reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.001 - TITLE AND SCOPE

Current through August 31, 2023
01.
Title
. These rules are titled IDAPA 16.05.03, "Contested Case
			 Proceedings and Declaratory Rulings." (3-17-22)
02.
Scope
. These rules establish
			 standards for petitions for rulemaking and declaratory rulings, and the conduct
			 of contested cases. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.002 - ACCESS TO RECORDS OF INDIVIDUALS WITH DEVELOPMENTAL OR MENTAL DISABILITIES

Current through August 31, 2023
The state Protection and Advocacy System established under
				42 USC
				15041, et seq., and
				42 USC
				10801 et seq.,
				29 USC
				794e, et seq., and
				42 USC
				300d as designated by the Governor has access
				to records of individuals who are clients of the system maintained by any
				program or institution of the Department if the individual has authorized or is
				unable to authorize the system to have such access, or does not have a legal
				guardian, conservator or other legal representative. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.003 - ADMINISTRATIVE APPEALS

Current through August 31, 2023
All contested cases are governed by the provisions of this
				chapter. The Board of Health and Welfare and the Director of the Department of
				Health and Welfare find that the provisions of IDAPA 04.11.01.000, et seq.,
				"Idaho Rules of Administrative Procedure of the Attorney General," are
				inapplicable for contested cases involving the programs administered by the
				Department, because of the specific requirements of federal and state law
				regarding hearing processes, and the complexity of the rules at IDAPA 04.11.01,
				"Idaho Rules of Administrative Procedure of the Attorney General."
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.010 - DEFINITIONS AND ABBREVIATIONS

Current through August 31, 2023
For the purposes of this chapter, the following definitions and
				abbreviations apply. (3-17-22)
01.
Administrative Review
. An informal review by a Division
			 Administrator or designee, to determine whether a Department decision is
			 correct. (3-17-22)
02.
Appellant
. A person or entity who files an appeal of Department action
			 or inaction. (3-17-22)
03.
Board
. The Idaho Board of Health and Welfare. (3-17-22)
04.
Complainant
. A person or
			 individual who has a grievance regarding Youth Empowerment Services (YES).
			 (3-17-22)
05.
Cost
			 Report
. A fiscal year report of provider costs required by the Medicare
			 program and any supplemental schedules required by the Department.
			 (3-17-22)
06.
Cost
			 Settlement
. Final determinations of payment, based on cost reports, to a
			 Medicaid-enrolled provider. (3-17-22)
07.
Department
. The Idaho
			 Department of Health and Welfare. (3-17-22)
08.
Director
. The Director of
			 the Department of Health and Welfare. (3-17-22)
09.
Hearing Officer
. The person
			 designated to preside over a particular hearing and any related proceedings.
			 (3-17-22)
10.
IPV
.
			 Intentional program violation. (3-17-22)
11.
Intervenor
. Any person,
			 other than an appellant or the Department, who requests to be admitted as a
			 party in an appeal. (3-17-22)
12.
Managed Care Entity (MCE)
. An entity contracted by Medicaid to
			 administer Medicaid services, which may be a Prepaid Ambulatory Health Plan
			 (PAHP), Prepaid Inpatient Health Plan (PIHP), or other Managed Care
			 Organization (MCO) as defined in
			 42 CFR
			 438.2. As used in these rules, the term does
			 not include service brokers or entities providing non-emergency medical
			 transportation (NEMT) services. (3-17-22)
13.
Party
. An appellant, the
			 Department and an intervenor, if intervention is permitted. (3-17-22)
14.
Youth Empowerment Services (YES)
			 Program Participant
. A YES program participant, is an Idaho resident
			 with a Serious Emotional Disturbance who: (3-17-22)
a. Is under the age of eighteen (18);
			 (3-17-22)
b. Has a mental health
			 condition described in the current Diagnostic and Statistical Manual of Mental
			 Disorders (DSM) and diagnosable by a qualified professional operating within
			 the scope of their practice as defined by Idaho state law; and
			 (3-17-22)
c. Has a substantial
			 functional impairment that is measured by and documented through the use of a
			 standardized instrument conducted or supervised by a qualified clinician.
			 (3-17-22)
d. A substance use
			 disorder or development disorder alone does not constitute an eligible
			 diagnosis, although one (1) or more of these conditions may coexist with an
			 eligible mental health diagnosis. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.040 - PETITION FOR ADOPTION OF RULES

