Source: http://regulations.delaware.gov/register/may2008/final/11%20DE%20Reg%201482%2005-01-08.htm
Timestamp: 2019-02-20 13:36:22
Document Index: 51633061

Matched Legal Cases: ['§5000', '§5000', '§5000', '§501', '§5304', '§5304', '§5304', '§1121', '§5304', '§5304', '§438', '§438', '§5405', '§273', 'art, 326', '§5405', '§3135', '§5405', '§5405', '§5405']

11 DE Reg 1482 05-01-08
Delaware Health and Social Services (“Department”) / Division of Social Services initiated proceedings to provide information of public interest with respect to Fair Hearing procedures. The Department’s proceedings were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Governor’s Advisory Council for Exceptional Citizens (GACEC) and the State Council for Persons with Disabilities (SCPD) offered the following observations and recommendations summarized below. DSS has considered each comment, found the comments to be helpful and instructive and have, for the most part, adopted the suggestions made.
First, in §5000, the definition of “DHSS” merits revision.
A. Paragraph 2 refers to “a managed care company (“MCO”) under contract with DHSS to manage an operation of the Medicaid Program.” The Division of Child Mental Health Services is a Medicaid MCO. It is not a “company”. Moreover, we lack information on whether its status as an MCO is established by “contract”, memorandum of understanding, or other document. DHSS should consider amending this section to accurately include the DCMHS.
Agency Response: DSS agrees and changed the reference in the final order regulation to read “managed care organization.” Also, in response to amending §5000 to include DCMHS, DSS decline the recommendation because §5000 describes the Divisions within the Department of Health and Social Services (DHSS) and DCMHS is a Division within the Department of Services to Children, Youth & Their Families. The rules adequately cover hearing requests over Medicaid Program services offered by DCMHS as a Medicaid Program managed care provider.
B. Paragraph 1 refers to “financial assistance”. This may be too narrow. The Delaware Code contemplates many forms of “public assistance”. See Title 31 Del.C. §§501-502. DSS administers a variety of public assistance benefits, including job training and education. Compare 16 DE Admin Code §5304: “An opportunity for a hearing will be granted to any... recipient who is aggrieved by any action of the Division of Social Services such as actions to... assign Food Stamp Program recipients to a specific employment and training component.” DSS is also involved in medical assistance. Apart from the Chronic Renal Disease Program, DSS is responsible for PASARR hearings. See 16 DE Admin Code §5304.1. Therefore, Par. 1 could be amended to refer to “economic, medical, vocational or child care subsidy assistance”. Parenthetically, 16 DE Admin Code §5304 refers to “economic assistance” rather than “financial assistance”. “Economic” is ostensibly a more encompassing term.
Agency Response: DSS adopted the Councils’ recommendation.
C. DDDS and DSAAPD are not mentioned in the definition of covered DHSS divisions. Both agencies administer some Medicaid waivers. The waivers authorize aggrieved applicants and participants to pursue a fair hearing. See, e.g. attached Appendix F-1:1 from ABI waiver.
Agency Response: DSS adopted this change in the final order regulation and also added the Division of Public Health to the list since that Division is involved with AIDS waiver services funded under the Medicaid Program.
D. The DLTCRP is not mentioned in the definition of covered DHSS divisions. Consistent with Title 16 Del.C. §1121(18), residents of licensed long-term care facilities can request a DHSS hearing to contest an involuntary discharge. Pursuant to 16 DE Admin Code §5304.2, DSS processes such fair hearing requests involving nursing homes. However, the DLTCRP has been processing hearings for non-nursing homes with no regulations. See attached October, 2004 correspondence between DLP and DLTCRP. It would be preferable to clarify that such hearings are subject to the Title 16 Admin Code 5000 procedures and clarify if they are processed by DSS or the DLTCRP.
Agency Response: The proposed rulemaking does not change the existing rule at §5304.2 and DSS has jurisdiction for residential nursing facility discharge hearings as provided under 42 CFR 483.202 and 483.204 (a) (1). (The reference in the current rule to §438.202 and §438.204 (a)(1) erroneously transposes the rule numbers and may have been superceded by changes in the federal numbering system. Please note that this jurisdictional issue is under review by DHSS’ legal council.)
Second, §5405(4) categorically disallows the hearing officer “to assist either party in the presentation of the case”. Since DHSS representatives are professionals routinely involved in hearings, this disallowance disproportionately affects pro se applicants. This provision also violates federal Food Stamp regulations which recite as follows:
(p) Household rights during hearing. The household may not be familiar with the rules of order and it may be necessary to make particular efforts to arrive at the facts of the case in a way that makes the household feel most at ease.
7 C.F.R. §273.15(p). The courts have often imposed an expectation of some assistance to pro se applicants in presenting their case in administrative hearings. See, e.g. Reefer v. Barnhart, 326 F.3d 376, 380 (3d Cir. 2003); Livingston v. Califano, 614 F.2d 342, (3d Cir. 1980); and Dobrowolsky v. Califano, 606 F. 2d 403 (3d Cir. 1979).
Agency Response: The only change in the rule text is to remove indefinite pronouns as references and replace with gender neutral language. DSS considered the comment and will retain the rule as proposed.
