reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and phrases, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise:
(1) Across the Board
				  Reduction of Services--The agency need not grant a hearing if the sole issue is
				  a Federal or State law requiring an automatic change adversely affecting some
				  or all recipients.
(2) Action
				  Effective Date--The date the agency action becomes effective.
(3) Adequate Notice--Notice in accordance
				  with applicable law, rules, and regulations of the programs.
(4) Agency--Any one of the agencies listed
				  under the Health and Human Services Agencies.
(5) Agency Action--The agency's decision to:
(A) reduce, suspend, terminate or deny
				  benefits or eligibility;
(B) deny
				  certification of a household; or
(C) grant a benefit in an amount less than
				  requested.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.3 - Authority and Right to Appeal

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Health and Human Services (HHS) System Authority and Responsibilities.
(1) 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, the Supplemental Nutrition Assistance Program (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 hear fair hearings.
(2) HHSC Appeals Division is responsible for:
(A) publishing fair hearing rules;
(B) receiving fair hearings appeal
				  requests;
(C) conducting fair
				  hearings; and
(D) issuing
				  decisions.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.5 - Hearings Officer Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) Fair
				  hearings are conducted by an impartial hearings officer who:
(1) does not have a personal involvement in
				  the case;
(2) was not involved in
				  the initial determination of the action that is being contested; and
(3) was not the agency representative who
				  took the action or the immediate supervisor of that representative.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.7 - Agency and Designee Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) The agency must:
(1) accept a request for a fair hearing
				  submitted within 90 days from the date on the notice of agency action, or,
				  under the Supplemental Nutrition Assistance Program, at any time during the
				  SNAP certification period;
(2)
				  notify the HHSC Appeals Division within five days of the date the client
				  expresses a desire to appeal; and
(3) allow the client to appeal more than one
				  action at the same time.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.9 - Burden of Proof in a Fair Hearing

Current through Reg. 49, No. 28; July 12, 2024
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, on the whole, favors
					 that party, as determined by the hearings officer. Depending on the type of
					 hearing, the following apply:
(1) The
				  agency or its designee bears the burden of proof.
(2) The nursing facility bears the burden of
				  proof in transfer and discharge hearings.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.11 - Notice and Continued Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  agency must:
(1) follow the notice
				  requirements set forth in the appropriate state or federal law or regulation
				  for the affected program;
(2) give
				  clients timely and adequate notice, as appropriate, of the right to a fair
				  hearing;
(3) explain the right of
				  appeal;
(4) explain the procedures
				  for requesting an appeal;
(5)
				  explain the right to be represented by others, including legal
				  counsel;
(6) provide information
				  about legal services available in the community;
(7) continue benefits if required to do so by
				  state or federal law or regulations of the affected program; and
(8) not reinstate or continue SNAP benefits
				  if a client requests a fair hearing after the date his certification period has
				  ended.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.13 - Appellant Rights and Responsibilities

Current through Reg. 49, No. 28; July 12, 2024
(a) Requesting an Appeal. Only the appellant
				  or the appellant's authorized representative has the right to appeal an action
				  by an agency.
(b) During the appeal
				  process, the appellant has the right to:
(1)
				  reapply for assistance;
(2) receive
				  continued benefits if required by state or federal regulation or
				  statute;
(3) confer with
				  supervisory staff within the appropriate agency about the case prior to the
				  hearing;
(4) continue with the fair
				  hearing after a case adjustment or correction is made;
(5) request that reasonable accommodations
				  due to disability or language comprehension be provided at the hearing at no
				  cost;
(6) make an audio recording
				  of the fair hearing;
(7) examine at
				  a reasonable time before the date of the hearing and during the hearing:
(A) the content of the appellant's case file;
				  and
(B) all documents and records
				  to be used by the agency or the skilled nursing facility or nursing facility at
				  the hearing;
(8) review
				  the appeal procedures outlined in agency policy; and
(9) request a copy of the official recording
				  at no charge after the decision is issued.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.15 - Scheduling Hearings and Notice Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Scheduling:
(1) Except as provided by paragraph (2) of
				  this subsection, the hearings officer schedules fair hearings in the order in
				  which the requests are received and determines a reasonable date, time, and
				  place for the fair hearing.
(2) For
				  good cause, the hearings officer may schedule fair hearings other than in the
				  order in which the requests were received.
(3) The hearings officer must expedite
				  hearing requests as provided in §
											RSA
				  357.17(b) of
				  this subchapter (relating to Types of Hearings).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.17 - Types of Hearings

