Human Service Zone Responsibilities - Appeals and Fair Hearings 448-01-30-20

(Revised 4/1/2023 ML #3711)

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The eligibility worker must:

 

• Inform the applicant of their right to appeal. Information regarding an applicants or recipients right to appeal and receive a fair hearing is provided with notices sent from the eligibility system.

 

• Assist an applicant or recipient in submitting their request for a fair hearing if the applicant or recipient requests their assistance. The SFN 162 – Request for Hearing may be used.

 

• When the applicant, recipient or authorized representative submits a request for fair hearing and does not use the SFN 162 the eligibility worker must complete the SFN 162 as follows:

 

• ‘Program Name’ Section – Enter the program name the client is appealing.

 

• ‘APPEAL OF’ Section – Enter the Name, Telephone Number, Address, City, State and Zip Code of the individual who is appealing.

 

• ‘STEP 1:’Section – Attach a copy of the notice that includes the decision the applicant or recipient is appealing.

 

• ‘STEP 2:’ Section – Indicate ‘Copy of Request for Appeal is attached (or if a verbal request was received for SNAP, verbal request) in this box and include the date the applicant or recipient requested the appeal.

 

• ‘STEP 3:' Section – If the recipient has provided this information, mark the appropriate box. If the recipient has not provided this information, leave the boxes blank.

 

• 'STEP 4:' Section – Complete the Name, Telephone Number, Address, City, State and Zip Code of the individual assisting the applicant or recipient in their appeal, if known. If not known, leave blank.

 

• 'STEP 5:' Section – Do not complete.

 

• Provide the household with a list of the legal service organizations, DN 1087 – Legal Service Organizations , to assist them with the fair hearing.

 

• Complete the SFN 1784 – Appeal Background Report. Mail or fax (701-328-2173) the Appeal Background Report, the request for hearing and other pertinent documents as soon as possible but no later than five calendar days from the date of receipt of the request for hearing to:

 

Department of Health & Human Services

Appeals Supervisor

600 E. Boulevard Ave., Dept. 325

Bismarck, ND 58505

 

Note: The documents submitted to the Legal Advisory Unit along with the Request for Hearing and Appeal Background Report are utilized by State Policy staff for review only. They are not forwarded to the Office of Administrative Hearing (OAH). Only the Request for Appeal and a copy of the notice that resulted in the appeal are forwarded to OAH.

 

• If the request is received by mail, the request form must be date stamped upon receipt and both the envelope and the request for hearing form must be sent to the DHHS Appeals Supervisor.

 

• If the applicant or recipient hand delivers the request to the county, the request form must be date stamped upon receipt and a notation must be made on the request for hearing that the form was hand delivered.

 

• When the DHHS Appeals Supervisor receives a request for hearing directly from the applicant or recipient, a copy will be sent to the eligibility worker. The eligibility worker must determine whether the household is entitled to continued benefits. See program policies for continuation of benefits at:

 

• SNAP 430-05-70-25, Continuation of Benefits

 

• NON-ACA Medicaid 510-05-25-30, Appeals

• ACA Medicaid 510-03-25-30, Appeals

 

• TANF 400-19-125-10 and 400-19-125-15, Requesting a Fair Hearings

 

• CCAP 400-28-155-20, Benefits Pending a Fair Hearings

 

• LIHEAP 415-05-20, Right to Appeal and Fair Hearing

 

• When the eligibility worker becomes aware that the individual requesting a hearing plans to move from the State before a fair hearing decision would normally be reached, the eligibility worker must expedite the hearing request to ensure the household receives a decision and restoration of lost benefits and the hearing must be processed faster than others, if necessary, to allow a decision before the household leaves the area.

 

• The eligibility worker will receive a letter from the Legal Advisory Unit indicating the Request for Appeal and a copy of the notice that resulted in the appeal was forwarded to OAH. This letter also indicates that OAH will be sending the eligibility worker a ‘Notice of Hearing & Specification of Issue’.

Note: Upon receipt of the ‘Notice of Hearing & Specification of Issue’, the eligibility worker must follow the instructions included in this notice, which includes sending all pertinent information to OAH and the appellant.

 

When preparing for the fair hearing, the eligibility worker must:

 

• Notify the DHHS Appeals Supervisor if the appellant has a legal guardian.

 

• Notify the DHHS Appeals Supervisor if the appellant is represented by legal counsel to ensure that legal counsel is also provided for the county.

 

• Notify the Appeals Supervisor of any problem the applicant or recipient may have accessing the hearing site.

 

• Review the applicable Administrative Rules and program policies. Any questions or clarifications needed in regards to the rules or policies must be addressed with appropriate program staff prior to the hearing.

 

• Organize all oral and written evidence and plan for its presentation at the hearing to avoid unnecessary delay or duplication.

 

• Present copies of policy directives or instructions at the hearing when they are involved in the matter.

 

• Arrange for the attendance of all necessary witnesses and the availability of all documents for presentation of the case by the county social service office.

 

• Prepare a complete final budget computation, month by month, for the period subject to review, and up to the date of hearing, if the issue is:

• Amount of assistance

• Adjustment(s)

• Demand for repayment

• Remain in touch with the applicant or recipient and report to the DHHS appeals supervisor any change in their address or any other circumstances which might affect the hearing, if possible. The responsibility to report changes in the applicant or recipient’s circumstances continues until a hearing decision has been reached.

 

• After the hearing, the Administrative Law Judge (ALJ) will issue a recommended finding and recommended order for review by the county and DHHS program staff. The appellant also receives a copy. This is not the final decision. Any concerns the county may have with these documents need to be sent to the appropriate DHHS program staff upon receipt.

NOTE: Never take action on the unsigned recommended finding and recommended order.

 

• Immediately upon receipt of the decision signed by the DHHS Commissioner, the eligibility worker must comply with the decision based on program policy.