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.