Current through Reg. 49, No. 28; July 12, 2024
(a) Telephone and
				  In-Person Hearings.
(1) The hearings officer
				  conducts fair hearings by telephone ensuring that all parties are able to hear
				  and respond to each other;
(2) An
				  appellant may request that a hearing be conducted in person; and
(3) The hearings officer determines whether
				  good cause for an in-person hearing exists.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.19 - Other Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a) Postponement.
				  The hearings officer considers a postponement for a hearing only if the
				  appellant or his authorized representative contacts the appropriate appeals
				  office before the scheduled hearing is to occur.
(1) SNAP Fair Hearings--The appellant is
				  entitled to receive one postponement of up to 30 days. Additional postponements
				  may be approved if the hearings officer determines that there is good
				  cause.
(2) All other Fair
				  Hearings--The hearings officer may postpone a fair hearing if the hearings
				  officer determines that good cause exists.
(3) The hearings officer must state in
				  writing the decision on the request to postpone and send it to the appellant
				  and agency.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.21 - Interpreters in Fair Hearings

Current through Reg. 49, No. 28; July 12, 2024
(a) Determining
				  the Need for Interpreters.
(1) The hearings
				  officer informs the appellant on the record that he will be provided an
				  interpreter at no cost if the appellant can show that the appellant or required
				  participants are not able to participate in the hearing due to a communication
				  barrier.
(2) No interpreter is
				  required if the hearings officer determines that all participants are
				  sufficiently able to communicate so that no barrier is present.
(3) The basis of the hearings officer's
				  decision will be stated on the record.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.23 - Hearings Officer Decision and Actions

Current through Reg. 49, No. 28; July 12, 2024
(a) Time Limits for Issuing Decisions.
(1) SNAP hearings--60 days from the date the
				  appeal request is received by the agency or designee.
(2) Non-SNAP hearings--90 days from the date
				  the appeal request is received by the agency or designee.
(3) The time limit for issuing a decision may
				  be extended by as many days as the fair hearing is postponed or recessed at the
				  request of the appellant.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter A - UNIFORM FAIR HEARING RULES › Section 357.25 - Records and Confidential Information

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Record Maintenance. The official record of the hearing includes the exhibits
				  offered to the hearings officer, the exhibits admitted, the recording of the
				  hearing, any briefs or memoranda filed in connection with the hearing, the
				  hearings officer's decision, and any items filed in connection with
				  administrative review and the decision on administrative review.
(b) Hearing Record Retention. The official
				  record of a hearing is retained by the HHSC Appeals Division according to the
				  HHSC Records/Retention Schedule.
(c) Public Access.
(1) HHSC Appeals Division records and
				  decisions are available for public inspection and copying, but are also subject
				  to federal and state rules and statutes regarding confidentiality.
(2) Names, addresses, and other identifying
				  information about household members and other individuals who provide
				  information about the household, medical information, and the status of pending
				  criminal prosecutions are confidential.
(3) An appellant or authorized representative
				  may record the hearing or request a copy of the recording, at no cost, from the
				  hearings officer.
(4) All other
				  public access to hearings records and decisions is subject to the Texas Public
				  Information Act.
(5) The agency
				  will redact all confidential information from the hearings decision and make
				  the decision available to the public, without cost, within 30 days of the date
				  of the hearing decision in Texas Health Step appeals.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.481 - Application of this Subchapter

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Hearings under this subchapter shall be conducted in accordance with the Texas
				  Administrative Procedure Act (APA), Chapter 2001 of the Texas Government
				  Code.
(b) Unless otherwise required
				  by subsection (a) of this section, the rules of this subchapter govern the
				  procedures of hearings under this subchapter, except the judge may:
(1) apply a procedural hearing rule of the
				  referring agency when the matter at issue is not addressed in this
				  subchapter;
(2) apply the Texas
				  Rules of Civil Procedure when the matter at issue:
(A) is not addressed in this subchapter;
				  and
(B) is not addressed in a
				  procedural hearing rule of the referring agency; or
(3) determine that the matter at issue is
				  governed by other law.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.482 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
(1) APA--the Administrative
				  Procedure Act, Chapter 2001 of the Texas Government Code.
(2) Adverse action--an action for which the
				  right to a hearing under the Administrative Procedure Act is granted by the
				  statute, rules or policy of a referring agency.
(3) HHSC--the Texas Health and Human Services
				  Commission.
(4) Judge--a licensed
				  attorney appointed by the director of the HHSC Appeals Division to preside over
				  the case.
(5) Referring agency--the
				  HHSC agency taking the action and that issues the notice of adverse action, or
				  the state agency that otherwise refers the matter to the HHSC Appeals Division
				  for a hearing under this subchapter. HHSC agency includes the Texas Health and
				  Human Services Commission, the Texas Department of Aging and Disability
				  Services, the Texas Department of Assistive and Rehabilitative Services, the
				  Texas Department of Family and Protective Services, and the Texas Department of
				  State Health Services.
(6)
				  SOAH--the Texas State Office of Administrative Hearings.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.483 - Powers and Duties of the Judge

