2910 People’s Right to Appeal and Request a Fair Hearing

Revision 25-2; Effective March 31, 2025

26 Texas Administrative Code (TAC) Section 271.155

(a) An applicant or person may request an appeal of any decision that denies, reduces, or terminates their benefits.
(b) A person is entitled to be notified 10 calendar days before any reduction or termination of their services, or to have the notification mailed 12 calendar days before the date of reduction or termination. If a person threatens their own health or safety or that of others, purchased services may be terminated without advance notice.

Inform the applicant or person in writing by sending Form 2065-A, Notification of Community Care Services, about their right to request a fair hearing if services are denied, reduced or terminated. A person may appeal their dissatisfaction concerning

  • ineligibility for services;
  • the tasks within a service;
  • the amount or number of units of service the person will receive;
  • the amount of the copayment for Residential Care; or
  • the denial or termination of the priority status.

A person also may appeal when they request a new service or requests an increase in the number of tasks or units of service, and the request is not acted on within required time limits.

To request a hearing, a person may return Form 2065-A with a check mark in the appropriate box. The person may also make a verbal or written request for a fair hearing.

A person must request a fair hearing within 90 calendar days from the date of the action they want to appeal. To continue receiving benefits until the hearings officer gives a decision, the person must request the fair hearing before the effective date shown on Page 1 of Form 2065-A. In situations where services were terminated because of threats to the health or safety of another person, the person is not entitled to continued services even if appealed before the effective date shown on Page 1 of Form 2065-A. Review 2811, Effective Dates, and Appendix IX, Notification/Effective Date of Decision, for guidance on effective date of termination if the person is not entitled to continued benefits.

When a fair hearing is requested after the 90-calendar day period, HHSC staff may not prevent an applicant or person from filing an appeal because they believe the appeal was not requested within the required number of days. If a fair hearing request is received after 90-calendar days from the date of the notice, the caseworker must follow current procedures to file the appeal. The hearings office makes the decision about the person’s right to appeal.

The hearings officer is the final authority about the timeliness of appeal requests and accepts appeals filed after the time limit to determine if there was good cause for the delay in filing.

2911 Notice to the Provider for Continuing Services

Revision 24-3; Effective July 1, 2024

If the person appeals before the effective date on Page 1 of Form 2065-A, Notification of Community Care Services, the caseworker must continue services at the current level pending the hearings officer’s decision unless denial is based on threats to health and safety. Review 2840, Threats to Health and Safety. The caseworker must complete a new Form 2101, Authorization for Community Care Services, in the Service Authorization System Online (SASO) reinstating services at the current level within three business days after receipt of the request for a fair hearing. The caseworker sends Form 2101 to the provider notifying them to provide services at the current level until the hearing officer’s decision is rendered. The Begin Date of services is the day after the termination date or reduction date on the previous Form 2101. The caseworker also sends Form 2067, Case Information, informing the provider to reinstate services pending the hearing officer’s decision.

Example 1: At the annual reassessment, the caseworker determines that the Primary Home Care personal attendant services (PAS) hours must be reduced from 20 to 15 hours per week. The caseworker sends Form 2065-A to the person and Form 2101 to the Home and Community Support Services Agency (HCSSA) as notification of the reduction in hours. The person appeals before the effective date of the case action. The caseworker authorizes PAS at 20 hours per week until the hearings officer’s decision is rendered.

When all services are terminated, such as at the annual reassessment when the person does not meet eligibility criteria, caseworkers must continue services at the current level when the person files an appeal before the effective date.

Example 2: At the annual reassessment, a Family Care person is terminated due to scoring 21 on Form 2060, Needs Assessment Questionnaire and Task/Hour Guide. The caseworker sends Form 2065-A to the person and Form 2101 to the provider as notification of the termination of services. The person appeals before the effective date of the case action. The caseworker authorizes services at the same level as the previous Form 2101 authorization.

When the person submits a clear, written statement requesting services stop during the appeal process, the caseworker sends Form 2067 to the provider with an effective date to stop service delivery. The caseworker does not send the person another Form 2065-A.