Current through August 31, 2023
Under Section
				67-5230, Idaho Code, any person
				may file a written petition with the Administrative Procedures Section
				requesting the promulgation, amendment, or repeal of a rule. The petition must
				include a name, address, and phone number to which the Department may respond;
				list the rule in question and explain the reasons for the petition; and include
				the suggested language of the rule. The Director will initiate rulemaking
				proceedings or deny the petition in writing within twenty-eight (28) days.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.050 - PETITION FOR DECLARATORY RULING

Current through August 31, 2023
Under Section
				67-5232, Idaho Code, any person
				may file a written petition to the Director through the Administrative
				Procedures Section for a declaratory ruling as to the applicability of any
				statute or rule of the Department to an actual set of facts involving that
				person. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.051 - CONTENTS OF PETITION FOR DECLARATORY RULING

Current through August 31, 2023
A petition for a declaratory ruling must identify that it is a
				request for a declaratory ruling under this section of rule; the specific
				statute, or rule with respect to which the declaratory ruling is requested; a
				complete description of the situation for which the declaratory ruling is
				requested; and the specific ruling requested. The petition must include the
				date of the petition, the name, address, and phone number of the petitioner and
				whether the petition is made on behalf of a corporation or organization. The
				petition must identify the manner by which the statute or rule interferes with,
				impairs, or threatens to interfere with or impair the legal rights, duties,
				licenses, immunities, interests, or privileges of the petitioner.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.052 - DISPOSITION OF PETITION FOR DECLARATORY RULING

Current through August 31, 2023
The Director will issue a final declaratory ruling in writing
				within seventy (70) days after receipt of the petition or within such
				additional time as may be required. The Director may decline to issue a
				declaratory ruling in the following circumstances: (3-17-22)
01.
Incomplete
. When a petition
			 fails to meet the requirements set forth in Section
			 051 of these rules;
			 (3-17-22)
02.
Contested
			 Case
. When the issue set forth in the petition would be more properly
			 addressed as a contested case, such as where there is a reasonable dispute as
			 to the relevant facts, or where witness credibility is an issue;
			 (3-17-22)
03.
No Legal
			 Interest
. When the petition fails to state a sufficient or cognizable
			 legal interest to confer standing; (3-17-22)
04.
Others Affected
. When the
			 issue presented would substantially affect the legal rights, license,
			 privileges, immunities, or interests of parties other than petitioners; or
			 (3-17-22)
05.
Beyond
			 Authority
. When the ruling requested is beyond the authority of the
			 Department. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.100 - DEPARTMENT RESPONSIBILITY

Current through August 31, 2023
When a decision is appealable, the Department will advise the
				individual or provider in writing of the right and method to appeal and the
				right to be represented. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.101 - FILING OF APPEALS

Current through August 31, 2023
01.
Appeals
. Appeals must be filed in writing and state the appellant's
			 name, address, and phone number, and the remedy requested, unless otherwise
			 provided in these rules. Appeals should be accompanied by a copy of the
			 decision notice that is the subject of the appeal and state the reason for
			 disagreement with the Department's action. (3-17-22)
02.
Time Limits for Filing
			 Appeal
. Unless otherwise provided by statute or these rules, individuals
			 who are aggrieved by a Department decision have twenty-eight (28) days from the
			 date the decision is mailed to file an appeal. An appeal is filed when it is
			 received by the Department or postmarked within the time limits provided in the
			 decision notice, or in these rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.102 - NOTICE OF HEARING

Current through August 31, 2023
All parties in an appeal will be notified of a hearing at least
				ten (10) days in advance, or within such time period as may be mandated by law.
				The hearing officer may provide a shorter advance notice upon request of a
				party or for good cause. The notice will identify the time, place and nature of
				the hearing; a statement of the legal authority under which the hearing is to
				be held; the particular sections of any statutes and rules involved; the issues
				involved; and the right to be represented. The notice must identify how and
				when documents for the hearing will be provided to all parties.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.103 - PREHEARING CONFERENCE

