Source: https://regs.health.ny.gov/book/export/html/54032
Timestamp: 2019-11-17 02:36:39
Document Index: 441092645

Matched Legal Cases: ['art.\n358', 'art 358', 'art.\n358', 'art.\n358', 'art 352', 'art 373', 'art 375', 'art 352', 'art 373', 'art 381', 'art 900', 'art 388', 'art.\n358', 'art 900', 'art.\n358', 'art.\n358']

FAIR HEARINGS: AID TO DEPENDENT CHILDREN, HOME RELIEF,
MEDICAL ASSISTANCE, EMERGENCY ASSISTANCE TO AGED, BLIND
OR DISABLED PERSONS, EMERGENCY ASSISTANCE TO NEEDY
FAMILIES WITH CHILDREN, FOOD STAMPS, FOOD ASSISTANCE,
HOME ENERGY ASSISTANCE AND SERVICES:
Social Services Law, Sections 20, 22, 34(3)(f); L. 1971, ch. 110, Section 83
Section 358-1.1 General. These regulations govern the fair hearing process and establish the rights and obligations of applicants, recipients, and social services agencies when an applicant or recipient seeks review of a social services agency action or determination regarding that individual's assistance or benefits under public assistance programs, medical assistance, food stamp, food assistance and the home energy assistance (HEAP) programs and under various service programs as defined in section 358-2.20 of this Part.
358-1.3 Social services agencies. For social services agencies, these regulations govern the following:
(a) notices to be sent to applicants and recipients of covered programs or services;
(b) agency conferences;
(c) information and documents to be provided to applicants/recipients, or their representatives, who have requested a fair hearing;
(d) the fair hearing process; and
(e) compliance with fair hearing decisions.
358-1.4 Effective date. (a) The provisions of this Part are effective January 15, 1989; however, provisions requiring that recipients be notified of increases in food stamp benefits are not effective until June 1, 1989.
(b) Except as provided in subdivision (c) of this section, social services agencies are required to utilize notices which meet the requirements of this Part no later than June 1,1989.
(c) (1) Notices used in the HEAP program are required to meet the requirements of this Part commencing with the 1989/90 HEAP program year.
(2) Automated notices currently in use by social services districts must conform to the requirements of this Part no later than October 1, 1989.
Section 358-2.0 Introduction. The terms in Part 358 have the meanings set forth in this Subpart.
358-2.1 Action taken notice. An action taken notice means a notice from a social services agency advising:
(a) an applicant for food stamp benefits or a recipient of food stamps at recertification of the social service agency's determination to accept or deny food stamp benefits; or
(b) a recipient of food stamp benefits, of an increase in benefits.
358-2.2 Adequate notice. (a) Except as provided in subdivision (b) of this section, an adequate notice means a notice of action, or an adverse action notice or an action taken notice which sets forth all of the following:
(a) the benefit level, including variations based on changes anticipated and at the time of certification, the date of initial issuance of the authorization to participate (ATP) and the dates covering the certification/eligibility period must be specified. In addition, if the initial allotment contains benefits for both the month application and the current month, the notice must explain that the initial allotment includes more than one month's benefits, and must indicate the monthly allotment amount for the remainder of the certification period;
(v) a denial of a food stamp application: when a household is potentially categorically eligible for food stamp benefits but is denied food stamp benefits, the notice must ask the applicant to inform the social services agency if the applicant is approved to receive aid to dependent children or supplemental security income benefits;
(viii) a restriction of a medical assistance authorization: the date the restriction will begin, the effect and scope of the restriction, the reason for the restriction, the right of the recipient to select a primary care provider within two weeks of the date of the notice of intent to restrict, if the social services agency provides a limited choice of providers to the recipient; the right of the social services agency to select a primary provider for the recipient, if a list of primary care providers is not provided or where the recipient fails to select a primary care provider within two weeks if the recipient is given a choice; and the right of the recipient to change providers every three months, or sooner for good cause shown; the right of the recipient to explain and present documentation, either at a conference or by submission, showing the medical necessity of the services cited in the recipient information packet; the right of the recipient to examine records maintained by the social services agency which identify medical assistance services paid for on behalf of the recipient (i.e. claim detail of recipient profile information), must be specified;
(xii) a disqualification of a food stamp household, or a member of such household for failure to comply with food stamp registration or work requirements: the particular act of non-compliance, the proposed period of disqualification and that the household or individual may reapply in order to resume participation in the food stamp program at the end of the disqualification period as well as information about avoiding or ending the disqualification, must be specified;
(13) information concerning the availability of community legal services to assist an applicant or recipient at the conference and fair hearing; and
(14) a copy of the budget or the basis for the computation, in instances where the social services agency's determination is based upon a budget computation. This subdivision does not apply to actions taken involving HEAP benefits.