HHSC does not continue services during the appeal process if Medicaid eligibility has been terminated unless Medicaid eligibility is reinstated during the appeal period. Refer to 3441, Loss of Categorical Status or Financial Eligibility, and 2932, Coordination of Fair Hearings with MEPD Utilizing OES CRU, for procedures related to Medicaid terminations and continuation of services.

2912 Special Procedures for Denials of Community Attendant Services (CAS) People

Revision 25-2; Effective March 31, 2025

Denials of CAS people must be coordinated with both the HHSC regional nurse and with the Medicaid for the Elderly and People with Disabilities (MEPD) specialist. If the HHSC caseworker denies the person based on functional need, Form H1746-A, MEPD Referral Cover Sheet, must be sent to advise MEPD of the denial.

If the person appeals the denial, another Form H1746-A must be sent to MEPD advising that services will be reinstated pending the fair hearings officer’s decision. MEPD must also be notified on Form H1746-A when a decision is rendered.

If the change that prompted the request for an appeal on a Community Attendant Services decision occurred in the course of an annual reassessment, use Form 2067, Case Information, to notify the provider and the HHSC regional nurse. The HHSC regional nurse submits Form 2101, Authorization for Community Care Services, to reinstate services.

2913 Coordinating with Utilization Review for Fair Hearing Requests as a Result of Utilization Review Findings

Revision 24-3; Effective July 1, 2024

HHSC caseworkers must notify the utilization review (UR) nurse and UR regional manager when an applicant or person has requested a fair hearing because of UR findings for concurrent reviews.

Caseworkers must follow normal time frames and procedures for implementing UR findings following receipt of a UR tool indicating a case action is required. When the action is completed for an addition or increase in services or termination or decrease in services, the caseworker must send a notice to the applicant or person notifying them of the case action. The applicant or person has the option to appeal the case action indicated on the notice. Caseworkers must follow current policies and procedures for continuation of services pending an appeal.

If the applicant or person requests a fair hearing, the caseworker must inform the UR nurse who completed the review and UR regional manager by email that a fair hearing has been requested because of the UR findings. The caseworker completes Form H4800, HHSC Fair Hearing Request Summary, and sends the form to the Hearing Division and supervisor within three days of the request for a hearing.

On Form H4800, the caseworker lists the UR nurse, Agency Representative, UR regional manager, and Agency Representative Supervisor. The caseworker may be listed. The caseworker must confirm the correct UR nurse and UR regional manager to list on the form. The caseworker includes the UR nurse whose name is in Section A of the UR tool. The caseworker identifies the name of the UR regional manager by calling the UR nurse or calling the Utilization Management and Review (UMR) manager identified on the UMR website.

The designated data entry representative (DER) is responsible for uploading the caseworker’s fair hearing evidence packet in the Texas Integrated Eligibility Redesign System (TIERS) Fair Hearings and Appeals system. The evidence packet submitted by the caseworker will include the applicable notification form. If available, the caseworker includes the signed notification form returned by the applicant or person. The caseworker does not include any other documentation in the evidence packet.

The UR nurse and UR regional manager develop the fair hearing evidence packet to support the decision made by UR to change the services planned or delivered to the applicant or person. The evidence packet includes a summary of the UR findings and applicable Texas Administrative Code (TAC) rules and policy. The UR representative will upload the evidence packet in TIERS.

Form H4800-A, Fair Hearing Request Summary (Addendum), must be included as the cover sheet for each fair hearing evidence packet. The DER and UR representative must upload the fair hearing evidence packets in TIERS no later than 10 calendar days before the fair hearing date. The caseworker and UR nurse must forward a copy of the fair hearing evidence packets to the applicant or person no later than 10 calendar days before the fair hearing date.

The UR nurse, UR regional manager (optional) and caseworker participate in the fair hearing to admit the fair hearing packets into evidence and provide testimony about the case action.

