2.3.1
GENERAL
PROVISIONS
A. The administrative
hearing process is initiated when an agency or the EHO receives an appeal
request.
B. The EHO is responsible
for scheduling the date for the appeal hearing. Upon scheduling a hearing, the
EHO must send a written notice to the appellant of the date, time, and location
or format of the hearing, no later than fifteen (15) days prior to the hearing
date. The EHO must also notify all other affected parties including any
authorized representatives of the hearing date.
C. The EHO must assure that the appellant is
sent an evidentiary packet, upon request, at least three (3) days in advance of
the hearing date, except when using the expedited appeal process. The evidence
packet shall, at a minimum, include:
1. Except
for HSRI, in eligibility cases, the appellant's original application, the
eligibility decision, and, if available, verification results from third party
data sources used to make the eligibility determination;
2. In all other cases, any documents provided
to the agency by or on behalf of the appellant that were material to the action
taken by the agency;
3. Any
documents and explanations provided by the appellant;
4. The agency response where
applicable;
5. All associated
notices.
D. The evidence
packet is available to all parties in attendance at the hearing. All parties
may request an opportunity to view the evidence packet prior to the hearing,
with sufficient advance notice prior to the scheduled hearing. Requests to
review the evidence packet should be made to the EHO.
E. The appellant and/or an authorized
representative of the appellant must appear for the hearing at the scheduled
time, date, and location. Hearings are held typically on the EHO or agency
premises or may be conducted by telephone.
1.
Request for continuance - If the appellant or an authorized representative is
unable to appear for the hearing, the appellant must contact the EHO prior to
the hearing date to report that he or she will not be able to appear, explain
the reason, and request a continuance/postponement of the hearing.
a. No more than two (2) requests for
continuances are permitted, unless the EHO allows, in its discretion, to permit
an additional continuance subsequent to a valid claim of good cause as
indicated below in §2.3.1(E)(3) of this Part.
b. A SNAP household may receive one
postponement of no more than 30 days.
c. A hearing may be held open to a later
date, at the discretion of the hearing officer, if an appellant requests
additional time in which to submit relevant documents.
2. Dismissal for Failure to Appear - If the
appellant or an authorized representative does not provide prior notification
to the agency or the EHO of an inability to appear, the appeal is dismissed
unless there is an approved claim of good cause. If good cause is found, the
dismissal is vacated and the hearing is rescheduled as below.
3. Good Cause for Failure to Appear - Good
cause for failure to attend a hearing is liberally interpreted in the
appellant's favor. EHO staff may assist the appellant in the establishment of
good cause, and when necessary, forward determining information to the hearing
officer. If the hearing officer determines that good cause exists, the hearing
is rescheduled within thirty (30) days of the request and
benefits/assistance/services must be reinstated without undue delay if
terminated due to dismissal of the appeal. Good cause claims include, but are
not, limited to:
a. Sudden and unexpected
event (such as loss or breakdown of transportation, illness or injury, or other
events beyond the individual's control) which prevents the appellant's
appearance at the hearing at the designated time and place; or appearance at
the wrong office;
b. Disabilities,
such as linguistic and behavioral health limitations, that may affect the
appellant's ability to attend;
c.
Injury or illness of appellant or household member that reasonably prohibits
the individual from attending the hearing; and
d. Death in family.
4. Vacating a Dismissal - Upon determining
that good cause exists, the dismissal is vacated, the hearing is rescheduled,
and the EHO provides appropriate notification to the affected parties and
agency. If the EHO finds that good cause does not exist, timely written notice
of the denial of a request to vacate a dismissal is sent to the appellant. In
HSRI appeal cases, the appellant must be advised in the notice in either case -
denial or approval of request to vacate a dismissal - of the right to pursue
the appeal at the federal level. An appellant choosing to exercise this right
must make a request to the federal DHHS appeal entity in no more than thirty
(30) days from the date of the EHO notice indicating whether the dismissal is
vacated.