Current through August 31, 2023
01.
Prehearing Conference
. The hearing officer may, upon written or other
			 sufficient notice to all interested parties, hold a prehearing conference. The
			 purpose of the prehearing conference is to: (3-17-22)
a. Formulate or simplify the issues;
			 (3-17-22)
b. Obtain admissions or
			 stipulations of fact and documents; (3-17-22)
c. Identify whether there is any additional
			 information that had not been presented to the Department with good cause;
			 (3-17-22)
d. Arrange for exchange
			 of proposed exhibits or prepared expert testimony; (3-17-22)
e. Limit the number of witnesses;
			 (3-17-22)
f. Determine the
			 procedure at the hearing; and (3-17-22)
g. Determine any other matters that may
			 expedite the orderly conduct and disposition of the proceeding.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.104 - SUBPOENAS

Current through August 31, 2023
At the request of a party, the hearing officer may issue
				subpoenas for witnesses or documents, consistent with Sections
				120 and
				134 of these rules.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.105 - DISPOSITION OF CASE WITHOUT A HEARING

Current through August 31, 2023
Any contested case may be resolved without a hearing on the
				merits of the appeal by stipulation, settlement, motion to dismiss, summary
				judgment, default, withdrawal, or for lack of jurisdiction. The hearing officer
				must dismiss an appeal that is not filed within the time limits set forth in
				these rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.106 - DEFAULT

Current through August 31, 2023
Unless otherwise provided by statute or rule, if a party fails
				to appear at a scheduled hearing or at any stage of a contested case, the
				hearing officer must enter a proposed default order against that party. The
				default order must be set aside if, within fourteen (14) days of the date of
				mailing, that party submits a written explanation for not appearing, which the
				hearing officer finds substantial and reasonable. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.107 - INTERVENTION

Current through August 31, 2023
Persons other than the original parties to an appeal who are
				directly and substantially affected by the proceeding may participate if they
				first secure an order from the hearing officer granting leave to intervene. The
				granting of leave to intervene is not to be construed as a finding or
				determination that the intervenor is or may be a party aggrieved by any ruling,
				order or decision of the Department for purposes of judicial review.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.108 - CONSOLIDATED HEARING

Current through August 31, 2023
When there are multiple appeals or a group appeal involving the
				same change in law, rules, or policy, the hearing officer will hold a
				consolidated hearing. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.120 - DISCOVERY

Current through August 31, 2023
Except for hearings involving Section
				56-1005(5), Idaho
				Code, prehearing discovery is limited to obtaining the names of witnesses and
				copies of documents the opposing party intends to offer as exhibits. The
				hearing officer may order production of this information if a party refuses to
				comply after receiving a written request. The hearing officer will issue such
				other orders as are needed for the orderly conduct of the proceeding. Nothing
				in Section 120 limits the authority of the
				Director provided in Section
				56-227C, Idaho Code.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.121 - BRIEFING SCHEDULE

Current through August 31, 2023
A hearing officer may require briefs to be filed by the
				parties, and establish a reasonable briefing schedule. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.122 - FILING OF DOCUMENTS IN AN APPEAL

Current through August 31, 2023
All documents intended to be used as exhibits must be filed
				with the hearing officer. Such documents will be provided to every party at the
				time they are filed with the hearing officer, in person, by first class mail,
				or as otherwise ordered by the hearing officer. Service by mail is complete
				when the document, properly addressed and stamped, is deposited in the United
				States or Statehouse mail. A certificate showing delivery to all parties will
				accompany all documents when they are filed with the hearing officer.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.123 - REPRESENTATION

Current through August 31, 2023
Any party in a contested case proceeding may be represented by
				legal counsel, at the party's own expense. An individual in an appeal involving
				benefits may also be represented by a non-attorney. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.130 - OPEN HEARINGS

Current through August 31, 2023
All contested case hearings are open to the public, unless
				ordered closed in the discretion of the hearing officer due to the sensitive
				nature of the hearing. The hearing officer can order that individuals be
				identified by initials or an alias if necessary to protect their privacy. At
				the discretion of the hearing officer, witnesses may testify by telephone or
				other electronic means, provided the examination and responses are audible to
				all parties. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.131 - AUTHORITY OF HEARING OFFICER