2913.1 Concurrent Utilization Review When a Fair Hearing is Pending or a Decision Has Been Rendered

Revision 24-3; Effective July 1, 2024

The caseworker must inform the Utilization Review (UR) nurse when a case record is selected for concurrent review and a fair hearing is pending. The caseworker does not submit the case record for concurrent review. UR will replace the case with another randomly selected case record for concurrent review.

The caseworker must inform the UR nurse of the fair hearing decision details when a case record is selected for concurrent review and a fair hearing decision has been rendered during the current plan year. They do this by providing the UR nurse with a copy of the final order submitted by the hearings officer. The caseworker must provide specific information to the UR nurse about the service(s) appealed and the actions the caseworker took to implement the hearings officer’s decision. The caseworker submits the case record for concurrent review following current procedures. The caseworker will follow current policy and procedures for implementing UR findings.

2914 Withdrawal of an Appeal

Revision 25-2; Effective March 31, 2025

An appellant or appellant representative may request to withdraw their appeal verbally by calling the hearings office. A verbal request to withdraw may be accepted by the hearings officer’s administrative assistant or the hearings officer. HHSC staff should advise the appellant or appellant representative to speak directly to the administrative assistant or hearings officer. If the appellant or appellant representative contacts HHSC staff about the withdrawal, HHSC staff must contact the hearings office by conference call with the appellant or appellant representative on the line so the appellant or appellant representative may inform the hearings office of the withdrawal. If the appellant or appellant representative sends a written request to withdraw to HHSC staff, HHSC staff must forward this written request to the hearings office. A fair hearing will not be dismissed based on an HHSC decision to change the adverse action. All requests to withdraw the hearing must originate from the appellant or appellant representative.

If the appellant or appellant representative requests to withdraw their appeal within 14 calendar days of the fair hearing date, the hearings officer will notify HHSC by phone or email and open the conference line to inform participants of the cancellation. If the appellant or appellant representative requests to withdraw their appeal more than 14 calendar days prior to the fair hearing date, the hearings officer will indicate the withdrawal in the Texas Integrated Eligibility Redesign System (TIERS). A written notice will be sent to participants informing them of the fair hearing cancellation.

2920 Request for Increase in Services During an Appeal

Revision 25-2; Effective March 31, 2025

When services are reduced or terminated, such as at the annual reassessment, and the person files an appeal before the effective date of the reduction or termination, the caseworker must continue services at the current level until the hearings officer’s decision is rendered. If the person requests increased services pending the hearings officer’s decision, the caseworker cannot process the request. Within 14 calendar days of the request, the caseworker must send the person Form 2065-A, Notification of Community Care Services. They must explain the request for increased services is denied pending the hearings officer’s decision and may be reviewed for authorization once the hearings officer’s decision is rendered, if the person is determined eligible.

2930 Fair Hearing Procedures

Revision 25-2; Effective March 31, 2025

All fair hearings are processed through the Fair and Fraud Hearings section of the Appeals Division of the Texas Health and Human Services Commission (HHSC). The appeals division receives appeal requests from applicants and people contesting actions taken for benefits and services of various programs. These include the Supplemental Nutrition Assistance Program formerly known as the Food Stamp Program, Temporary Assistance for Needy Families, all Medicaid-funded services, and other agency programs required by state or federal law, or rules, to provide the right to a fair hearing. Hearings officers conduct hearings, consider evidence and issue decisions per rules, regulations and state and federal law.

Review the HHSC Fair and Fraud Hearings Handbook for specific information about the HHSC rules and requirements governing the fair hearings process.

2931 Processing Fair Hearing Requests Using TIERS

Revision 25-2; Effective March 31, 2025

When a request for a fair hearing is received from an applicant or person verbally or in writing, the Texas Health and Human Services Commission (HHSC) must refer the request to the hearings officer within five calendar days from the date of the request. Information is not mailed to the hearings officer but is entered into the Texas Integrated Eligibility Redesign System (TIERS) Fair Hearings and Appeals system by the designated data entry representative.

Upon receipt of the fair hearing request, the caseworker completes Form H4800, Fair Hearing Request Summary.