Third, §5405(3)(b) changes the order of presentation. The current standard establishes a norm of DHSS presenting first unless the hearing officer exercises discretion to have the individual present first. The amendment requires the party with the burden of proof to proceed first and disallows any hearing officer discretion. This is highly objectionable. The hearing officer should be granted some discretion in establishing the order of presentation. Moreover, it would be preferable to retain the current approach in which the State normally presents first. This is the approach adopted in other administrative hearings. See, e.g. attached Department of Education hearing procedures under Title 14 Del.C. §3135. As a practical level, it may streamline the hearing to have the State present first. For example, if a pro se applicant has been denied eligibility for a program, it is logical to have DHSS present first on the program eligibility standards and specific reasons why the applicant does not meet the standards. If the applicant proceeds first, the applicant may not be clear on the standards and eligibility deficits. As a result, the presentation will be unfocused and protracted. Moreover, if the unsophisticated pro se applicant simply recites that he believes he is eligible, his appeal will be summarily denied for failure to prove all essential elements of the case with no presentation by the State based on §5405(3)c).
Agency Response: This change was prompted by a 2007 Delaware Supreme Court decision, Urban v. Meconi, No. 439, 2006. In the matter before the Court a party claimed that the Department had improperly allocated the burden of proof at a fair hearing. The Court considered “it noteworthy that DHSS, itself, took the position that the relevant sections of the Delaware Social Services Manual are inconsistent and ‘improper.’ . . . In light of that admission, we assume DHSS is reviewing the Manual and making appropriate changes.”
DSS has reviewed the Social Services Manual. The change in the order of presentation at fair hearings as proposed is a result of that review. In light of the Delaware Supreme Court’s remark, the proposed change, as written, is appropriate.
If the proposed changes to §5405(3)b) are retained, DHSS should amend the fourth sentence to read as follows:
The appellant or claimant is the moving party for actions related to initial ineligibility determinations, initial denials of claims or the failure to act upon a claim with reasonable promptness.
Councils’ rationale is that any termination or discontinuation of assistance decision amounts to an “ineligibility determination” or “denial”.
Agency Response: To facilitate clarity and enable recognition of the party who carries the burden of proof, DSS adopted the Councils’ recommendation.
Fourth, the amendment to §5405(3)d) is problematic. It recites:
If the second party has presented evidence, the first party may, in the discretion of the hearing office, present rebuttal evidence.
The words “second” and “first” should be retained for clarity. Otherwise, it is unclear which “party” is being referenced.
Agency Response: DSS changed the terms in the final order regulation to the “moving” and “non-moving” parties.
Further analysis by Division staff resulted in changes to the rule as proposed to correct administrative and publication errors and omissions as indicated by [bracketed bold type].
THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Division of Social Services Manual regarding Fair Hearing procedures is adopted and shall be final effective May 10, 2008.
DSS FINAL ORDER REGULATIONS #08-16
1) the Division of Social Services (“DSS”), in connection with [financial assistance economic, medical, vocational] or child care subsidy assistance;
2) the Division of Medicaid and Medical Assistance (“DMMA”) or a managed care [company organization] (“MCO”) under contract with DHSS to manage an operation of the Medicaid Program, in connection with medical assistance;
3) the Division of State Service Centers (“DSSC”) in connection with the Emergency Assistance Program [.;]
[4) the Division of Developmental Disabilities Services (DDDS) in connection with Medicaid Program services;
6) the Division of Services for the Aging and Adults with Physical Disabilities (DSAAPD) in connection with Medicaid Program services.]
The hearing officer shall conduct the hearing in an informed fashion, consistent however with the procedural rights of the Department and the [appellant or] claimant to a courteous, fair, and fairly conducted hearing consistent with due process and the requirements of the federal regulation. Parties will be courteous to each other and the hearing officer at all times and will obey the orders and rulings of the hearing officer.
b) The State will present its case first, unless, in the discretion of the hearing officer, The moving party will present its case first. tThe burden of persuasion proof rests on the other party (the claimant) is on the moving party. The moving party is the party to the hearing seeking a change in the status quo ante. The Department is the moving party for actions to discontinue, terminate, suspend, or reduce assistance. The appellant or claimant is the moving party for actions relating to [initial] ineligibility determinations, the [initial] denials of claims or the failure to act upon a claim with reasonable promptness. This shall Each party’s case shall include the presentation of all witnesses to give testimony and all documents and other evidence which is admissible offered to prove its case. The other party may cross-examine each witness and may raise any legal basis for exclusion of any evidence at appropriate times during the hearing. Witnesses may be sequestered by or with the approval of the hearing officer.
c) The other Each party may present any witnesses to give testimony (and may testify his/herself) and other evidence which is admissible to prove support his/her/its case. However, such the non-moving party need not present any evidence, but may rely upon the other moving party's failure to prove an essential element of his/her/its case. If evidence or testimony is presented, the other party shall have the opportunity to raise any legal basis for its exclusion and the opportunity to cross examine witnesses at the appropriate time during the proceeding.
d) If the second [non-moving] party has presented any evidence, the first [moving] party may, in the discretion of the hearing officer, present rebuttal evidence.
11 DE Reg. 1482 (05/01/08) (Final)