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  judge is a designee of the HHSC Executive Commissioner for purposes of:
(1) issuing default, final, and other orders,
				  and
(2) ruling on any motions for
				  rehearing.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.484 - Request for a Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) Who may file.
				  Any person who has received notice of adverse action may file a request for a
				  hearing.
(b) Time for filing. A
				  person must file a written request for a hearing with the HHSC Appeals Division
				  so that it is received within 15 days from the date the person receives the
				  referring agency's notice of adverse action. If a person does not file the
				  hearing request in accordance with this section, the judge may deny the
				  request.
(c) Form of request. The
				  request for hearing must:
(1) be in writing,
				  in the form of a petition or letter;
(2) state the basis for the appeal of the
				  adverse action; and
(3) include a
				  legible copy of the notice of adverse action. If a person does not provide a
				  copy of the notice of adverse action within 15 days from the date the hearing
				  request is filed, the judge may deny the hearing request.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.485 - Venue

Current through Reg. 49, No. 28; July 12, 2024
(a) General venue. The judge shall conduct
				  the hearing in Austin, Texas unless the judge grants a change of venue in
				  accordance with subsection (b) of this section.
(b) Change of venue. A party may file a
				  motion to transfer venue. The judge may grant the motion to change venue upon
				  consent of the parties or upon a showing of good cause. Good cause includes,
				  but is not limited to, the following:
(1) the
				  case arose at a location closer to an HHSC office outside Austin,
				  Texas;
(2) a majority of the
				  witnesses reside more than 100 miles from Austin, Texas; or
(3) judicial and party resources will be
				  conserved by the change of venue.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.486 - Computation of Time

Current through Reg. 49, No. 28; July 12, 2024
In computing any period of time under this subchapter, the
					 period begins on the day after the act or event in question and concludes
					 either:
(1) on the last day of the
				  period; or
(2) if the last day of
				  the period is a Saturday, Sunday, or official State holiday, on the next day
				  that is not a Saturday, Sunday, or official State holiday.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.487 - Representation of Parties

Current through Reg. 49, No. 28; July 12, 2024
(a) Respondent. A
				  licensed attorney for the referring agency represents the referring
				  agency.
(b) Petitioner. Any of the
				  following persons may represent the petitioner:
(1) the petitioner;
(2) an attorney for the petitioner, upon
				  filing of a notice of representation with the judge and service on the other
				  party; or
(3) a person designated
				  by the petitioner in writing to the judge.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.488 - Filing and Service of Documents

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Filing of documents. A party must file with the judge all documents relating to
				  any pending proceeding and must serve a copy on the other party. If the HHSC
				  Appeals Division has transferred the case to SOAH, the party must also file the
				  documents with SOAH.
(b) Documents
				  are considered filed only when received by the HHSC Appeals Division by 5:00
				  p.m. on a business day. A document received after 5:00 p.m. on a business day
				  is considered filed on the next business day.
(c) Service. Every document required to be
				  served under these rules, the APA, or an agency's statute or rules, may be
				  served by any of the following methods to a party or its representative:
(1) hand-delivery;
(2) courier-receipted delivery;
(3) certified or registered mail;
				  or
(4) facsimile transmission.
				  Service to the petitioner or its representative shall be made to the petitioner
				  or representative's last known address or facsimile number as shown by the
				  referring agency's records.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.489 - Notice of Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) The referring
				  agency must give the petitioner written notice of hearing in accordance with
				  2001.052, Texas Government Code.
(b) The referring agency must serve the
				  notice of hearing on the petitioner or petitioner's representative by any of
				  the following methods using the petitioner's or representative's last known
				  address or facsimile number as shown by the referring agency's records:
(1) hand-delivery;
(2) courier-receipted delivery;
(3) certified or registered mail;
				  or
(4) facsimile
				  transmission.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.490 - Pre-Hearing Conference

