117-4          PRE-HEARING CONFERENCE

The pre-hearing conference is a meeting between an agency representative, the client, and/or the client's care coordinator or legal representative before the fair hearing conference. Pre-hearing does not replace the fair hearing. The purpose of the pre-hearing is to have a resolution by defining and discussing the disputed issue(s), and clarifying program rules.

Clients are not required to have or participate in a pre-hearing conference. However, the agency must offer a pre-hearing conference to each client requesting a fair hearing.

When there is a legal representative involved and they are representing a client, the pre-hearing conference and fair hearing must be completed with the attorney and not with the client. However, if a client has an authorized representative who is not an attorney, the client may still participate in the pre-hearing conference and fair hearing.

117-4 A.      SCHEDULING THE PRE-HEARING CONFERENCE

A pre-hearing conference must be offered to the client promptly after the fair hearing request is received. The conference will be conducted by the supervisor, lead worker, or eligibility manager. The caseworker and/or case manager responsible for the issue in dispute may also participate in the conference.

A pre-hearing conference must be scheduled and held before the scheduled fair hearing date at a time convenient to the client. If the client cannot be contacted for a pre-hearing conference, a notice is sent to them notifying that a pre-hearing conference is needed.

A pre-hearing conference may be held by telephone or in person in a DPADivision of Public Assistance office, the client's home, or any other location convenient to both the client and the agency.

Note:

The scheduling of the fair hearing must not be delayed pending the arrangement or outcome of the pre-hearing conference. If contact with the client is not possible, send a pre-hearing conference notice to the client.

117-4 B.      RESPONSIBILITIES OF THE SUPERVISOR OR ELIGIBILITY MANAGER

1. Forward the fair hearing request to the DPADivision of Public Assistance hearing representative in Contracted Service Quality Assurance Unit the same day it is received via I-Sight;
2. Ensure that a pre-hearing conference is immediately offered orally or in writing;
3. Review the case file to determine whether the contested action was taken correctly;
4. Determine the issue(s) in dispute;
5. Determine the household's eligibility for continued benefits if the client requests it. If eligibility for continued benefits exists, take action within five days to continue the benefits pending the fair hearing decision;
6. Schedule and hold the pre-hearing conference as soon as possible and attempt to resolve the fair hearing issue. If a pre-hearing conference is held and the issue is not resolved, ensure that the client understands that the fair hearing will be held at a later date;
7. Record the content and outcome of the pre-hearing conference in the case record or Case Notes screen;
8. Notify the DPADivision of Public Assistance hearing representative in Contracted Services Quality Assurance Unit of the outcome of pre-hearing conference.

117-4 C.      PRE-HEARING CONFERENCE FOR INTERIM ASSISTANCE DENIALS BASED ON MEDICAL REVIEW

Fair hearing requests for Interim Assistance (IAInterim Assistance) denials based on a medical review of the AD 2Preliminary Examination for Interim Assistance and supporting medical documentation requires a pre-hearing conference, the same as any other fair hearing request. Although the IAInterim Assistance decision is made by the medical reviewer, it is the responsibility of the supervisor, lead worker, or eligibility manager to offer applicants a pre-hearing conference.

During the pre-hearing conference, the supervisor, lead worker, or eligibility manager should provide the applicant information about the Interim Assistance program, including:

• The IAInterim Assistance reimbursement process.
• That DPADivision of Public Assistance is a separate entity from SSASocial Security Administration. The applicant must work continuously with SSASocial Security Administration in regard to their Social Security disability benefits.
• The process for determining disability for Interim Assistance. Include information about the medical screening process and meeting SSISupplemental Security Income criteria.
• That IAInterim Assistance is a cash-only program, and is not attached to Medicaid eligibility. The applicant will not receive Medicaid even if they are found eligible for IAInterim Assistance.

PROCESS FOR CONDUCTING THE PRE-HEARING

1. At the pre-hearing conference, ask the applicant if they have additional medical information they want the medical reviewer to consider. Inform the applicant that providing the additional information will allow the medical reviewer to reevaluate their medical condition, but does not guarantee approval of IAInterim Assistance benefits. It is the applicant's responsibility to obtain the medical information they want to submit. The agency may help obtain additional medical documents, but it is ultimately the applicant's responsibility to contact their provider and get the documents to the caseworker or the medical screener.
2. If the applicant does not have any additional information and it appears there is no other reason to rescind the IAInterim Assistance denial, the hearing process continues.
3. If the applicant agrees to provide additional information, ask the applicant if they want to withdraw their hearing request while the medical screener reconsiders their eligibility for IAInterim Assistance. Advise the applicant that they can withdraw the hearing request, and retain the right to request it again if the pre-hearing fails to resolve issues. Allow the applicant an additional time to provide the information (for example, 10-15 days, or more if necessary, depending on how long it will take to provide the information).
4. If the applicant does not agree to withdraw their hearing request, the hearing process continues.
5. If the applicant agrees to withdraw their hearing request pending reconsideration of additional medical information by the medical reviewer:

• Request a written withdrawal
• Send a general correspondence notice (N011) to inform the applicant of the agency's action and the time frame for providing the additional medical information.
• Notify the hearing representative in Contracted Services Quality Assurance Unit that the hearing request is withdrawn.

Once the applicant provides the additional medical information, forward it to the medical screener, and if the hearing request was not withdrawn, to the hearing representative at DOSTDivision Operations Support Team. Inform the medical reviewer that the additional information is being provided as a result of a pre-hearing conference.

• If the medical screener approves IAInterim Assistance based on the new information, open the IAInterim Assistance case.
• If the medical screener does not approve IAInterim Assistance based on the new information, deny the IAInterim Assistance again by sending another denial notice such as the P304, APAAdult Public Assistance Held - IAInterim Assistance Denied. The applicant may request another fair hearing for the new IAInterim Assistance denial.

6. If the applicant does not provide the additional medical information within the requested time frame, send another denial notice, such as the P304, APAAdult Public Assistance Held - IAInterim Assistance Denied. In the free form section at the bottom of the notice, inform the applicant that the time frame for them to submit additional medical information has ended and because they did not provide any additional medical information, the agency's denial of IAInterim Assistance benefits stands. The applicant may request another fair hearing for the IAInterim Assistance denial.