1613 Client's Rights Related to a Fair Hearing - The client or the client's representative shall have adequate opportunity to:
1614 Responsibilities of the Local Office - Every applicant/recipient shall be informed in writing at the time of application and at the time of any subsequent action affecting cash, food assistance, child care or medical assistance of the right to a fair hearing, the method of obtaining such hearing, and that representation may be by an authorized representative such as legal counsel, relative, friend, or other spokesperson. In addition, for medical assistance, the applicant/recipient shall be informed of the circumstances under which eligibility may be continued or reinstated during the appeal as well as an explanation that an appeal decision for one household member may result in a change in eligibility for other household members. Information printed on the application/redetermination form and notices of action will provide this information.
Agency hearing procedures shall be uniform, clearly written, and available to any interested party. At a minimum, the procedures shall include time limits for filing requests for appeals, advance notice requirements, hearing timeliness standards, and the rights and responsibilities of persons requesting a hearing. The booklet, Fair Hearing Procedures, shall be used for this purpose.
1614.1 Standard Procedures
- The procedures set forth below shall be followed whenever a
client makes an inquiry concerning a fair hearing, asks for fair hearing
forms, or files a request for a fair hearing.
The worker or supervisor should find out why the client is questioning the agency action.
If the client is only disagreeing with a federal or state law or policy, the reason for such policy should be discussed with the client.
If a client appears to be questioning the application of a federal or state law or policy to his individual situation (incorrect grant computation or use of incorrect facts), an administrative review shall be conducted to determine if the agency action was correct. Upon reconsideration, the agency may amend or change its decision at any time before or during the hearing. The hearing shall not be delayed or canceled because of this preliminary review.
If a satisfactory adjustment is reached prior to the hearing, the agency shall submit a written report to the hearing officer but the appeal shall remain pending until the client submits a signed written statement withdrawing the request for a fair hearing.
If the client is questioning the decision regarding disability and the decision was made related to an SSI or SSA application for benefits, the client is to be referred to the SSA office to file an appeal. See 2637.
If the client is questioning the decision regarding disability and the decision was made by Disability Determination and Referral Services (DDRS) based on an DCF request via the DD-1104 and DD-1105, the appeal will be processed through DDRS as specified in 1614.3 (9).
Food Assistance and Medical Assistance - When a household member or representative makes an oral request for a fair hearing to the local office or to the Office of Administrative Hearings by telephone or in person, the agency shall document the request by using the Request for Administrative Hearing form. The date of the request shall be the date the oral communication was made to the agency and that date shall appear on the form. Lack of signature by the household member on the form used to document an oral request shall not invalidate the request.
1614.2 Agency Conference
- Local service centers shall offer agency conferences to households
wishing to contest an adverse agency action. Local office staff shall
advise households that use of an agency conference is optional and that
it shall in no way replace or delay the fair hearing process. The following
procedures apply:
Such conferences shall be scheduled within 2 working days of the date the appeal is filed, unless the household requests that it be scheduled later or states that it does not wish to have an agency conference.
1614.3 Completion of Summary
- Within 15 days after the appellant has filed a request for
a fair hearing, the agency shall furnish the appellant, or appellant’s representative, and the Office
of Administrative Hearings with a copy of the summary. The summary sets forth
the following information:
Name and address of the appellant;
a summary statement concerning why the appellant is filing a request for a fair hearing;
a brief chronological summary of the agency action which led to the appeal and the agency's action after receiving the request for fair hearing;
a statement of the basis for the agency's decision;
a citation of the applicable policies relied upon by the agency;
a copy of the notice which notified the appellant of the decision in question;
applicable correspondence; and
the name and title of the person or persons who will
represent the agency at the hearing.
1614.4 Informing the Client of Termination of Assistance - The agency shall promptly inform the client in writing if assistance is to be terminated pending the fair hearing decision.
1614.5 Procedures
For Requests Related to a Disability Determination - A request
for a fair hearing on a decision based on a disability determination made
by the agency, or contractors, according to 2662
is initially reviewed by the entity responsible for the disability decision.
The Office of Administrative Hearings will generally direct these
requests directly to DDS. DDS will request information from the eligibility
worker to process the reconsideration. The Medical Assistance Reconsideration
Disability Report will be sent to the worker. The form
lists the information needed by DDS to complete the redetermination.
A new DD-1104, with the Reconsideration field checked, and two new
Authorization to Release Information forms (DD-1103) are included
with the Reconsideration referral. It shall also include copies of
the medical information and forms (the original DD-1104 and DD-1105)
received back from DDS. Any additional medical or social information
that has become available and would have bearing on the decision,
including additional medical services and hospitalizations since the
initial referral, are to be included as part of the referral. DDS
will process the reconsideration.
If the disability is approved in the reconsideration, the case will
be referred back to DCF for redetermination. If the DDS decision remains
negative, a request for Administrative Hearing and agency summary
must be completed and submitted to the Office of Administrative Hearings.
The eligibility worker must ensure the case is clearly designated
a DDS case. DDS will take the lead in developing the agency's case
for the fair hearing.
For cases where there is sufficient medical evidence,
the PMDT will process a reconsideration. All cases approved for Tier
2 but denied Tier 1 will have sufficient evidence and be reconsidered.
Any additional information available to the eligibility worker must
be noted on the referral (e.g., medical services, social information,
hospitalizations, etc). Copies of the fair hearing request and any
related materials are included with the referral. The PMDT may request
additional information from the eligibility worker to develop the
reconsideration.
If the reconsideration establishes a disability, or a higher level of disability, does exist the case will be referred back to the eligibility worker for redetermination. If the reconsideration upholds the original decision, the case will be prepared for a fair hearing. The PMDT will take the lead in preparing the appeal summary and representing the agency at the hearing, with the support of the eligibility worker.