State Fair Hearings
If you disagree with Superior’s appeal decision, you have the right to ask for a Medicaid State Fair Hearing from the Texas Health and Human Services Commission (HHSC) You may represent yourself at the Fair Hearing, or name someone else to be your representative. This could be a doctor, relative, friend, lawyer, or any other person. You may name someone to represent you by writing a letter to Superior telling them the name of the person that you want to represent you.
You or your representative must ask for a Fair Hearing within 120 days of the date this notice.
If we’re stopping or reducing a service, you can keep getting the service while your case is being reviewed. To qualify, you must ask for a Fair Hearing within 10 days of the date of this notice or before the service is stopped or reduced, whichever is later.
To ask for a Fair Hearing, you or your representative should write or call Superior at 1-877-398-9461; 5900 E. Ben White Blvd., Austin, TX 78741.
If you believe that waiting for a Fair Hearing will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you or your representative may ask for an expedited Fair Hearing by writing or calling Superior. To qualify for an expedited Fair Hearing through HHSC, you must have completed Superior’s internal expedited appeals process.
If you ask for a Fair Hearing, you will get a packet of information letting you know the date, time and location of the hearing. Most hearings are held by telephone. You can also contact the HHSC hearings officer if you would like the hearing to be held in-person.
During the hearing, you or your representative can tell why you need the service or why you disagree with the Superior’s action. You have the right to examine, at a reasonable time before the date of the Fair Hearing, the contents of your case file and any documents to be used by Superior at the hearing. Before the hearing, Superior will send you all of the documents to be used at the hearing.
HHSC will give you a final decision within 90 days from the date you asked for the hearing.