358-2.3 Adverse action notice. Adverse action notice means a notice from a social services agency advising a recipient of food stamp benefits of its determination to discontinue, reduce, or suspend such recipient's food stamp benefits, within the food stamp certification period.
358-2.4 Agency conference. Agency conference means an informal meeting at which an applicant or recipient may have any decision of a social services agency concerning the applicant's or recipient's public assistance, medical assistance, food stamp benefits, HEAP or services reviewed or may have any other aspect of the applicant's or recipient's case reviewed by an employee of that agency who has the authority to change the decision with which the applicant or recipient disagrees.
358-2.5 Aid continuing. Aid continuing means the right to have public assistance, medical assistance, food stamp benefits or services continued unchanged until the fair hearing decision is issued.
358-2.6 Appellant. Appellant means the party for whom the fair hearing is requested.
358-2.7 Applicant. Applicant means a person who has applied for public assistance, medical assistance, HEAP, food stamp benefits, or a service.
358-2.8 Commissioner. Commissioner means the New York State Commissioner of Social Services or the commissioner's designee.
358-2.9 Covered programs or services. Covered programs or services means one or more of the following: aid to dependent children, home relief, medical assistance, emergency assistance to aged, blind or disabled persons, emergency assistance to needy families with children, food stamps, HEAP, and any services funded through the New York State Department of Social Services as defined in section 358-2.20 of this Subpart.
358-2.10 Department. Department means the New York State Department of Social Services.
358-2.12 Fair hearing. Fair hearing means a formal procedure provided by the department upon a request made for an applicant or recipient to determine whether an action taken or failure to act by a social services agency was correct.
358-2.13 Hearing officer. Hearing officer means an attorney who is employed by the department and designated and authorized by the commissioner to preside at hearings.
358-2.14 Mass change in the Food Stamp Program. Mass change in the Food Stamp Program means changes initiated by the Federal government or the department which affect all food stamp households or a significant portion of all food stamp households. Mass changes may include, but are not limited to, adjustments to income eligibility standards, shelter and dependent care deductions; the thrifty food plan and the standard deduction; annual and seasonal adjustments to social security, supplemental security income and other Federal benefits.
358-2.15 Notice of action. Notice of action means a notice from a social services agency advising an applicant, recipient or resident of a tier II facility of any action the agency intends to take or has taken on any assistance or benefits except food stamp benefits, including the acceptance, denial, discontinuance, suspension, or reduction of public assistance, medical assistance or services, an increase in public assistance or medical assistance, a change in the amount of one of the items used in the calculation of a public assistance grant or medical assistance spenddown although there is no change in the amount of such public assistance grant or medical assistance spenddown, a change in the manner or method or form of payment of a public assistance grant, a determination that an applicant for or recipient of public assistance or medical assistance is employable, a restriction of a medical assistance authorization, and a denial or acceptance of HEAP or a determination to discharge a resident of a tier II facility involuntarily after such resident requests and participates in a hearing held by the facility or the social services district in which the facility is located.
358-2.16 Parties to a fair hearing. Parties to a fair hearing means the person for whom a fair hearing is requested and the social services agency or agencies whose decision, action or failure to act is subject to review at the fair hearing.