Current through Reg. 49, No. 28; July 12, 2024
(a) On the motion
				  of a party or on the judge's own motion, the judge may direct the parties to
				  appear in person, by telephone, or by video conference for a pre-hearing
				  conference.
(b) A pre-hearing
				  conference under this subchapter shall be conducted in accordance with Rule
				  166, Texas Rules of Civil Procedure.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.491 - Motions

Current through Reg. 49, No. 28; July 12, 2024
(a) Unless the request for relief is made on
				  the record at a pre-hearing conference or hearing, a party must file a motion
				  to change a setting, obtain a ruling or order, or obtain any other procedural
				  relief under this subchapter.
(b) A
				  party must file all motions in writing no later than seven days before the date
				  of the hearing or setting. For good cause shown, the judge may consider a
				  motion filed after this deadline.
(c) A party must file any responses to a
				  motion in writing and no later than the earlier of:
(1) five days after receipt of the motion;
				  or
(2) the date and time of the
				  hearing.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.492 - Discovery and Subpoenas

Current through Reg. 49, No. 28; July 12, 2024
(a) Parties may
				  begin discovery under the APA and, to the extent not inconsistent with the APA,
				  the Texas Rules of Civil Procedure, immediately after the filing of a request
				  for hearing. The judge may establish deadlines for discovery requests and
				  responses.
(b) For good cause
				  shown, the judge may issue a subpoena at the written request of a party. The
				  party requesting the subpoena is responsible for preparation and service of the
				  subpoena. The judge may prepare the subpoena for a party if an attorney does
				  not represent the party. The subpoena may require the attendance of witnesses
				  and the production of books, records, papers, or other objects that are
				  necessary and proper for the purposes of the proceedings.
(c) If a person fails to comply with a
				  subpoena issued under subsection (b) of this section, the requesting party may
				  bring suit to enforce the subpoena in a district court in Travis County or the
				  county in which the hearing is conducted.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.494 - Evidence

Current through Reg. 49, No. 28; July 12, 2024
(a) The provisions of Texas Government Code
				  §§
										RSA
				  2001.081-RSA 2001.086
				  shall govern the admission or exclusion of evidence.
(b) Exclusion of witnesses. At the request of
				  a party, or on the judge's motion, the judge may order witnesses excluded from
				  the hearing so they cannot hear the testimony of other witnesses. This
				  subsection does not authorize exclusion of a party, a party's spouse, or a
				  person who a party shows to be essential to the presentation of its
				  case.
(c) Stipulations. Subject to
				  the judge's approval, the parties may stipulate to any factual, legal, or
				  procedural matters, subject to the following requirements:
(1) The parties must state in a written
				  motion any agreements that would modify a schedule or procedure previously
				  ordered by the judge.
(2) The
				  parties may file a stipulation in writing or enter it on the record. The judge
				  may require additional development or clarification of a stipulation.
(3) The judge may choose not to enforce an
				  agreement between the parties either for good cause, or if the agreement is not
				  in writing, signed, and filed with the judge, or entered on the
				  record.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.495 - Default and dismissal

Current through Reg. 49, No. 28; July 12, 2024
(a) Default. The
				  judge may proceed on a default basis if a party without the burden of proof
				  fails to appear. The factual allegations listed in the notice of hearing may be
				  deemed admitted. The party with the burden of proof must show that:
(1) proper notice under §
											RSA 357.489 of
				  this title (relating to Notice of Hearing) was provided to the defaulting
				  party; or
(2) a statute or rule
				  authorizes service of the notice by sending it to the party's last known
				  address as shown by the agency's records, and there is credible evidence that
				  the notice was sent by first class mail to that address.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.496 - Summary disposition

Current through Reg. 49, No. 28; July 12, 2024
(a) The judge
				  may issue a proposal for decision or final order without an evidentiary hearing
				  if the judge determines that:
(1) there is no
				  genuine issue as to any material fact; and
(2) a party is entitled to a decision in its
				  favor as a matter of law.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.497 - Proposals for Decision, Exceptions, and Replies

