26 Tex. Admin. Code § 910.8 - Appeal Process

(a) Right to appeal. If the individual or legally authorized representative (LAR) has provided complete financial information and the individual or LAR disagrees with any fees assessed by the Texas Health and Human Services Commission (HHSC), then the individual or LAR is entitled to appeal such fees.

(b) Obtaining forms to initiate an appeal. To appeal a fee, the individual or LAR must notify the reimbursement office at the facility providing support, maintenance, and treatment to the individual of their intent to appeal the fee. Upon such notification, the reimbursement office shall ensure the individual or LAR has provided complete financial information before sending the individual or LAR a copy of this chapter and a Request for Appeal form. Upon determination that complete financial information has been provided to the reimbursement office, the reimbursement office must provide the form to the individual or LAR within five business days. Additionally, forms can be obtained at, www.hhs.texas.gov/services/mental-health-substance-use/state-hospitals and www.hhs.texas.gov/services/disability/intellectual-or-developmental-disabilities/state-supported-living-centers-sslcs.

(c) Initiating the appeal.

(1) The individual or LAR initiates an appeal by completing, signing, and sending the Request for Appeal form, referenced in subsection (b) of this section or § 910.9(a)(4) of this chapter (relating to Filing Notice of Lien), to: OCC_Appeals_ContestedCases@hhs.texas.gov or HHSC Appeals Division, P.O. Box 149030, Mail Code W-613, Austin, Texas 78714-9030.

(2) An appeal may be initiated before the 45th business day after notification of charges.

(d) Representation.

(1) The appellant may represent their self or use legal counsel, a relative, a friend, or other spokesperson.

(2) HHSC is represented by an HHSC attorney.

(e) Type of hearing. The appellant may choose to:

(1) appear by telephone conference, or by virtual platform, or have their representative appear by telephone conference or by virtual platform at the hearing; or

(2) have a document desk review hearing in which the administrative law judge (ALJ) makes a decision based solely upon documentation filed by the parties with neither party appearing.

(f) Scheduling the hearing. The ALJ shall schedule the hearing to be held not later than the 120th business day after the date the Request for Appeal form is received by the Appeals Division. The ALJ shall consider any request for reasonable accommodations related to a disability of the appellant or the appellant's representative.

(1) If the appellant chooses to appear by telephone conference, the ALJ shall schedule a date, time, and phone number for the hearing. At least 20 calendar days before the hearing, the ALJ shall notify the parties, in accordance with subsection (g) of this section, of the scheduled date, time, and phone number of the hearing.

(2) If the appellant chooses to have a document desk review, at least 20 calendar days before the document hearing, the ALJ shall notify the parties, in accordance with subsection (g) of this section, of the date that all documentation must be filed with the Appeals Division and copies submitted to the other party or the other party's representative.

(g) Notification of parties.

(1) The appellant is notified by electronic and certified mail.

(2) The designated HHSC attorney is notified by intra-agency mail, fax, or electronic mail.

(h) Ex parte communication. Except for communications regarding procedural matters, the ALJ may not communicate with a party, directly or indirectly, on any issue of fact or law, unless both parties are present, or the communication is in writing and a copy is delivered to both parties.

(i) Privileged communication. No party is required to disclose communications between an attorney and the attorney's clients, accountant and the accountant's client, a husband and wife, a clergy-person and a person seeking spiritual advice, or the name of an informant, or other information protected from being divulged by substantive federal or state law.

(j) Withdrawing. The appellant may withdraw the appeal or HHSC may withdraw the fees being appealed at any time prior to the hearing. Upon withdrawal of either party, no hearing is held. The ALJ will issue an order of dismissal and notify the parties of such dismissal in accordance with subsection (g) of this section.

(k) Settlement. At any time before the hearing, parties may enter into a settlement disposing of the contested issues. A settlement agreement must be in writing, signed by the parties or their representatives, and filed with the Appeals Division. Upon receipt of the settlement agreement, the ALJ will issue an order of dismissal and notify the parties of such dismissal in accordance with subsection (g) of this section.

(l) Filing documents.

(1) Hearing at which the parties will appear by telephone.