The caseworker sends Form H4800 to the Hearing Division and the supervisor within three calendar days of the request for a hearing. The three-day time frame allows the data entry representative two days to enter the information into the TIERS system. See the Form H4800 Instructions for specific directions for completion and transmittal.

Designated Data Entry Representative Procedures

Within two calendar days of receipt of Form H4800, the data entry representative enters the information into the Fair Hearings and Appeals system in TIERS. When the entry of all the information is completed, the system assigns the appeal identification (ID) number. The data entry representative will note the appeal ID number on the bottom of the form and in the designated space on the front of the form and send a copy back to the caseworker and supervisor.

HHSC Fair Hearings and Appeals Procedures

The TIERS system will generate a hearing packet which includes Form H4803, Notice of Hearing, and Form H4800. The caseworker and supervisor receive a copy of Form H4800 and the letter identifying the hearings officer assigned and information on the time and location for the hearing. It is the supervisor's responsibility to ensure that the caseworker or a designated representative participates in the hearing and is sufficiently prepared and knowledgeable about the case to represent the agency during the fair hearing process.

If Form H4800 has already been submitted into TIERS and there are subsequent changes such as address changes, participant updates, withdrawal forms or supporting documents needed for a fair hearing, the caseworker completes Form H4800-A, Fair Hearing Request Summary Addendum, with the updated information and submits it to the data entry representative.

The data entry representative must check TIERS for the fair hearings officer assigned to the case. If a fair hearings officer is not yet assigned, the data entry representative must wait until one is assigned to send the additional information. When sending information, the data entry representative completes the following activities according to the situation:

  • When Form H4800-A is completed informing the fair hearings officer of address changes, participant updates and withdrawal forms, the data entry representative sends Form H4800-A directly to the hearings officer’s email address. The caseworker must enter the appeal ID number in the subject line.
  • When the data entry representative submits supporting documentation for an appeal, they upload the information directly into TIERS and send the hearings officer an email with Form H4800-A attached. The caseworker must enter the appeal ID number in the subject line. The email must also inform the hearings officer that supporting documentation listed in Section 2 of Form H4800-A has been uploaded in TIERS. The caseworker and data entry representative must follow current time frames and procedures to ensure supporting documentation is uploaded into TIERS no later than 10 calendar days before the fair hearing date.

2932 Coordination of Fair Hearings with Access and Eligibility Services, Integrity Support Services Appeals and Mitigation

Revision 24-4; Effective Sept. 1, 2024

Texas Health and Human Services Commission (HHSC) Access and Eligibility Services (AES), and Integrity Support Services Appeals and Mitigation (A&M) handles all hearings for Medicaid for the Elderly and People with Disabilities (MEPD) and Texas Works staff (TW). A&M replaces MEPD and TW staff in specific steps for denying AES applications and ongoing cases and:

  • represents HHSC AES in fair hearings;
  • completes and implements all AES case actions based on fair hearing decisions; and
  • coordinates required actions with AES staff and Community Care Eligibility Services (CCSE) staff.

The caseworker must coordinate all appeals with A&M, where AES staff determine financial eligibility. The caseworker must remember that A&M replaces AES staff in the following steps and to only send notices to AES staff if specified. All correspondence on appeals will go to the A&M supervisor and A&M administrative assistant.

People may appeal a decision verbally, in person or in writing. The caseworker must complete Form H4800, Fair Hearing Request Summary, to file the appeal through the Texas Integrated Eligibility Redesign System (TIERS) when a person requests a fair hearing. The method that the form is completed depends on the action being appealed. CCSE staff must determine if the appealed action is:

  • a CCSE service denial which are denials based on a CCSE denial action or
  • an AES financial denial which are denials based on an AES denial action.

If the appealed action is related to CCSE criteria other than an AES financial denial action, the caseworker completes Form H4800 and enters their name as the agency representative.

When the appealed action is an AES financial denial, the caseworker creates the appeal task in TIERS and A&M will process the appeal.