*358-2.17 Public assistance. Public assistance includes aid to dependent children and home relief or the successor public assistance programs, emergency assistance to aged, blind or disabled persons, emergency assistance to needy families including special grants and benefits available pursuant to Part 352 of this Title and, for the purposes of this Part, refugee cash assistance issued in accordance with Part 373 of this Title and cash assistance under the Fish-Wilson program issued in accordance with Part 375 of this Title. * NB Effective until 98/06/27
*358-2.17 Public assistance. Public assistance includes aid to dependent children, home relief, emergency assistance to aged, blind or disabled persons, emergency assistance to needy families including special grants and benefits available pursuant to Part 352 of this Title and, for the purposes of this Part, refugee cash assistance issued in accordance with Part 373 of this Title. * NB Effective 98/06/27
358-2.18 Recipient. Recipient means a person who is, or has been, receiving a covered program or service. For the purpose of this Part, recipient includes a former recipient seeking to review a determination of a social services agency and who would have a right to a hearing under section 358-3.1 of this Part if such person were a current recipient.
358-2.19 Restricted payment. Restricted payment means one of the methods of payment described in Part 381 of this Title, including restricted money payment, indirect or vendor payment and protective payment.
358-2.20 Services funded through the New York State Department of Social Services. Services funded through the New York State Department of Social Services means services provided pursuant to the local social services district's consolidated services plan. Such services may include, but are not limited to day care services, preventive services for children and families and for adults, protective services for adults, homemaker services, housekeeper/chore services and information and referral services.
358-2.21 Social services agency. Social services agency means the State, county, city, town official or town agency, social services district or HEAP certifying agency responsible for making the determination or for the failure to act, which is the subject of review at the fair hearing.
358-2.22 Social services district. Social services district means the county department of social services or the New York City Department of Social Services.
358-2.23 Timely notice. Timely notice means a notice which is mailed at least 10 days before the date upon which the proposed action is to become effective.
358-2.24 Title. Title means Title 18 of the New York State Official Compilation of Codes, Rules and Regulations (NYCRR) also referred to as the regulations of the Department of Social Services.
358-2.25 Witness. Witness means a person, other than the applicant, recipient, or the representative thereof, who presents testimony and/or documentary evidence at a fair hearing.
358-2.26 Resident of a tier II facility. Resident of a tier II facility means a family or family member residing in a tier II facility as defined in Part 900 of this Title.
358-2.27 Food Stamps. Whenever the term "food stamps" is used in this Part it means food stamps under the Food Stamp Program and food assistance under the Food Assistance Program as set forth in Part 388 of this Title.
Social Services Law, Sections 20(3)(d), 22(8), 34(3)(f)
Section 358-4.0 Introduction. The rights and obligations of social services agencies are governed by this Subpart.
358-4.1 Proposed actions. (a) A social services agency proposing to approve, deny, discontinue, suspend, or reduce a public assistance grant, medical assistance authorization, food stamp benefits, or services, or to increase a public assistance grant or food stamp benefits or a medical assistance spenddown, or to change the amount of one of the items used in the calculation of a public assistance grant, food stamp benefits or a medical assistance spenddown, or to accept or deny an application for HEAP benefits, or to discharge a resident of a tier II facility involuntarily as defined in Part 900 of this Title, must review or cause to be reviewed the intended action to determine whether the intended action is correct on the basis of the available evidence included in the applicant's or recipient's case record.
(b) Where it is determined that the intended action is correct after review, the social services agency must send to the applicant/recipient a notice which meets the requirements of section 358-3.3 of this Part.
358-4.2 Prehearing responsibilities. (a) When requested, the social services agency must provide assistance to applicants and recipients in making a request for a fair hearing.
(b) (1) Upon notification by the department that a fair hearing has been requested and that the appellant's public assistance, medical assistance, food stamp benefits, or services must be continued or reinstated in accordance with section 358-3.6 of this Part until the fair hearing decision is issued, the social services agency, except as provided in section 358-3.6(b) and (c) (6) of this Part, must take immediate action to assure that the appellant's public assistance, medical assistance, food stamp benefits and services continue unchanged until the fair hearing decision is issued.