F. The appellant
may designate anyone, including someone who is not licensed to practice law, to
serve as an authorized representative during the appeal process. The appellant
may make this designation to the EHO or the agency in-person or in writing by
fax, email or U.S. mail or, as appropriate, the state's web-based IES.
1. Role of the Authorized Representative -
Once the designation has been recognized by the EHO, the authorized
representative is copied on all correspondence pertaining to the appeal that is
provided to the appellant. Although the authorized representative may act on
behalf of the appellant in all matters leading up to, and including, formal
adjudication in a fair hearing, the appellant may opt to participate on his or
her own in any dispute resolution proceeding.
2. Legal representation - In situations in
which the appellant chooses to engage a licensed attorney to serve as an
authorized representative, the EHO must be notified in advance that the
attorney intends to make an appearance on the appellant's behalf. Such
notification must be provided directly to the EHO by the attorney.
3. Authorized representatives who are
out-of-state attorneys must file a pro hac vice motion in Rhode Island Supreme
Court to request to be temporarily admitted to practice prior to providing
legal representation in the administrative appeal process. In addition, all
out-of-state attorneys must meet the requirements of the Rhode Island Supreme
Court's Article II, Rule 9 (requirements for non-resident attorneys).
4. If an appellant chooses to have legal
representation at the hearing, the representative shall file a written "Entry
of Appearance" with the EHO at or before the hearing. The Entry of Appearance
acts as a release of confidential information, allowing the legal
representative access to the appeal record. The Entry of Appearance is also
needed for the EHO to confirm the representation for purposes of follow-up,
review, requests for continuances, etc.
G. Persons attending the hearing typically
include the appellant, the appellant's authorized representative, the EOHHS
Hearing Officer, state attorneys, and one or more representatives from the
agency that took the action on appeal. In instances in which the subject on
appeal is a change in agency policy, other affected parties may also have
representatives in attendance.
1. Agency
representatives attending the hearing must be prepared to answer questions
related to the action on appeal.
2.
It is the responsibility of the hearing officer to record the attendance of all
persons who were involved in the relevant action under appeal.
H. All parties, authorized
representatives, witnesses, and other persons present at a hearing must conduct
themselves with the same decorum commonly observed in any Rhode Island court.
Where such decorum is not observed, the hearing officer may take any
appropriate actions to restore order, including ejection of parties or
adjournment, as appropriate.
I. No
person who is a party to or a participant in any proceeding before the agency
or EHO or the party's counsel, employee, agent, or any other individual, acting
on the party's or their own or another's behalf, is permitted to communicate ex
parte with the hearing officer. The hearing officer must not request or
entertain any such ex parte communications. These prohibitions do not apply to
those communications that relate solely to general matters of procedure and
scheduling.
J. Hearing officers
hear the case de novo (or with no prior knowledge of the specific issue) and
base decisions on applicable laws, regulations, rules and procedures.
K. Persons with disabilities must have access
to services and processes necessary to ensure their full participation in the
hearing process.
L. In compliance
with state and federal statutes and regulations, EHO must have interpreters
available for persons with limited English proficiency and other persons
needing such services, such as a telephonic interpreter service or a language
line.
M. The EHO administrative
hearing officer is an impartial designee of the Secretary of EOHHS.
Accordingly, a person who has participated in any way in the matter on appeal -
either in an official or unofficial capacity - is prohibited from serving as a
hearing officer. The hearing officer is responsible for eliciting all relevant
facts bearing on the appellant's claim and agency rules, regulations, policies,
and/or procedures pertinent to the matter in dispute.
N. The EHO maintains an official transcript
of oral presentations made in the hearing. If not transcribed, any tape
recording and any memorandum prepared by a presiding official summarizing the
contents of those presentations shall be maintained on file. This is the
official record for matters appealed from the EOH. Any person who testifies at
the hearing shall be sworn in by the hearing officer. An orderly procedure must
be followed that includes but is not limited to the following:
1. A statement by the hearing officer
reviewing the agency's purpose relative to the hearing; the reason for the
hearing; the hearing procedures; the basis upon which the decision will be
made, and the manner in which the individual is informed of the
decision.