Current through August 31, 2023
The hearing officer will consider only information that was
				available to the Department at the time the decision was made. If appellant
				shows that there is additional relevant information that was not presented to
				the Department with good cause, the hearing officer will remand the case to the
				Department for consideration. No hearing officer has the jurisdiction or
				authority to invalidate any federal or state statute, rule, regulation, or
				court order. The hearing officer must defer to the Department's interpretation
				of statutes, rules, regulations or policy unless the hearing officer finds the
				interpretation to be contrary to statute or an abuse of discretion. The hearing
				officer will not retain jurisdiction on any matter after it has been remanded
				to the Department. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.132 - BURDEN OF PROOF - INDIVIDUAL BENEFIT CASES

Current through August 31, 2023
The Department has the burden of proof if the action being
				appealed is to limit, reduce or terminate services or benefits; establish an
				overpayment or disqualification; revoke or limit a license; or to contest a
				tobacco violation under Sections
				39-5705 and
				39-5708, Idaho Code. In a child
				support matter, the Department must first establish that arrearages are
				sufficient for child support enforcement action. The appellant has the burden
				of proof on all other issues, including establishing eligibility for a program,
				service or license; seeking an exemption required due to criminal history, or
				abuse registry information; or seeking to avoid license suspension, asset
				seizure, or other enforcement actions for failure to pay child support.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.133 - BURDEN OF PROOF - PROVIDER CASES

Current through August 31, 2023
The Department has the burden of proof if the action being
				appealed is to revoke or limit a license, certification, or provider agreement;
				or to impose a penalty. The appellant has the burden of proof on all other
				issues, including establishing entitlement to payment. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.134 - EVIDENCE

Current through August 31, 2023
Under Section
				67-5251, Idaho Code, the hearing
				is informal and technical rules of evidence do not apply, except that
				irrelevant, immaterial, incompetent, unduly repetitious evidence, evidence
				excludable on constitutional or statutory grounds, or evidence protected by
				legal privilege is excluded. Hearsay evidence will be received if it is
				relevant to a matter in dispute and is sufficiently reliable that prudent
				persons would commonly rely on it in the conduct of their affairs, or
				corroborates competent evidence. Any part of the evidence may be received in
				written form if doing so will expedite the hearing without substantially
				prejudicing the interest of any party. Documentary evidence may be received in
				the form of copies or excerpts if the original is not readily available. Unless
				otherwise stated in statute, rule, or regulation, the evidentiary standard is
				proof by a preponderance of the evidence. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.135 - DISCRETIONARY JUDICIAL NOTICE

Current through August 31, 2023
Notice may be taken of judicially cognizable facts by the
				hearing officer or authority on its own motion or on motion of a party. In
				addition, notice may be taken of generally recognized technical or scientific
				facts within the Department's specialized knowledge. Parties will be notified
				either before or during the hearing, or by reference in preliminary reports or
				otherwise, of the material noticed including any staff memoranda or data, and
				the parties will be afforded an opportunity to contest the material so noticed.
				The Department's experience, technical competence, and specialized knowledge
				may be utilized in the evaluation of the evidence. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.136 - MANDATORY JUDICIAL NOTICE

Current through August 31, 2023
The hearing officer will take judicial notice, on its own
				motion or on the motion of any party, of the following admissible, valid and
				enforceable materials: Rules of the Department and other state agencies;
				Federal regulations; State plans of the Department; The Constitutions and
				statutes of the United States and Idaho; Public records; and Such other
				materials that a court of law must judicially notice. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.137 - HEARING RECORD

Current through August 31, 2023
The hearing officer must arrange for a record to be made of a
				hearing. The hearing must be recorded unless a party requests a stenographic
				recording by a certified court reporter, in writing, at least seven (7) days
				prior to the date of hearing. The record must be transcribed at the expense of
				the party requesting a transcript and prepayment or guarantee of payment may be
				required. Once a transcript is requested, any party may obtain a copy at the
				party's own expense. The Department must maintain the complete record of each
				contested case for a period of not less than six (6) months after the
				expiration of the last date for judicial review, unless otherwise provided by
				law. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.138 - DECISION AND ORDER