(e) The social services agency must encourage the use of agency conferences to settle disputes and complaints concerning actions regarding an applicant's or recipient's public assistance, medical assistance, food stamp benefits, HEAP benefits or services so as to eliminate the need to hold fair hearings wherever the dispute can be resolved by scrutiny of documents and/or thorough investigation.
(i) Social services agencies may provide telephone conferences upon prior approval of the Office of Administrative Hearings of the department. The Office of Administrative Hearings may approve such requests in its discretion, where holding an in-person conference is not feasible.
358-4.4 Compliance with fair hearing decision. A social services agency must comply with fair hearing decisions in accordance with section 358-6.4 of this Part.
Section 358-6.0 Introduction. All decisions of the commissioner issued after a request for fair hearing are governed by this Subpart.
358-6.1 All decisions. (a) The fair hearing decision issued by the commissioner must be based exclusively on the fair hearing record, or in the case of a decision without hearing, on the documents submitted by the appellant and the social services agency. The decision must be in writing and must set forth the fair hearing issues, the relevant facts, and the applicable law, regulations, and approved policy, if any, upon which the decision is based. The decision must make findings of fact, determine the issues and state reasons for the determinations and when appropriate, direct specific action to be taken by the social services agency. In addition, the decision may address the violation of any provision of this Part by the social services agency, including but not limited to violations of regulations concerning notice, aid continuing and provision of documents and records and set forth appropriate relief for such violations.
(b) Upon issuance, the decision is final and binding upon social services agencies and must be complied with in accordance with section 358-6.4 of this Subpart.
(c) A copy of the decision, accompanied by written notice to the appellant of the right to judicial review except as set forth in subdivision (d) of this section, will be sent to each of the parties and to their representatives, if any. In addition, such notice will advise the appellant that the appellant or the appellant's authorized representative may request the Department's assistance in obtaining compliance with the decision.
(d) Where the decision relates to a complaint regarding on-the-job working conditions or workers' compensation coverage related to participation in a work-related program or activity under the Job Opportunities and Basic Skills Training (JOBS) Program or under a program authorized by section 1115 of the Social Security Act or to wage rates used in calculating the hours of participation in the Community Work Experience Program, the decision will be accompanied by written notice that any party dissatisfied with the decision may, within 20 days of receipt of the decision, appeal to the United States Department of Labor for review of the decision.
358-6.3 Direction relative to similar cases. When a fair hearing decision indicates that a social services agency has misapplied provisions of law, department regulations, or such agency's own State-approved policy, the commissioner's letter transmitting such decision to such agency may contain a direction to the agency to review other cases with similar facts for conformity with the principles and findings in the decision.
358-6.5 Compliance with direction relative to similar cases. When a direction has been given to a social services agency to correct a misapplication of law, department regulations or such agency's own State-approved policy in all cases similar to the one in which a decision has been issued, such social services agency must report the actions it has taken to comply with such direction to the department within 30 days after receipt of the direction. The social services agency must make such additional reports as the department may require.
358-6.6 Corrected decisions and reopened hearings. (a) Corrected decisions.
(1) The Commissioner may review an issued fair hearing decision for purposes of correcting any error found in such decision.
(2) After review, the commissioner may correct any error occurring in the production of an issued fair hearing decision including, but not limited to, typographical and spelling errors.
(3) After review, on notice to the parties, the commissioner may correct any error of law or fact which is substantiated by the fair hearing record.
(4) During the pendency of any review of an issued fair hearing decision, the original decision is binding and must be complied with by the social services agency in accordance with the provisions of section 358-6.4 of this Subpart.
(b) Reopened hearings. On notice to all parties, the commissioner may reopen a previously closed fair hearing record for purposes of completing such record. If such reopening occurs subsequent to the issuance of a fair hearing decision, the provisions of paragraph (a) (4) of this section apply.