HHSC Policy Flexibility for Member State Fair Hearings ends on May 11, 2023

Date: March 21, 2023

Attention: All Providers

Call to action: The Health and Human Services Commission (HHSC) is ending the additional 30 days a member has to request a fair hearing starting May 12, 2023. For services provided up until May 11, 2023, Texas Children’s Health Plan (TCHP) will allow the additional 30 days. For services provided beginning May 12, 2023, and ongoing, the normal policy of allowing no less than 90 calendar days and no more than 120 calendar days from the date of the notice of resolution to request a State fair hearing will apply.

Background information: In response to the COVID-19 Public Health Emergency (PHE), the HHSC extended the timeframe individuals, legally authorized representatives, or member authorized representatives have to request a fair hearing. Individuals normally have up to 120 days to request a fair hearing after the Texas Children’s Health Plan appeal. HHSC extended the timeframe to 150 days during the COVID-19 PHE.

How this impacts providers: This notice is informational. No action is required by Providers.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.