<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER IMEDICAID PROGRAM APPEALS PROCEDURES
DIVISION 2RECIPIENT NOTICE AND FAIR HEARING
RULE §354.2213Maintaining Benefits or Services

(a) Except as otherwise specified in subsection (e) of this section, if the recipient is currently receiving a service upon which an action is taken and requests a fair hearing within the time allowed, the service will be continued until a final decision is rendered following a fair hearing.

(b) The department may terminate or reduce services before rendering a decision only if:

  (1) the department informs the recipient in writing of its intent to reduce or terminate services at least five days before the termination or reduction would be effective; and

  (2) it is determined at the fair hearing that the sole issue is one of state or federal law or policy.

(c) The department may deny, terminate, suspend, or reduce services after an adverse decision is rendered following a fair hearing.

(d) The department may recover or recoup the cost of any services provided as a result of this section, if the fair hearing decision supports the department's action.

(e) The department has no obligation to begin services requiring prior authorization pending a final decision.


Source Note: The provisions of this §354.2213 adopted to be effective May 29, 1997, 22 TexReg 4369; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4562

Next Page Previous Page



Home TxReg TAC OM NewTac Public Footer Bar