1. (a) An individual applying for or receiving benefits from the Newborn Screening Program may have his/her application denied or his/her benefits modified, suspended, or terminated for any of the following reasons.

   1. (1) Benefits may be denied, modified, suspended, or terminated if:

      1. (A) the individual does not have a confirmed diagnosis of a disorder for which program benefits are available;
      2. (B) the individual is not a bona fide resident of the state;
      3. (C) the individual fails or refuses to provide the periodic information regarding residency and financial status when requested by the program.

   2. (2) Benefits may be denied, modified, suspended, or terminated if:

      1. (A) the individual submits an application form or any document required in support of the application or continued participation in the program which contains an intentional misstatement of fact which is material to the program's determination that the individual is eligible for program benefits; or
      2. (B) program funds are curtailed.

2. (b) An individual applying for or receiving benefits from the Newborn Screening Program may not appeal or request an administrative hearing concerning adjustments made by the program in poverty income guidelines to conform to federal poverty income guidelines or adjustments in the type and amount of program benefits available when such adjustments are necessary to conform to budgetary limitations.

   1. (1) An individual applying for program benefits will be notified in writing if their application has been denied. The notification will outline the reasons for denial.
   2. (2) An individual receiving newborn screening benefits will be notified if the benefits are to be modified, suspended, or terminated. Notification will be by certified mail to the most recent address known to the program.
   3. (3) Within 30 days after receiving notice as specified in paragraph (2) of this subsection, the individual, or if the individual is a minor, the individual's parent, managing conservator, or guardian, may appeal the program's decision to deny, suspend, modify, or terminate the services to the department and request an administrative hearing before the department. Appeals and request for hearings must be in writing and sent to the following address by certified mail: Newborn Screening Program, Health Screening and Case Management Unit, Mail Code 1918, Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756. Failure to respond will be deemed a waiver of the appeal and of the opportunity for a hearing.
   4. (4) Appeals and administrative hearings will be conducted in accordance with the department's fair hearing rules, §§1.51 - 1.55 of this title (relating to Fair Hearing Procedures).

Source Note:The provisions of this §37.63 adopted to be effective November 1, 2006, 31 TexReg 8835.