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.