Current through Reg. 49, No. 28; July 12, 2024
(a) Proposals for Decision. For cases
				  referred by an agency other than HHSC, the judge issues a proposal for decision
				  unless the law governing the case provides for a final order to be issued by
				  the judge. The judge shall submit the proposal for decision to the final
				  decision maker and furnish a copy to each party.
(b) Exceptions. A party must file exceptions
				  to the proposal for decision within 15 days of the issuance of the proposal for
				  decision, in accordance with section §
										RSA
				  357.488 of this title (relating to Filing and
				  Service of Documents).
(c) Replies.
				  A party must file a reply to exceptions within 15 days of the filing of the
				  exception, in accordance with section §
										RSA
				  357.488 of this title.
(d) Amendments. The judge shall make any
				  amendments to the proposal for decision within 15 days of the deadline under
				  subsection (c) of this section.
(e)
				  Final Orders and Motions for Rehearing. When the judge issues a proposal for
				  decision, the referring agency's rules govern final orders and motions for
				  rehearing.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter I - HEARINGS UNDER THE ADMINISTRATIVE PROCEDURE ACT › Section 357.498 - Final Orders and Rehearing

Current through Reg. 49, No. 28; July 12, 2024
(a) Final
				  Orders. The judge issues a final order for a case:
(1) referred by HHSC; or
(2) when the law governing the case provides
				  for a final order to be issued by the judge.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter J - MEDICAID THIRD-PARTY RECOVERY › Section 357.501 - Basis and Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) This section
				  implements the obligation of the Texas Department of Human Services (DHS) under
				  federal and state law to:
(1) set forth the
				  requirements of Medicaid applicants and recipients, and representatives of
				  applicants and recipients, regarding assignment of causes of action against
				  third parties, or their insurer(s), responsible for injury to the applicant or
				  recipient that requires medical care and/or services for which the third party
				  or the third party's insurer is legally obligated to pay; and
(2) establish the priority of distributions
				  of third-party recoveries among DHS, the federal government, and the
				  recipient.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter J - MEDICAID THIRD-PARTY RECOVERY › Section 357.502 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Applicant--An
				  individual, or the parent or legal guardian of an individual, who has applied
				  to the Texas Department of Human Services (DHS) or another agency of the state
				  for medical assistance from the Medicaid program.
(2) Commissioner--The Commissioner of the
				  Texas Department of Human Services;
(3) Department or DHS--The Texas Department
				  of Human Services and its designee.
(4) Recipient--A person who has been
				  certified as eligible to receive medical assistance from the Medicaid program
				  by DHS or other agency of the state.
(5) State Plan--The comprehensive written
				  statement submitted by the single state agency describing the nature and scope
				  of the Medicaid program and giving assurances that the Medicaid program will be
				  administered in compliance with Title XIX requirements and federal
				  regulations.
(6) Third party--Any
				  person, or the insurer of a person, who is or may be liable to pay all or part
				  of the expenditures for medical assistance furnished under the State
				  Plan.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter J - MEDICAID THIRD-PARTY RECOVERY › Section 357.503 - Distribution of Recoveries

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas
				  Department of Human Services (DHS) will distribute third-party recoveries as
				  follows:
(1) DHS will receive an amount equal
				  to DHS's Medicaid expenditures for the recipient or for another individual
				  eligible for Medicaid benefits under the State Plan for whom the recipient can
				  legally make an assignment to medical support and payment;
(2) the federal government will receive the
				  federal share of the Medicaid expenditures, minus any incentive payment
				  authorized by federal law; and
(3)
				  the recipient will receive any remaining amount. Any amount distributed to the
				  recipient is income or resources for purposes of establishing eligibility for
				  Medicaid benefits.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter J - MEDICAID THIRD-PARTY RECOVERY › Section 357.504 - Waiver Authority of the Commissioner

Current through Reg. 49, No. 28; July 12, 2024
The commissioner of the Texas Department of Human Services
					 (DHS) has the authority to waive all or part of DHS's right to recover from
					 liable third parties when:
(1) the
				  commissioner finds that enforcement of DHS's right of recovery would tend to
				  defeat the purpose of public assistance; or
(2) the cost of recovery exceeds the amount
				  that could be recovered.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.521 - Introduction and Legal Basis

Current through Reg. 49, No. 28; July 12, 2024
A household member becomes ineligible to participate in the
					 Food Stamp program and/or Temporary Assistance for Needy Families (TANF)
					 program if a state or federal court or administrative agency determines he has
					 committed an intentional program violation, in Food Stamps/Aid to Families with
					 Dependent Children (AFDC)/TANF.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.522 - Designation of Hearing Officer