When the hearing officer renders a decision based on program criteria, the caseworker is notified by email of the decision. Based on the hearing decision, the caseworker determines the appropriate action per program specific time frames. The caseworker may need to coordinate an effective reinstatement date with A&M and must email the A&M mailbox. Per current procedures, the caseworker reports the implementation of the hearing decision through TIERS on Form H4807, Action Taken on Hearing Decision.

2933 Submitting the Appeals Evidence Packet

Revision 24-3; Effective July 1, 2024

When an applicant or person requests a fair hearing, the burden of proof to uphold the Texas Health and Human Services Commission (HHSC) decision rests with HHSC. The hearings officer is a neutral party and is restricted by law from presenting the agency's case. It is crucial that staff complete and organize all fair hearing packets to support the agency decision.

The Texas Integrated Eligibility Redesign System (TIERS) generates a hearing packet that includes Form H4803, Notice of Hearing, and Form H4800, Fair Hearing Request Summary. The caseworker and their supervisor receive a copy of Form H4800, the letter identifying the hearings officer assigned, and the time and location of the hearing. Staff or the designated representative participating in the hearing must be sufficiently prepared and knowledgeable about the case to represent the agency during the fair hearing process.

Each entity involved in the fair hearing is responsible for preparing its packet and forwarding the packet to both the:

  • hearings officer identified on Form H4800; and
  • appellant.

All documentation must be neatly and logically organized, and all pages numbered. Staff use Form H4800-A, Fair Hearing Request Summary (Addendum), to submit all supporting documentation to the hearings officer. The appeal identification number assigned by TIERS must be written on the top of Form H4800-A.

Provide the names, titles, addresses and phone numbers of all people or designees who will attend the hearing. Depending on the issue being appealed, the region may elect to send more staff such as the regional nurse or regional attorney. However, it is mandatory that the following staff attend:

  • Medicaid for the Elderly and People with Disabilities (MEPD) or Centralized Representation Unit (CRU), for financial denials;
  • caseworker or designee, for all case decisions; or
  • Utilization Review nurse to the appeal action, if applicable.

All related documentation necessary to support the agency's decision must be sent by the data entry representative (DER) to the fair hearings officer as soon as possible, but by 10 calendar days before the hearing. Examples of additional information and who is responsible for submitting that information to the state fair hearings officer and appellant include, but are not limited to:

  • the caseworker or designee:
    • Texas Administrative Code or policy handbook references about the case action;
    • summary of events;
    • a copy of any individual service plans, Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, or other official documentation forms including form instructions;
    • other documentation supportive of the decision, such as records of phone calls or visit summaries;
    • any relevant Utilization Review findings; and
    • a signed copy of the denial notification form and if available, use the signed form returned by the applicant or person when the appeal was filed;
  • MEPD:
    • documentation supportive of the financial decision, including official documentation forms and phone calls; and
    • a copy of the original signed denial form returned by the member, if available and if unavailable, send unsigned copy;

Uploading the Appeals Evidence Packet into TIERS

All evidence packets must be scanned into the TIERS Appeals application using the process described below. The regional data entry representative (DER) uses Form H4800-A to submit all supporting documentation, also referred to as the appeals packet, to the fair hearings officer. The appeal identification number assigned by TIERS must be written on the top of Form H4800-A. The DER must upload the fair hearing evidence packet in TIERS by 10 calendar days before the fair hearing date.

The caseworker must provide the information to the DER by 12 calendar days before the fair hearing date, to allow enough time for the evidence packet to be submitted on time. The caseworker must:

  • go to the multi-function HHSC Work Center and scan in the documentation;
  • save the document by either allowing the default document name or entering a name of the user's choosing;
  • retrieve the scanned document and attach it to an email; and
  • send the document to the regional DER.

By 10 calendar days before the fair hearing date, the caseworker must forward a copy of the fair hearing evidence packet to the applicant or person requesting the fair hearing.

