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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.