Current through August 31, 2023
A preliminary order must be issued by the hearing officer not
				later than thirty (30) days after the case is submitted for decision. The order
				must include specific findings on all major facts at issue; a reasoned
				statement in support of the decision; all other findings and recommendations of
				the hearing officer; a preliminary decision affirming, reversing or modifying
				the action or decision of the Department, or remanding the case for further
				proceedings; and the procedures and time limits for filing requests for review
				of the order. Unless otherwise provided by a statute governing a particular
				program, motions for reconsideration of a preliminary order will not be
				accepted. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.150 - REVIEW OF PRELIMINARY ORDERS BY DEPARTMENT

Current through August 31, 2023
Unless otherwise provided in these rules, in cases under the
				jurisdiction of the Department, either party may file a request for review with
				the Administrative Procedures Section not later than fourteen (14) days from
				the date the preliminary order was mailed. The request must identify all legal
				and factual bases of disagreement with the preliminary order. The Director or
				designee must allow for briefing by the parties and determines whether oral
				argument will be allowed. The Director or designee determines whether a
				transcript of the hearing is needed and if so, one will be provided by the
				party who requests review of the preliminary order. The Director or designee
				must exercise all of the decision-making power they would have had if they had
				presided over the hearing. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.151 - PETITION FOR REVIEW BY BOARD OF HEALTH AND WELFARE

Current through August 31, 2023
In cases under the jurisdiction of the Board, either party may
				file a petition for review with the Administrative Procedures Section not later
				than fourteen (14) days from the date the preliminary order was mailed. The
				request must identify all legal and factual bases of disagreement with the
				preliminary order. The Administrative Procedures Section will establish a
				schedule for the submission of briefs and if allowed, oral argument. The Board
				chair or designee will determine whether a transcript of the hearing is needed
				and, if so, one will be provided by the party who requests review of the
				preliminary order. Board members will exercise all of the decision-making power
				they would have had if they had presided over the hearing. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.152 - FINAL ORDER

Current through August 31, 2023
The Board, Director or designee may affirm, modify, or reverse
				the order, or remand the matter to the hearing officer for further proceedings.
				The decision informs the parties of the procedure and time limits for filing
				appeals with the district court. Motions for reconsideration of a final order
				will not be accepted. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.153 - SERVICE OF PRELIMINARY AND FINAL ORDERS

Current through August 31, 2023
Orders will be deemed to have been served when copies are
				mailed to all parties of record or their attorneys. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.154 - MAINTENANCE OF ORDERS

Current through August 31, 2023
All final orders of the Board or the Director will be
				maintained by the Administrative Procedures Section and made available for
				public inspection for at least six (6) months, or until all appeals are
				concluded, whichever is later. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.155 - EFFECT OF PETITION FOR JUDICIAL REVIEW

Current through August 31, 2023
The filing of a petition for judicial review will not stay
				compliance with a final order or suspend the effectiveness of the order, unless
				otherwise ordered or mandated by law. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.199 - SPECIFIC CONTESTED CASE PROVISIONS

Current through August 31, 2023
The following sections of this chapter provide special
				requirements of various Department divisions or programs that supersede the
				general provisions of these rules to the extent that they are different.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.200 - DIVISION OF WELFARE: APPEALS

Current through August 31, 2023
The provisions of Sections
				200 through
				299 of these rules govern the
				conduct of individual benefit hearings to determine eligibility for benefits or
				services in the Division of Welfare and its programs. (3-17-22)
01.
Division of Welfare
			 Programs
. The following programs are covered under the following chapter
			 of rules: (3-17-22)
a. IDAPA 16.03.01,
			 "Eligibility for Health Care Assistance for Families and Children";
			 (3-17-22)
b. IDAPA 16.03.03, "Child
			 Support Services"; (3-17-22)
c.
			 IDAPA 16.03.04, "Idaho Food Stamp Program"; (3-17-22)
d. IDAPA 16.03.05, "Eligibility for Aid to
			 the Aged, Blind, and Disabled (AABD)"; (3-17-22)
e. IDAPA 16.03.08, "Temporary Assistance for
			 Families in Idaho (TAFI) Program"; (3-17-22)
f. IDAPA 16.04.14, "Low-Income Home Energy
			 Assistance Program"; (3-17-22)
g.
			 IDAPA 16.06.12, "Idaho Child Care Program (ICCP)."
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.201 - DIVISION OF WELFARE: TIME FOR FILING APPEAL

