| (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.
(b) Expedited Appeals. The following hearings are expedited:
(1) Hearings for Transients--Transient appeals are
SNAP and/or TANF appeals submitted by an appellant who plans to move
from the jurisdiction of the hearings officer before the hearing decision
would normally be issued. An example of a transient appeal is an appeal
filed by a household that includes migrant farm workers. The hearing
must be held and a decision made within 15 working days from the date
the hearings officer receives the hearing request if:
(A) the appellant agrees to the reduced notice of the
time, date, and place of the hearing; and
(B) the hearings officer has sufficient information
available to make a decision without requesting additional information.
(2) Hearings for Individuals Whose Health Is Jeopardized--Any
individual who believes and can demonstrate that a delay in his Medicaid
hearing could seriously jeopardize his life or health may request
an expedited fair hearing. Except as provided in subparagraph (A)
of this paragraph, an individual receiving Medicaid services through
a managed care organization (MCO) must exhaust the MCO's expedited
appeals process before requesting an expedited fair hearing from the
Health and Human Services Commission (HHSC). An individual does not
need to exhaust the MCO's expedited appeals process before requesting
a fair hearing that follows HHSC's standard fair hearing processes.
(A) An MCO must send an individual who has requested
an expedited appeal a written notice of the outcome of the appeal,
or a written notice denying the request. The individual may request
an expedited fair hearing if the MCO has not sent a notice by the
following deadlines:
(i) for requests relating to ongoing medical or dental
emergencies or denials of continued hospitalization, no later than
one business day after the MCO received the request; or
(ii) for all other requests, no later than three business
days after the MCO received the request.
(B) During the expedited appeals process, an MCO must
comply with the requirements of 42 C.F.R. §438.420, regarding
the continuation of benefits.
(c) Group Hearings--The hearings officer may consolidate
hearings, upon request of multiple appellants, if the sole issue involved
in the cases is one of Federal or State law or policy. In all cases
except SNAP cases, the request must be in writing, signed by each
appellant, and state the common issue(s). Requests for group hearings
in SNAP cases may be made orally or in writing. An appellant may also
withdraw from a group hearing at any time before a final decision
is issued. If an appellant wishes to withdraw, he must submit a signed
request in writing. Group hearings follow the same procedures as individual
hearings.
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