1. (a) Purpose. The Health and Human Services Commission (HHSC) is required by state law to promulgate uniform fair hearing rules for all Medicaid-funded services. An opportunity for a fair hearing is required by federal law and regulation in any Medicaid case for an individual whose claim for services is denied or not acted upon promptly. An opportunity for a fair hearing is also required when an operating agency or its designee takes action to suspend, terminate, or reduce services, including a denial of a prior authorization request for Medicaid-covered services. These fair hearing rules will also apply to any hearing involving the transfer or discharge of an individual from a nursing facility or to an individual adversely affected by the preadmission screening and annual resident review requirements.

2. (b) Scope.

   1. (1) These rules establish fair hearing procedures which an operating agency will follow when the operating agency is required to conduct a fair hearing for Medicaid-funded services.
   2. (2) An individual's authorized representative, as defined by the operating agency, may, on the individual's behalf, take any action that the individual can take as described in these rules.

Source Note:The provisions of this §357.1 adopted to be effective March 31, 1999, 24 TexReg 2293.