Current through August 31, 2023
A decision issued by the Department in a Division of Welfare
				benefit program will be final and effective unless an individual or
				representative appeals within thirty (30) days from the date the decision was
				mailed, except that a recipient or applicant for Food Stamps has ninety (90)
				days to appeal. An individual or representative may also appeal when the
				Department delays in making an eligibility decision or making payment beyond
				the limits specified in the particular program within thirty (30) days after
				the action would have been taken if the Department had acted in a timely
				manner. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.202 - DIVISION OF WELFARE: INFORMAL CONFERENCE

Current through August 31, 2023
An appellant or representative has the right to request an
				informal conference with the Department or Community Action Agency before the
				hearing date. This conference may be used to resolve the issue informally or to
				provide the appellant with information about the hearing or actions. The
				conference will not affect the appellant's right to a hearing or the time
				limits for the hearing. After the conference, the hearing will be held unless
				the appellant withdraws the appeal, or the Department withdraws the action
				contested by the appellant. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.203 - DIVISION OF WELFARE: WITHDRAWAL OF AN APPEAL

Current through August 31, 2023
An appellant or representative may withdraw an appeal upon
				request to the hearing officer using any one (1) of the methods listed in
				Section 200 of these
				rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.204 - DIVISION OF WELFARE: TIME LIMITS FOR COMPLETING HEARINGS

Current through August 31, 2023
The Department must conduct the hearing relating to an
				individual's benefits and take action within ninety (90) days from the date the
				hearing request is received, unless as provided in Subsections
				204.01 through
				204.03 of this rule.
				(3-17-22)
01.
Community Spouse
			 Resources Allowance
. When the hearing request concerns the computed
			 amount of the Community Spouse Resource Allowance, the hearing will be held
			 within thirty (30) days from the date the hearing request is received.
			 (3-17-22)
02.
Food
			 Stamps
. When the hearing relates to Food Stamps, the hearing, the
			 decision of the hearing, and the notice regarding the outcome of the hearing
			 will be completed within sixty (60) days from the date the hearing request is
			 received. (3-17-22)
03.
Expedited Hearings
. The Department will expedite hearing requests from
			 appellants for the following reasons: (3-17-22)
a. Migrant farm workers who are planning to
			 move before the hearing decision would normally be reached; or
			 (3-17-22)
b. Individuals requesting
			 an expedited fair hearing will be provided a hearing as required according to
			 42 CFR
			 431.224. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.205 - DIVISION OF WELFARE: APPEAL OF AUTOMATIC ADJUSTMENTS

Current through August 31, 2023
An appeal will be dismissed if the hearing officer determines
				that the sole issue is an automatic grant adjustment, change in rule that
				affects benefit amount or eligibility, or reduction of Medicaid services under
				state or federal law. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.207 - DIVISION OF WELFARE: POSTPONEMENT OF FOOD STAMP HEARINGS

Current through August 31, 2023
An appellant may request, and be granted a postponement of a
				hearing, not to exceed thirty (30) days. The time limit for the Department's
				response will be extended for as many days as the hearing is postponed.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.250 - DIVISION OF WELFARE: FOOD STAMPS DISQUALIFICATION HEARINGS

Current through August 31, 2023
A disqualification hearing will be scheduled when the
				Department has evidence that an individual has allegedly committed one (1) or
				more acts of intentional program violations (IPV). (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.251 - DIVISION OF WELFARE: COMBINING DISQUALIFICATION HEARING AND BENEFIT HEARING

Current through August 31, 2023
The hearing officer must consolidate a hearing regarding
				benefits or overpayment and a disqualification hearing if the issues are the
				same or related. The appellant must be notified that the hearings will be
				combined. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.252 - DIVISION OF WELFARE: RIGHT NOT TO TESTIFY

