Revision 22-3; Effective Dec. 1, 2022

The Texas Health and Human Services Commission (HHSC) hearings officer:

• notifies all people listed on Form H4800, Fair Hearing Request Summary, of the date, time and location of the hearing;
• prepares a final order disposing of a case through withdrawal
• sends copies of final order to the appellant and Program Support Unit (PSU) upon written notification from the appellant to withdraw a state appeal;
• conducts the hearing;
• considers all testimony and exhibits;
• uses the Texas Medicaid & Healthcare Partnership (TMHP) nurse to determine if any new medical information introduced at the hearing meets the medical necessity (MN) criteria for nursing facility care;
• reserves the right to hold a hearing record open after a State Fair Hearing to get more information;
• submits a written request for medical review to TMHP for all new medical information presented at a hearing in situations where the TMHP nurse determines the new medical information presented does not meet the MN criteria;
• renders a decision; and
• sends a written copy of all hearing decisions to the member or applicant, TMHP and the PSU staff within five days of making the decision.

Administrative review of any hearings officer's decision provided in the fair hearings rules must be initiated by the appellant (applicant, member or legally authorized representative). Program staff may disagree with the decision. However, the hearings officer's decision is final. Program staff submit disagreements on policy or legal issues to the regional attorney.