Section 354.2407 - Recipient Rights(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.1 Tex. Admin. Code § 354.2407
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