Within two business days after receipt, the DER must:

  • save the attachment to the appropriate network drive, as assigned by regional management;
  • go into the TIERS portal without launching TIERS and select the Appeals tab;
  • ensure the appeal has been entered in TIERS, a requirement that must be met before the next step can be completed;
  • select Hearing Evidence Packets Upload and enter the appeal identification;
  • select Document Type: Agency Evidence Packet and note that items entered in any other selection will not be included in the evidence packet;
  • select Validate;
  • check the details to ensure the right person has been selected;
  • browse for the document; and
  • select Upload.

Users who make mistakes that cannot be reversed may contact the state office Document Maintenance manager to help correct the error and upload the appropriate information.

2934 Presentation of Evidence at the Fair Hearing

Revision 25-2; Effective March 31, 2025

Staff listed on Form H4800, Fair Hearing Request Summary, will receive Form H4803, Notice of Hearing, notifying participants when the hearing will be held. HHSC staff must adequately prepare both the fair hearing packet and presentation of evidence at the fair hearing. The burden of proof to uphold the agency's decision rests with the agency. The hearings officer is a neutral party and is restricted by law from presenting the agency's case.

Documentation contained in the fair hearing packet will not be considered in the decision unless the packet is offered into evidence. To accomplish this6tqy requirement, the agency representative must present the packet, ask that it be submitted as evidence and summarize what the packet contains.

Example: "I want to offer the following packet as evidence in the appeal filed on the behalf of Joe Smith. Pages 1-10 contain information about the completion of Form 2060, Needs Assessment Questionnaire and Task/Hour Guide. Pages 11-15 contain policy from the Community Care Services Eligibility Handbook, which relate directly to the issue in question. Pages 16-20 contain documents about individual rights. Page 21 has Form 2065-A, Notification of Community Care Services, mailed to the applicant on March 2, 2024."

The hearings officer usually can only consider the specific information offered in evidence when making the hearing decision. For example, the caseworker may clearly explain how the applicant must score 24 points on Form 2060 to be eligible for Primary Home Care. However, if documentation backing up that explanation handbook policy, Form 2060 instructions and appropriate appendices is not in the packet, the explanation will not be considered.

Verbal testimony may be considered only if read into the record and if the appellant agrees to allow it.

The hearings officer will ask the appellant if they received the evidence packet. If not, the hearings officer will attempt to determine why. If no effort was made to send a packet to the appellant, the packet may not be admitted and the appropriate agency representative will have to read information into the record to have it considered.

The hearings officer will then ask for objections and allow all admissible documents into evidence. Any documents admitted by the hearings officer may be considered when a decision is rendered. Specific items of importance on a page or policy section must be emphasized as the case is presented to ensure the case has been clearly presented. If any documents are not admitted, the hearings officer will explain the reasons for excluding the material.

2935 Action Taken after the Hearing Decision

Revision 17-1; Effective March 15, 2017

2935.1 Action Taken on the Hearing Decision for Reductions

Revision 25-2; Effective March 31, 2025

After the hearing is held, the Texas Health and Human Services Commission (HHSC) hearings officer sends a decision letter, Form H4807, Action Taken on Hearing Decision, to the appellant and sends copies to the caseworker and the supervisor. If the HHSC decision is sustained, then the caseworker takes the appropriate action. If services continued during the appeal period, then the caseworker completes a new Form 2101, Authorization for Community Care Services, and sends it to the provider with the reduced service amounts. The action must be completed within 10 calendar days after the hearings officer’s decision. It is not necessary to send the person another Form 2065-A, Notification of Community Care Services, since the person has already been notified of the change.

If the hearings officer reverses the decision, the hearings officer also sends HHSC Form H4807 and specifies the corrective action to be taken and a 10 calendar day time frame for the completion of the action. The caseworker continues authorization at the higher level of services. The caseworker sends the person Form 2065-A showing the new level of services. A new Form 2101 is not required, since the provider is already delivering services at the higher level. The caseworker actions required by the hearings officer must be reported back through the Texas Integrated Eligibility Redesign System (TIERS) within the 10 calendar day time frame designated by the hearings officer. Form H4807 is no longer completed and mailed back to the hearings officer. All communication will be through TIERS.

