1. (a) In accordance with federal and state regulations, the Heath and Human Services Commission (HHSC) gives timely and adequate notice of the action to limit the recipient to a designated provider and an opportunity for a fair hearing. If a hearing is requested, the procedures described in Chapter 357 of this Title, Subchapter K, §§357.1-357.11 relating to medical fair hearings apply.

   1. (1) The recipient can request a fair hearing within:

      1. (A) 90 days of the initial notification of intent to assign a designated provider; or
      2. (B) 90 days of the notice to continue the recipient on limited status is made at the end of a limited period.
   2. (2) If the request for a fair hearing is received before the deadline to change the limited status effective date, HHSC will not take action until the hearing has been held and a final decision rendered.
   3. (3) If the request for a fair hearing is received after the deadline to change the limited status effective date, the limited status will remain in effect until the hearing has been held and a final decision rendered.
   4. (4) The recipient does not have the right to a fair hearing when the limited status is the result of a misdemeanor or felony conviction related to fraud and/or abuse of Medicaid benefits and/or services.

   5. (5) During the limited status period, the recipient is not entitled to a fair hearing for denial of either of the following requests:

      1. (A) Change in primary care provider
      2. (B) Termination of the limited status
   6. (6) The special warning message is not considered a restriction and does not require a fair hearing.
2. (b) In accordance with federal requirements, the HHSC ensures reasonable access to Medicaid services and benefits. Recipients who are on limited status may receive emergency care services for an emergency medical condition. Providers other than the designated providers may provide the emergency care services. The emergency care provider must certify that the recipient required emergency care services for an emergency medical condition

Source Note:The provisions of this §354.2407 adopted to be effective April 2, 2000, 25 TexReg 2817; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4563; amended to be effective April 6, 2003, 28 TexReg 2738.