Current through Reg. 49, No. 28; July 12, 2024
Hearings are conducted by an impartial
					 official.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.523 - Disqualification of Hearing Officer

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  hearing officer is disqualified if he participates in the decision to:
(1) refer the case to the investigation unit;
				  or
(2) recommend disqualification
				  for intentional program violation.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.524 - Hearing Officer's Powers and Duties

Current through Reg. 49, No. 28; July 12, 2024
The hearing officer:
(1) administers oaths or
				  affirmations;
(2) ensures that all
				  relevant issues are considered;
(3)
				  requests, receives, and includes in the record all evidence determined
				  necessary to resolve the issues;
(4) ensures an orderly hearing by regulating
				  the conduct and course of the hearing;
(5) orders an independent medical assessment
				  or professional evaluation, if relevant and useful, from a source mutually
				  satisfactory to the household and the Texas Department of Human Services
				  (DHS);
(6) makes the final
				  administrative decision concerning the hearing in the name of DHS;
				  and
(7) requires the attendance of
				  an agency representative, if necessary and appropriate.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.525 - Scheduling the Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) The hearing
				  must be held and a written decision issued no later than 90 calendar days from
				  the date the household member is notified of the hearing.
(b) The hearing officer schedules the hearing
				  at a reasonable time and place. He considers the household member's physical
				  condition, location, and access to transportation. The hearing may be held in
				  the field office where the file is located.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.526 - Advance Notice of Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) The hearing
				  officer sends the household member an advance notice of the hearing in
				  sufficient time to allow receipt at least 30 calendar days before the scheduled
				  hearing date. The notice is sent first class and certified mail, return-receipt
				  requested, and marked "return service requested" to the address where the
				  household member last received benefits. Delivery is not restricted to the
				  addressee. The notice specifies the charges against the household member and a
				  summary of the evidence (including how and where it may be examined). If the
				  notice is returned showing a new address, it will be resent and the normal due
				  process rules will be reapplied.
(b) Advance notice requirements are met when
				  the notice is mailed to the most current mailing address available to any
				  division within the department whether or not the certified or first class mail
				  is returned. The hearing will be conducted.
(1) If the returned notice shows a new
				  address, another notice is mailed following the procedures in subsection (a) of
				  this section, and the 90-day time requirement for issuing a decision begins
				  again with the date that the second notice is mailed.
(2) If the household member claims
				  non-receipt of notice of the hearing, he has 30 days after the date of the
				  written notice of the hearing decision to claim good cause for not appearing at
				  the hearing. In all other instances, the household member has ten days to claim
				  good cause for not appearing. If the household member is found to have
				  committed an intentional program violation but a hearing officer later
				  determines that good cause existed for not appearing, the previous decision
				  shall no longer be valid and a new hearing will be conducted.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.527 - Participation While Hearing is Pending

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The Texas Department of Human Services (DHS) may not disqualify a household
				  member for an intentional program violation until the hearing officer
				  determines the person committed an intentional program violation. A pending
				  hearing does not affect the household member's or the household's right to be
				  certified and participate in the program.
(b) DHS reduces or terminates benefits if:
(1) DHS has documentation substantiating the
				  household is ineligible or eligible for fewer benefits (even if these facts
				  suggest an intentional program violation and lead to an administrative
				  disqualification hearing); or
(2)
				  the household fails to request a fair hearing and continued benefits pending
				  the hearing.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.528 - Conduct of Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) The hearing
				  officer conducts the administrative disqualification hearing as an informal
				  proceeding, not as a formal court hearing. The participants are placed under
				  oath, but the technical rules of evidence are not required.
(b) At the hearing, the hearing officer must
				  advise the household member or his representative that he may refuse to answer
				  questions during the hearing.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.529 - Attendance at Hearing

Current through Reg. 49, No. 28; July 12, 2024
The hearing is not open to the public; however, at the
					 household member's request, friends and relatives may attend. If space is
					 limited, the hearing officer may limit the number of people attending the
					 hearing.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.530 - Household Member's Rights during Hearing

