117-12        THE FAIR HEARING DECISION

The administrative law judge reviews the record of the hearing, including all testimony, evidence, and material introduced at the hearing, along with the applicable statutes and regulations, and makes a decision on all relevant issues addressed at the hearing.

The role of the administrative law judge is to make certain the agency correctly applied the laws, regulations, and policies in making the determination and taking action on the case.

The administrative law judge does not have the authority or the responsibility to establish program policy or procedure. Therefore, the decision of the administrative law judge applies only to the client's case and not to other cases similarly situated. If a hearing decision is determined to apply to other cases, appropriate changes in those other cases will be ordered by the Director through program manual changes.

Subject to statues and regulations, and safeguarding public assistance and medical assistance information, all hearing decisions of the agency are public information. Requests for copies of hearing decisions will be forwarded to the Office of Administrative Hearings for action.

There are two hearing decisions rendered upon the completion of a fair hearing:

1. The first is a proposed decision. The proposed decision is written by the administrative law judge assigned to the case, outlining his/her initial findings based on documentary evidence and verbal testimony. Upon receipt of the proposed decision, both the client and the agency have ten days to submit written opposition if they disagree with the proposed decision. Once the ten days has expired, the proposed decision will move forward from the Office of Administrative Hearings to the Commissioner's office.
2. The second is the final decision rendered by the Office of the Commissioner. The Commissioner or his designee will review the proposed decision, any written oppositions and hearing record to tissue the final decision. Once at the Commissioner's Office renders the final decision, it is binding upon the agency. The agency has no appeal rights. However, the client can appeal to Superior Court.

117-12 A.      TIME LIMITS ON DECISIONS

1. Temporary Assistance, Medicaid, Adult Public Assistance, General Relief Assistance, and Chronic and Acute Medical Assistance programs:

Fair hearing decisions must be completed no later than 90 calendar days from the date of request.

2. Supplemental Nutrition Assistance Program:

Fair hearing decisions must be completed no later than 60 calendar days from the date of the fair hearing request.

117-12 B.      DENIAL OR DISMISSAL OF A FAIR HEARING

Only the administrative law judge can deny or dismiss a client's request for a hearing. A supervisor, lead worker, or eligibility manager has no authority to deny or dismiss fair hearing requests. The administrative law judge must send written notice to each client whose request for a hearing is denied.

The client has no right to a fair hearing to contest the denial of a fair hearing request. However, a client may appeal the Commissioner's decision to the Superior Court.

1. Reasons to Deny a Fair Hearing Request

The administrative law judge may deny a client's request for a fair hearing when:

1. The issues the client wishes to address at the hearing are not those specified in section 117-1A;
2. The sole issue relates to grant adjustment due to a mass change and does not concern program eligibility, the computation of benefits, or the agency's interpretation of state and federal law;
3. The request is not timely as specified in section 117-1D;
4. A hearing decision was previously rendered on the same issue(s) involving the same month(s) of benefits;
5. The issues involve matters where the administrative law judge has no jurisdiction, such as complaints against staff members, agency operating policies and civil rights complaints. These grievances will be handled through the agency's standard procedures; or
6. The issues are under another agency's jurisdiction (Department of Labor, Child Support Services Division, Worker's Compensation, Social Security Administration, etc.).

2. Dismissal of a Fair Hearing Request

The administrative law judge may dismiss a fair hearing request, terminate or consider a hearing abandoned when:

1. The client withdraws the request for a fair hearing in writing;
2. The agency concedes and the client agrees with the concession; or
3. The client or client's representative fails without good cause to appear at the scheduled fair hearing.

When a written withdrawal is needed

Once a case is referred to the OAHOffice of Administrative Hearings, DPADivision of Public Assistance must obtain a signed statement from clients if they withdraw their request for a fair hearing. Once the supervisor, lead worker, or eligibility manager is made aware that the client wants to withdraw their fair hearing request, they must follow the steps below:

• Ask the client to put the withdrawal in writing and sign it.

• Inform the client to submit their signed statement by fax, mail, email, or dropping it off at the nearest DPADivision of Public Assistance office.

• Document in CANOCase Notes that the client withdrew their fair hearing request and was informed to submit a signed statement.

• Forward the signed statement to the DPADivision of Public Assistance hearing representative in Contracted Services Quality Assurance Unit the same day it is received.

While waiting for the client to submit their signed document, the supervisor, lead worker, or eligibility manager must still submit the hearing request to the DPADivision of Public Assistance hearing representative the same day it is received (refer to MS 117-4B(1)).

Before case is referred to OAHOffice of Administrative Hearings

If the case has not been referred to OAHOffice of Administrative Hearings, a client may request a fair hearing withdrawal in writing or verbally for any DPADivision of Public Assistance programs. Supervisor or lead worker must case note the withdrawal request.

After case referred to OAHOffice of Administrative Hearings and no written withdrawal received

Once a case is referred to OAHOffice of Administrative Hearings, DPADivision of Public Assistance is required to schedule a fair hearing conference and proceed with the process until a written fair hearing withdrawal is received from the client. If DPADivision of Public Assistance does not receive a written withdrawal before the scheduled fair hearing conference, a hearing will be conducted. At this hearing, the administrative law judge will contact the client and confirm their decision to withdraw the hearing request. Once confirmed, the hearing issue will be dismissed. If the client denies withdrawing the request or changes their position, a new hearing date will be scheduled.

117-12 C.      NOTICE OF THE FAIR HEARING DECISION

The administrative law judge and the Commissioner, or the Commissioner's designee, must provide the client a written notice of each proposed and final hearing decision. Each notice must include the decision, the reason behind the decisions, and the evidence and laws, or regulations supporting the decision. In addition, the notice must include a statement of the client's right to submit opposition to the proposed decision and appeal rights to the final decision. Time frames for the opposition or appeal must also be identified in the notice.

The administrative law judge's proposed decision and the Commissioner's final decision will be sent to all parties involved at the hearing. The agency hearing representative is responsible to forward copies of the final decision to the appropriate functional unit, team supervisor, and Policy and Program Development Team.

The case file copy will be forwarded to the office or team supervisor for all necessary action and filing in the case file.

The actions ordered in the notice of the decision must be taken within 10 days of the agency's receipt of the decision.