2. A statement by the
appellant and/or authorized representative outlining the appellant's
understanding of the matter in dispute.
3. A statement by an agency representative,
setting forth the legal basis for the agency's action that specifies applicable
rules, regulations, policies, and/or procedures.
4. A full and open discussion of all facts
and policies at issue by participants under the active leadership of the
hearing officer.
O. The
hearing may be adjourned from day to day or, within reason, held open to a
later date at the discretion of the hearing officer if the appellant has reason
to believe that he or she will obtain further relevant information to present
at the hearing.
P. The appellant
may submit supporting documents into evidence in-person at the time of the
hearing, by mail, or by fax, the time frame for such being at the discretion of
the EHO.
Q. The EHO must provide
the appellant with the opportunity to:
1.
Review the appeal record, including all documents and records to be used by
agency at a reasonable time of no less than 72 hours before the date of the
hearing, as well as during the hearing;
2. Bring witnesses to testify;
3. Establish all relevant facts and
circumstances;
4. Be informed of
the right to judicial review, if dissatisfied with the hearing
decision;
5. Present an argument
without undue interference;
6.
Question or refute any testimony or evidence, including the opportunity to
confront and cross-examine adverse witnesses;
7. Testify telephonically upon request of the
appellant and/or at the discretion of the EHO;
8. For HSRI actions, an appellant shall be
informed of the right to appeal further to the federal HHS, if dissatisfied
with the hearing decision; and
9.
For appeals related to HSRI and MAGI Medicaid, an appellant must be informed
that a hearing decision affecting one household member may require eligibility
re-determinations for other household members.
R. The EOHHS Hearing Officer considers all
relevant evidence presented during the course of the appeals process, including
any evidence introduced at the formal hearing. Only information bearing
directly on the issue under review and the policy, regulation or law put forth
as supporting the agency action may be presented by the agency. The hearing
officer is prohibited from reviewing any information that is not made available
to all parties to the appeal. Further, the hearing officer is prohibited from
reviewing any records or evidence that have not been introduced at the
hearing.
S. When a hearing involves
medical documentation required by federal or state law, such as a diagnosis, a
physician's report, or a medical review team's decision, a medical assessment
from a qualified person (other than the person(s) involved in the original
decision) may be obtained at the expense of the agency and integrated into the
appeal record if the hearing officer deems it necessary.
T. No evidence is admitted after completion
of a hearing or after a case is submitted on the record, unless the hearing
officer allows the record to remain open for such limited purpose, or the
hearing officer reopens the hearing, or the parties agree to the submission,
and all the parties have been notified of allowing the record to remain open or
said reopening.
2.3.2
APPEAL HEARING DECISIONS
A. The
full responsibility of the EHO in the hearing process is discharged when a
final decision has been made, in writing, by the EHO.
B. The hearing decision must include a full
report of the findings and the applicable provisions stipulated in federal
and/or state policies, rules, regulations, and/or procedures and any additional
relevant evidence presented during the course of the appeals process, including
at the hearing, that serve as the basis for the decision.
C. The hearing decision must include findings
of fact and conclusions of law, separately stated, and a concise statement of
the underlying facts supporting the findings. The hearing decision must include
a plain language description of the effect(s) of the decision on the appellant
and, when applicable, members of the appellant's household. In addition, the
EHO must indicate in writing that the appeals decision is final, unless the
appellant chooses to exercise the right to pursue legal action through the RI
court system or, in HSRI cases, appeal to the federal DHHS as indicated in
§ 2.4.4 of this Part. For exceptions to this requirement, see § 2.4.6
of this Part.
D. The EHO must issue
written notice of the decision to the appellant within ninety (90) days of the
date the appeal request is received, unless otherwise indicated in the
program-specific special provisions indicated in §
2.4 of this Part. The EHO
must provide notice of the appeal decision and implementation instructions to
the agency pertaining to the continuation, reinstatement, or termination of
benefits/assistance/services or any required changes in the scope, amount,
and/or duration of benefits/assistance/services.