Current through Reg. 49, No. 28; July 12, 2024
The hearing officer must give the household member or his
					 representative an adequate opportunity to:
(1) examine all relevant documents and
				  records at a reasonable time before and during the hearing. The case record is
				  also available, including the application form and documents of verification
				  used to establish the household's ineligibility or eligibility and allotment
				  amount. If the household member or his representative requests a copy, the
				  Texas Department of Human Services provides a free copy of the portions of the
				  case record that are relevant to the hearing. Confidential information is
				  protected from release. It may include the names of people who have disclosed
				  information about the household without its knowledge. Information that
				  identifies the nature or status of pending criminal prosecutions is also
				  confidential. Confidential information and other documents or records that the
				  household may not otherwise have an opportunity to contest or challenge are not
				  introduced at the hearing. They do not affect the hearing officer's
				  decision;
(2) present the case or
				  have it presented by a legal counsel or another person;
(3) present witnesses;
(4) present arguments without undue
				  interference;
(5) question or
				  refute any testimony or evidence, including an opportunity to confront and
				  cross-examine adverse witnesses; and
(6) submit evidence to establish all
				  pertinent facts and circumstances in the case.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.531 - Consideration of the Case by the Hearing Officer

Current through Reg. 49, No. 28; July 12, 2024
The hearing officer must base his determination on clear
					 and convincing evidence that the household member committed an intentional
					 program violation, as defined in § 79.2001 of this title (relating to
					 Terms and General Policy).
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.532 - Failure of Household Member To Appear

Current through Reg. 49, No. 28; July 12, 2024
(a) If advance notice requirements, as
				  outlined in § 79.1906 of this title (relating to Advance Notice of
				  Hearing) are met and the household member or his representative fails to attend
				  a hearing without good cause, the hearing is conducted without him. The
				  household member has 10 calendar days from the date of the hearing to present
				  good cause for failing to appear.
(b) If the hearing officer finds the
				  household member committed an intentional program violation but later
				  determines that the household member or his representative did not receive
				  notice of the hearing or had good cause for not appearing, the Texas Department
				  of Human Services (DHS) conducts a new hearing. The previous decision is no
				  longer valid. There is no time limitation for the household member to show good
				  cause for failure to appear because he did not receive notice of the
				  hearing.
(c) If advance notice
				  requirements are not met, the hearing officer:
(1) checks the administrative
				  disqualification record for any contacts from the household member before the
				  hearing date;
(2) phones the client
				  once if the client's current telephone number is listed on the Office of
				  Inspector General's case report form. The purpose of the call is to determine
				  whether the correct household member received the notice. The hearing officer
				  must talk to the household member to confirm that the notice was
				  received;
(3) sends another notice
				  if:
(A) the household member has moved;
				  and
(B) an address correction is
				  provided by the postal service; and
(4) dismisses the case without prejudice if:
(A) the household member has moved;
(B) no address correction is provided by the
				  post office; and
(C) the hearing
				  officer is unable to determine that the household member received the
				  notice.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.533 - Postponements

Current through Reg. 49, No. 28; July 12, 2024
Until 10 calendar days before the scheduled hearing, the
					 household member or his representative may request one postponement of up to 30
					 calendar days. The 90-calendar-day limit for issuing a written decision is
					 extended by the number of days that the hearing is postponed.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.534 - Recessing the Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) If the
				  household member, the investigator, or the hearing officer requests to have the
				  Food Stamp or Temporary Assistance for Needy Families (TANF) record at the
				  hearing, the hearing may be recessed to obtain the record. The household member
				  may question or refute any additional testimony or evidence after a
				  recess.
(b) The hearing officer may
				  order a recess to request and receive additional testimony or evidence. He
				  advises the household member or his representative of the reason for the recess
				  and the nature of the additional requested information. The household member
				  may question or refute any additional testimony or evidence after a
				  recess.
Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 357 - HEARINGS › Subchapter K - ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS › Section 357.535 - Findings of the Hearing Officer

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  hearing officer normally makes a determination at the close of the hearing
				  whether or not the household member committed an intentional program violation,
				  as defined in this chapter. The decision of the hearing officer must comply
				  with Texas Department of Human Services (DHS) policy and federal law and
				  regulations, and must be based exclusively on the hearing record.
(b) The hearing officer may not find that the
				  household member committed an intentional program violation unless there is
				  clear and convincing evidence in the record to support a determination that the
				  household member knowingly, willfully, and with deceitful intent committed an
				  act described in § 79.1901 of this title (relating to Introduction and
				  Legal Basis). The decision by the hearing officer is DHS's final administrative
				  action concerning a determination of intentional program violation for purposes
				  of administrative disqualification.