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.
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, site manager, or regional 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. Holding the pre hearing conference promptly allows the Division the opportunity to resolve the issue without going through the actual fair hearing session.
A pre hearing conference may be held by telephone or in person in a DPA 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.
117-4 B. RESPONSIBILITIES OF THE SUPERVISOR, SITE MANAGER, OR REGIONAL MANAGER
Forward the fair hearing request to the DPA hearing representative in Field Services the same day it is received;
Ensure that a pre hearing conference is immediately offered orally or in writing;
Review the case file to determine whether the contested action was taken correctly;
Determine the issue(s) in dispute;
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;
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;
Record the content and outcome of the pre hearing conference in the case record or Case Notes screen;
Notify the DPA hearing representative in Field Services 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 (IA) denials based on a medical review of the AD 2 and supporting medical documentation requires a pre hearing 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, lead worker, site manager, or regional manager to offer applicants a pre hearing conference.
During the pre hearing conference, the supervisor, lead worker, site manager, or regional manager should provide the applicant information about the Interim Assistance program, including:
The IA reimbursement process.
That
DPA is a separate entity from SSA. The applicant must work continuously with SSA 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
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 PRE HEARING
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 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.
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.
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 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).
If the
applicant does not agree to withdraw their hearing request, the hearing
process continues.
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
Field Services 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 Field Services. Inform
the medical reviewer that the additional information is being provided
as a result of a pre hearing 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
Held - IA Denied. The applicant may request another fair hearing
for the new IA denial.
If the applicant does not provide the additional medical information within the requested time frame, send another denial notice, such as the P304, APA 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.
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