Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter I - MEDICAID PROGRAM APPEALS PROCEDURES
Division 2 - RECIPIENT NOTICE AND FAIR HEARING
Section 354.2213 - Maintaining Benefits or Services

Universal Citation: 1 TX Admin Code ยง 354.2213

Current through Reg. 49, No. 38; September 20, 2024

(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.

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