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7.2.2 Fair Hearing Requests for Authorizations or Prior Authorizations
After an administrative review, providers who are dissatisfied with the CSHCN Services Program's decision and the supporting reason may request a fair hearing.
The fair hearing is the final appeal process and is described in the Texas Administrative Code (TAC) Title 25, Part 1, Chapter 1, Subchapter C (www.sos.state.tx.us). The fair hearing process is conducted by the Department of State Health Services (DSHS) Office of General Counsel.
Providers may choose to represent themselves or have legal counsel or another spokesman at the hearing. If unable to attend the hearing in person, providers may request arrangements to attend by teleconference.
Fair hearing requests must be submitted in writing to the DSHS-CSHCN Services Program within 20 days of the date of the administrative review decision notice. The request should state the reasons for the disagreement and include any documents or other proof that help support those reasons. Providers who fail to request a fair hearing within the 20-day period are presumed to have waived the request for a fair hearing, and the CSHCN Services Program will take final action.
Mail or fax fair hearing requests to:
CSHCN Services Program-Fair Hearing
Purchased Health Services Unit, MC-1938
Texas Department of State Health Services
PO Box 149347
Austin, TX 78714-9347
Fax: 1-800-441-5133 or 1-512-458-7162 (in Austin)
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