judicial review.
Supplemental Nutrition Assistance Program (SNAP) or Medicaid fair hearing decision,	Yes	Yes
TANF fair hearing decision,	Yes	No
SNAP administrative disqualification hearing (ADH) decision,	Yes	Yes
TANF ADH decision,	No	Yes

 

B—1071 Administrative Review

Revision 15-4; Effective October 1, 2015

All Programs

An administrative review is a review of the hearing record conducted by an agency attorney to determine if the hearing officer's decision was correct. The agency attorney issues a new decision, which includes the hearings officer's signature in all administrative reviews, and this decision is the agency's final action. Administrative reviews apply to SNAP, TANF and Medicaid fair hearing decisions and SNAP ADH decisions.

If the individual or individual's authorized representative is dissatisfied with a fair hearing decision issued on or after September 1, 2007, an administrative review may be requested but must be submitted in writing within 30 calendar days from the date of the hearing officer's decision. The request for an administrative review must be mailed to the following address:

Hearings Administrator
P.O. Box 149030, Mail Code W-613
Austin, TX 78714-9030

Notes:

• For TANF fair hearings, the individual's request for an administrative review only requires that the agency attorney review the hearing record for procedural and programmatic accuracy. The case is returned to the fair hearing officer for the final decision.
• An administrative review of the fair hearing or ADH decision by an agency attorney must be requested and completed before a judicial review is allowed. Exception: There is no prerequisite for an administrative review for a TANF ADH before a judicial review is requested.

 

B—1071.1 Centralized Representation Unit (CRU) Staff Responsibilities Following an Administrative Review

Revision 15-4; Effective October 1, 2015

All Programs

CRU Staff

When a fair hearing decision is reversed because of an administrative review, the agency must take action on the agency attorney's decision, as described in B-1040, Timely Action on Fair Hearings.

CRU:

• completes actions as required by the administrative review decision; and
• notifies the agency attorney and hearing officer that the required action has been completed.

Note: Continued benefits are not provided if the hearing officer sustains the agency action.

CRU Supervisory Staff

The CRU supervisor reviews the actions taken on the reversal and ensures all actions are complete and correct.

 

B—1072 Judicial Reviews

Revision 15-4; Effective October 1, 2015

All Programs

A judicial review is a review of the hearing decision by the court to determine whether the decision taken by the agency was correct. ADH decisions must be filed by the individual in a district court in Travis County. The court will determine whether the decision of the agency is correct. The individual must file a petition for a judicial review within 30 calendar days after the date the administrative review decision is rendered. The individual must complete the administrative review process before filing a petition for a judicial review.

An individual dissatisfied with a TANF ADH decision has the right to file for a judicial review in the district court in the county in which the violation occurred no later than the 30th calendar day after the date the hearing officer makes the determination.

Exception: There are no judicial review rights for a TANF fair hearing decision, but the appellant may still request a procedural review of the hearing officer's decision. A procedural review is a review of the hearing record by an agency attorney to ensure procedural and programmatic accuracy.

 

B—1072.1 Agency Staff Responsibilities Following a Judicial Review

Revision 15-4; Effective October 1, 2015

All Programs

Local Office and CCC Staff

If the agency's decision is reversed as a result of a judicial review, staff must implement the decision within the time frames as specified within the final orders of the court.

Note: Continued benefits are not provided due to a request for a judicial review.

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must verify that the household waived its right to continued benefits according to B-1052, Waiver of Continued Benefits.

Related Policy

Questionable Information, C-920
Providing Verification, C-930

Revision 15-4; Effective October 1, 2015

All Programs

Advisors must document the reason why the household is not entitled to continued benefits according to B-1051, Continued Benefits.

Related Policy

Documentation, C-940
The Texas Works Documentation Guide