E. In accordance with
7 C.F.R. §
273.15(c)(l),
the state agency has sixty (60) days from the receipt of a SNAP beneficiary's
request for a hearing to:
1. conduct the
hearing;
2. reach a decision;
and
3. notify household and
agency.
F. The EHO is
responsible for assuring that the written decision is disseminated to the
following:
1. Appellant/Authorized
representative;
2. Agency
representatives, including caseworker if there is one, and the associate
director and administrator of the agency unit/division responsible for
implementation of the action in dispute;
3. Chief legal counsel assigned to the
agency, if applicable;
4. Agency
Administrative Rules Coordinator, if applicable; and
5. Any other such interested persons or
parties that may be involved directly in the decision's
implementation.
G. The
hearing responsibility of the state agency is considered discharged when the
following steps have been completed:
1. The
hearing officer renders a written decision, based exclusively on evidence and
other material introduced at the hearing, on behalf of the state
agency.
2. Copies of the decision
are distributed to the appellant, the agency representatives including specific
case managers, program administrators, and department senior staff as
appropriate, and other interested parties. The decision must set forth the
issue, the relevant facts brought out at the hearing, the pertinent provisions
in the law and state agency policy, and the reasoning which led to the
decision; and
3. Action required by
the decision, if any, has been completed by the agency, and confirmed in
writing to the EHO.
H.
The table below provides an overview of special hearing requirements by agency
and program:
Special Hearing Requirements
|
State Agency Administering Program
|
Name of Program
|
Deadline for Hearing
(From Date Appeal is Received)
|
Hearing Decision Due
|
(01) Department of Human Services
|
General Public Assistance (GPA)
|
Unspecified
|
90 days from date the appeal request is
received
|
(02) Department of Human Services
|
Child Support Services
|
Unspecified
|
30 days from date of close of hearing
|
(03) Department of Human Services
|
Supplemental Nutrition Assistance Program
(SNAP)
|
60 days from date appeal request is
received
|
60 days from date appeal request is
received
|
(04) Department of Human Services
|
Office of Rehabilitative Services
|
60 days from the date appeal request is
filed
Note: Requests for informal resolution must take
place within days of the appeal request and within 30 days of hearing
date
|
30 days from the date of the close of the
hearing
|
(05) Department of Human Services
|
Division of Elderly Affairs, Home and
Community-based Services
|
14 days from date the appeal request is
received
|
90 days from the date the appeal is
received
|
(06) Department of Human Services
|
All Other DHS Programs including Child Care
Assistance, and the State-funded Supplemental Security Program
|
90 days from the date the appeal is
received
|
90 days from the date the appeal is
received
|
(07) Department of Children, Youth, &
Families
|
Findings of Abuse and Neglect
|
120 days from date appeal request is
received
|
120 days from date appeal request is
received
|
Other programs
|
180 days from date appeal request is
received
|
120 days from date appeal request is
received
|
(08) Department of Behavioral Healthcare,
Developmental Disabilities, and Hospitals
|
Non-Medicaid Programs
|
15 days from the date the appeal is
received
|
25 days from date of close of hearing
|
(09) HealthSource RI - health benefit
exchange
|
Qualified Health Plan, Advanced Premium Tax
Credits and Cost Sharing Reductions
|
Varies - See
§ 2.4.3 of this Part
|
Varies - See
§ 2.4.3 of this Part
90 days of the date of the appeal request as
administratively feasible
|
(10) Executive Office of Health & Human
Services
|
Medicaid
|
90 days from date appeal is received unless
expedited
|
90 days from date appeal is received unless
expedited See § 2.4.3 of this Part for expedited appeal
requirements
|
(11) Executive Office of Health and Human
Services
|
Nursing Facility/Assisted Living Transfers and
Discharged
|
Varies - see
§ 2.4.7 of this Part
|
10 days from the date of close of a hearing
unless expedited. If expedited, see § 2.4.2 of this Part
|