2935.2 Action Taken after the Hearing Decision of Terminations

Revision 25-2; Effective March 31, 2025

Once the hearings officer’s decision is rendered and if the person is determined eligible to continue receiving services, the caseworker sends Form 2065-A, Notification of Community Care Services, to the person to notify them that the hearings officer’s decision overturned the termination and their eligibility is continued. The caseworker includes the following statement in the comments: “The hearings officer has overturned the termination decision and you have been determined eligible for continued services effective the begin date.” The caseworker sends the provider an updated Form 2101, Authorization of Community Care Services, reinstating services.

If the hearings officer sustains the termination decision and services were not continued, then no further caseworker action is required on the case. If the hearings officer sustains the termination decision and services were continued, the caseworker must terminate services in Service Authorization System and send the provider Form 2101 ending services within 10 calendar days after the hearings officer decision, or per instructions provided by the hearings officer. The caseworker does not send another Form 2065-A to the person to provide notification that the person is not eligible based on the hearings officer’s decision. The caseworker verbally notifies the person of the termination of services and the effective date and documents the contact in the case record.

2935.3 Fair Hearings Officer Orders a New Assessment

Revision 25-2; Effective March 31, 2025

If the hearings officer’s final decision orders completion of a new Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, the hearing is closed because of this ruling. The caseworker must notify the person of the results of the new assessment on Form 2065-A, Notification of Community Care Services. The person may appeal the results of the new assessment. If the person chooses to appeal, the caseworker must show in Section 8, Summary of Agency Action of Form H4800, HHSC Action Taken on Hearing Decision, and also during the fair hearing that the new assessment was ordered from a previous fair hearing decision. If the person requests an appeal of the new assessment, HHSC continues services until the second fair hearing decision is implemented.

2935.4 Reporting the Action Through TIERS

Revision 25-2; Effective March 31, 2025

The caseworker completes Form H4807, Action Taken on Hearing Decision, recording case actions taken and sends it to the supervisor and the designated data entry representative. The caseworker must send Form H4807 within the time frames to allow at least two business days for the data entry representative to enter the information into the system. If the action cannot be taken within the time frame designated by the hearings officer, the caseworker must complete Section B on Form H4807 and send to the supervisor and data entry representative providing the reason for the delay. Acceptable reasons are listed on the form and the begin delay date and end delay date must be included. Review the form instructions for detailed information on completing Form H4807.

2936 Fair Hearing Exception Process

Revision 24-3; Effective July 1, 2024

Staff must implement the decision of the fair hearings officer within the applicable time frames when a fair hearing decision is rendered. This includes the restoration of any benefits or services.

Staff who disagree with the result of a fair hearing must follow regional procedures in referring the issue to the regional director. Staff use Form 1590, Request for a Fair Hearing Exception, to initiate a fair hearing exception request. The form documents the region's request for a review of a fair hearing decision.

If they agree with the region's request, the regional director forwards Form 1590 to the Community Services Policy (CSP) unit manager. The CSP unit manager must receive the form by the fifth calendar day following the date on the hearing decision. A copy of the form is kept in regional files, not in the case record.

Once the region's exception request is reviewed, the CSP unit manager decides whether to forward it to HHSC for consideration. If the CSP unit manager or designee:

  • concurs with the regional assertion that policy was misapplied and forward the form to the Fair and Fraud Hearings Section.
  • determines a clear error of law or fact was made by the hearings officer and they request that HHSC review the case action and, if they agree, issue a revised hearing decision.
  • does not concur with the regional request and the request is not forwarded to HHSC.

If the CSP unit manager forwards the exception request for consideration by HHSC, then the HHSC caseworker or designee must mail Form 1015 or Form 1015-S, Fair Hearing Exception Letter, and a copy of the exception request to the applicant or person. The caseworker or designee must place the letter and exception request in the outgoing mail by the close of the next business day following receipt of the notification from the CSP unit manager. A copy of the letter and exception request must be placed in the case record.

The region will be notified of the decision if the request was or was not forwarded to HHSC. Even if an exception request is being filed, the hearings officer's decision must be implemented within the required time frames.