(A) If a party intends to introduce documents at the hearing, the party shall send such documents to the Appeals Division and submit a copy of the documents to the other party or the other party's representative at least 10 business days before the hearing. Failure to submit copies of documents to the other party will result in a continuance if requested by the party who did not receive the documents.

(B) At the hearing, the ALJ may request either or both parties to file additional documents for consideration in making a decision. The ALJ shall indicate in writing the date by which the additional documents must be received by the Appeals Division.

(2) Document hearing. If a party intends for the ALJ to consider their documents at a document hearing, then the party shall send such documents to the Appeals Division and submit a copy of the documents to the other party or the other party's representative by the date identified by the ALJ as described in subsection (f)(2) of this section. Failure to submit copies of documents to the other party will result in a continuance if requested by the party who did not receive the documents.

(m) Continuance. The ALJ may grant continuances on the request of either party provided the party shows good cause for requesting the continuance. A request for a continuance may be written or oral and may be made before or during a hearing. If a hearing is continued, the ALJ shall schedule the hearing to be continued on a day that is not later than the 45th day after the hearing was originally scheduled. The ALJ must notify the parties, in accordance with subsection (g) of this section, of the continued hearing date within five business days of granting a continuance.

(n) Telephone conference.

(1) Telephone conference equipment used for a hearing must be capable of allowing the parties and the ALJ to hear and speak to each other at all times during the hearing.

(2) If a party elected to appear by telephone, on the date and time of the hearing, the ALJ shall initiate telephone contact with the party using the telephone number provided by the party.

(o) Failure to appear. If the appellant fails to appear at the hearing, the ALJ shall adjourn the hearing. If the appellant notifies the ALJ within three business days after the hearing date and provides evidence of good cause for failing to appear and requests a continuance, the ALJ may grant a continuance. If the ALJ has not been notified by the fourth business day after the hearing date, the ALJ shall close the record and consider all the documents previously filed by both parties and prepare a decision based on such previously filed documents.

(p) Evidence.

(1) Documents. Documents provided as evidence for the hearing do not need authentication.

(2) Testimony. Material and relevant testimony is admissible.

(q) Procedural rights. Each party has the right to:

(1) establish all pertinent facts and circumstances;

(2) present an argument without undue interference;

(3) question or refute any evidence; and

(4) have an audio recording of the hearing proceedings. The ALJ will provide a recording on request.

(r) Audio recording of hearing proceedings. If the hearing is not a document desk review, the ALJ shall make an audio recording of the hearing proceedings. The appellant may request and receive a copy of the audio recording at minimal charge.

(s) Record. The record of the hearing closes when the hearing is adjourned or at the end of the business day on the date that all documents are required to be submitted. The record consists of:

(1) all documents submitted to the Appeals Division, together with the ruling on admissibility made by the ALJ; and

(2) the audio recording of the hearing proceedings made by the ALJ, as required in subsection (r) of this section, if the hearing was not a document desk review.

(t) Decision. Not later than the 30th calendar day after the hearing record has closed, the ALJ shall issue a decision. Hearing decisions must be based exclusively on evidence in the record. Evidence admitted in the hearing is retained in accordance with the HHSC retention schedule. The decision shall be in writing, signed, and dated by the ALJ, and state:

(1) the names of the parties and their representatives (if any), and that they appeared by telephone, if the hearing was not a document desk review;

(2) findings of fact and conclusions of law, separately stated;

(3) whether the appealed fees have been sustained, reduced, or increased; and

(4) the amount of the fees.

(u) Effective date. A decision issued under this section is effective on the date it is signed by the ALJ.

(v) Notice of decision. After the ALJ signs the decision, the Appeals Division shall send a copy of the ALJ's decision to the parties in accordance with subsection (g) of this section.

(w) Finality. The decision of the ALJ is final. For correcting a clerical error, the ALJ retains jurisdiction for 20 calendar days after the date the decision is signed.

(x) Charges. HHSC will not seek reimbursement for services while an appeal decision is pending. Any adjustments made to the service charge as a result of an appeal decision will be included in the updated charge submitted to an individual or their LAR.

Notes

26 Tex. Admin. Code § 910.8

Adopted by Texas Register, Volume 47, Number 11, March 18, 2022, TexReg 1457, eff. 3/24/2022