Haw. Code R. § 17-1703.1-12 - The hearing

(a) The hearing shall include consideration of:

(1) Any adverse action by the department or managed care health plan which includes:

(A) Failure to determine eligibility within the specific time limits of the medical assistance programs;

(B) Refusal to consider a request for or failure to make a payment adjustment within time limits set by the medical assistance programs; or

(C) Discontinuance, termination, suspension, withholding, or reduction of medical assistance or coverage; and

(2) The department's decision regarding:

(A) An initial and subsequent determination of eligibility for medical assistance;

(B) Amount of spenddown or change in spenddown;

(C) Amount of premium share or change in premium share; or

(D) The method of delivery of service, included restricted status.

(b) The individual shall be required to appear in person at the hearing unless authorization for an authorized representative was received by the department. When mutually agreed upon by the individual and the department, a hearing may be conducted over the telephone or through videoconference.

(c) Unless both the department and the individual agree to the presence of other persons in the hearing room, the hearing officer or person conducting the hearing shall limit attendance to the following individuals necessary for the conducting of the hearing:

(1) The individual, the authorized representative, or both, interpreter, if any, legal counsel, and witnesses;

(2) Representatives of the section or unit offices;

(3) Representatives of the Med-QUEST Division; and

(4) Hearing officer and staff.

(d) The individual or the authorized representative shall, upon request, be able to examine the electronic and physical case record as well as all available documentary evidence used by the department at the hearing as specified in section 17-1703.1-6.

(e) The hearing shall be conducted at a reasonable time, date, and place and generally be held in the Jurisdiction of the department in which the individual is living at the time of the hearing. The hearing shall be conducted at a location or a videoconference specified by the hearing officer, or a teleconference is scheduled if the individual is unable to travel to the site because of health issues.

(f) The hearing officer shall have access to the department's information necessary to issue a proper hearing decision, including information concerning policies and regulations.

(g) The decision of the hearing officer shall be based exclusively on evidence and other material introduced at the hearing. If, after a hearing has begun, additional evidence is necessary for the proper determination of the case, the hearing officer may:

(1) Continue the hearing to a later date. The hearing officer may order further investigation and may direct either party to produce additional evidence; or

(2) Close the hearing and hold the record open for a period not to exceed thirty (30) days to permit the receipt of additional documentary evidence.

Notes

Haw. Code R. § 17-1703.1-12

[Eff 09/30/13] (Auth: HRS § 346-14(9); 42 C.F.R. §§431.240, 431.242, 431.241, 431.244) (Imp: HRS § 346-12; 42 C.F.R. §§431.240, 431.242, 431.241, 431.244)