117-4          PREHEARING CONFERENCE

The prehearing conference is a meeting between an agency representative, the client, and/or the client's representative before the fair hearing conference. Prehearing does not replace the fair hearing. The purpose of the prehearing 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 prehearing conference. However, the agency must offer a prehearing conference to each client requesting a fair hearing.

117-4 A.      SCHEDULING THE PREHEARING CONFERENCE

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

A prehearing conference must be scheduled and held before the scheduled fair hearing date at a time convenient to the client. Holding the prehearing conference promptly allows the Division the opportunity to resolve the issue without going through the actual fair hearing session.

A prehearing conference may be held by telephone or in person in a DPA Division 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 prehearing conference.  

117-4 B.      RESPONSIBILITIES OF THE SUPERVISOR, SITE MANAGER, OR REGIONAL MANAGER

1. Forward the fair hearing request to the DPA Division of Public Assistance hearing representative in Field Services the same day it is received;

2. Ensure that a prehearing 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 prehearing conference as soon as possible and attempt to resolve the fair hearing issue.  If a prehearing 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 prehearing conference in the case record or Case Notes screen;

8. Notify the DPA Division of Public Assistance hearing representative in Field Services of the outcome of prehearing conference.

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

Fair hearing requests for Interim Assistance (IA) denials based on a medical review of the AD #2 and supporting medical documentation requires a prehearing conference, the same as any other fair hearing request.  Although the IA decision is made by the medical reviewer, it is the responsibility of the supervisor, site manager, or regional manager to offer applicants a prehearing conference.

During the prehearing conference, the supervisor, site manager, or regional manager should provide the applicant information about the Interim Assistance program, including:

• The IA reimbursement process.
   

• That DPA Division of Public Assistance is a separate entity from SSA Social Security Administration . The applicant must work continuously with SSA Social 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 SSI Supplemental Security Income criteria.
   

• That IA 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 IA.

PROCESS FOR CONDUCTING THE PREHEARING

1. At the prehearing 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 IA 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 IA 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 IA.  Advise the applicant that they can withdraw the hearing request, and retain the right to request it again if the prehearing 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:

1. • 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 Field Services that the hearing request is withdrawn.
      

6. 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 Field Services.  Inform the medical reviewer that the additional information is being provided as a result of a prehearing conference.  
    

   • If the medical screener approves IA based on the new information, open the IA case.  
      

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

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