| (a) The Health and Human Services Commission (HHSC)
gives a recipient timely and adequate notice of an action to assign
the recipient to a designated provider and opportunity for a fair
hearing. Hearings are conducted under Chapter 357, Subchapter A, of
this title (relating to Uniform Fair Hearing Rules).
(1) The written notice to a recipient of the recipient's
right to a hearing will be mailed at least ten calendar days before
the lock-in period effective date.
(2) HHSC will grant a hearing if it receives a recipient's
request for a hearing no later than:
(A) 90 calendar days from the date of the initial notice
of intent to assign a designated provider; or
(B) 90 calendar days from the date of the notice of
intent to continue a lock-in period.
(3) If a request for a hearing is received by the lock-in
effective date, HHSC will not implement the lock-in status until the
hearing has been held and a final decision rendered.
(4) If a request for a hearing is received after the
lock-in effective date, the lock-in status will remain in effect until
the hearing has been held and a final decision rendered that reverses
the lock-in action.
(5) The recipient does not have the right to a fair
hearing when the lock-in is the result of a misdemeanor or felony
offense related to fraud and/or abuse of Medicaid benefits and/or
services, or to controlled substances.
(6) During the lock-in period, the recipient is not
entitled to a fair hearing for denial of either of the following requests:
(A) change in designated provider; or
(B) termination of the lock-in period.
(b) A lock-in recipient must have reasonable access
to Medicaid services and benefits and must be able to receive emergency
services for an emergency medical condition. A provider other than
the designated providers may provide the emergency services. The emergency
care provider must certify that the recipient required emergency 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; amended to be effective April 2, 2013, 38 TexReg 2095 |
