|(a) An individual applying for or receiving benefits
described in §37.60 of this title (relating to Newborn Screening
Program Benefits) may have his/her application denied or his/her benefits
modified, suspended, or terminated for any of the following reasons:
(1) the individual does not have a confirmed diagnosis
of a disorder screened by the program for which benefits are available
(including confirmatory testing), as referenced in §37.61(a)(1)
of this title (relating to Eligibility Requirements for the Newborn
Screening Program Benefits);
(2) the individual is not a bona fide resident of the
(3) the individual fails or refuses to provide the
information requested by the program (e.g., regarding residency, financial
status, eligibility for other benefits);
(4) 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
(5) exhaustion of budgeted program funds, prioritized
as required under §37.60 of this title.
(b) An individual applying for or receiving benefits
under §37.60 of this title may not appeal or request an administrative
hearing concerning adjustments made by the program regarding the type
and amount of program benefits available when such adjustments are
necessary to conform to budgetary limitations.
(c) An individual applying for benefits will be notified
in writing if the individual's application is denied. The notification
will state the reasons for denial.
(d) An individual receiving benefits will be notified
by certified mail to the most recent address known to the program
if the benefits are to be modified, suspended, or terminated. The
program will state the reasons for the proposed action.
(e) Prior to making a final decision adverse to an
affected individual, the program shall give the affected individual
written notice of an opportunity for a hearing on the proposed action.
The notice shall contain:
(1) a statement of the action the department intends
(2) an explanation of the reasons for the action the
department intends to take;
(3) a reference to the statutory and regulatory authority
supporting the intended action;
(4) an explanation of the affected person's right to
request a hearing; and
(5) the procedure by which an affected person may request
(f) The affected individual has 20 days after receiving
the notice to request a hearing on the proposed action. It is a rebuttable
presumption that a notice is received five days after the date of
the notice. Unless the notice letter specifies an alternative method,
a request for a hearing shall be made in writing, and mailed or hand-delivered
to the program at the following address: Newborn Screening Unit, Mail
Code 1918, Department of State Health Services, P.O. Box 149347, Austin,
Texas 78714-9347. If an individual who is offered the opportunity
for a hearing does not request a hearing within the prescribed time
for making such a request, the individual is deemed to have waived
the hearing and the action may be taken.
(g) Appeals and administrative hearings will be conducted
in accordance with the department's fair hearing rules at §§1.51
- 1.55 of this title (relating to Fair Hearing Procedures).