Current through August 31, 2023
The hearing officer must advise the appellant that they may
				refuse to answer questions during a disqualification hearing. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.253 - DIVISION OF WELFARE: FAILURE TO APPEAR

Current through August 31, 2023
If an appellant or representative fails to appear at a
				disqualification hearing or cannot be located, the hearing will be conducted in
				their absence. The Department must present proof that advance notice of the
				hearing was mailed to the appellant's last known address. The hearing officer
				must consider the evidence and determine if an IPV occurred based solely on the
				information provided by the Department. The appellant has ten (10) days from
				the date of the scheduled hearing to show good cause for failure to appear. If
				an IPV had been established, but the hearing officer determines the appellant
				had good cause for not appearing, the previous decision will be void and a new
				hearing will be conducted. The previous hearing officer may conduct the new
				hearing. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.254 - DIVISION OF WELFARE: STANDARD FOR DETERMINING INTENTIONAL PROGRAM VIOLATIONS

Current through August 31, 2023
The determination that an intentional program violation has
				been committed must be established by clear and convincing evidence that the
				appellant committed or intended to commit an IPV. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.298 - DIVISION OF WELFARE: CHILD SUPPORT SERVICES

Current through August 31, 2023
In a child support enforcement proceeding, an individual or a
				representative may request a hearing after being served notice of license
				suspension or notice of an asset withholding order from the Financial
				Institution Data Match (FIDM) process. (3-17-22)
01.
Time Limits for Requesting a
			 Hearing
. (3-17-22)
a. License
			 Suspension. The licensee has twenty-one (21) days from the date of service of
			 the notice either by personal service or certified mail, to request a hearing
			 by filing with the Department to contest the suspension of license or licenses.
			 A timely request for a hearing stays the suspension of the license or licenses
			 through the issuance of the order by the Department. The Department will notify
			 the licensing authority if the suspension is vacated or stayed.
			 (3-17-22)
b. Financial Institution
			 Data Match (FIDM). The obligor or co-owner has fourteen (14) days from the date
			 of mailing the notice of asset withholding order to request a hearing in
			 writing to contest the asset being withheld. Upon receiving a timely request
			 for hearing, the Department will notify the financial institution that it must
			 continue to hold the asset until an order is issued and the Department provides
			 instructions for the disposition of the asset. If the obligor or co-owner does
			 not file a timely request for hearing, the Department will notify the financial
			 institution to promptly surrender the amount of the asset that has been frozen
			 to the Department. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.300 - DIVISION OF MEDICAID: ADMINISTRATIVE REVIEWS FOR PROVIDERS AND FACILITIES

Current through August 31, 2023
01.
Written
			 Request
. An action relating to audited cost reports or Medicaid cost
			 settlement calculations required by administrative rule is final and effective
			 unless the provider or facility requests in writing an administrative review
			 within thirty (30) days after the notice is mailed. The request must: (3-17-22)
a. Be signed by the licensed administrator of
			 the facility or by the provider; (3-17-22)
b. Identify the challenged decision;
			 (3-17-22)
c. State specifically the
			 grounds for its contention that the decision was erroneous; and
			 (3-17-22)
d. Include copies of any
			 documentation on which the facility or provider intends to rely to support its
			 position. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.301 - DIVISION OF MEDICAID: SCOPE OF APPEAL HEARING

Current through August 31, 2023
If the Department's decision after the administrative review is
				appealed, only issues and documentation that were presented in the
				administrative review will be admissible in the appeal hearing.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.302 - DIVISION OF MEDICAID: APPEALS PROCESS FOR MEDICAID PARTICIPANTS

Current through August 31, 2023
01.
Medicaid Participant
			 Appeals
. Medicaid participants whose appeals are not related to services
			 delivered through a Managed Care Entity (MCE), as defined in Section
			 010 of these rules, must use the
			 appeals process provided in Sections
			 101 through
			 199 of these rules.
			 (3-17-22)
02.
Medicaid
			 Participant Appeals Related to Services Delivered Through Managed Care
			 Entity
. (3-17-22)
a. Participants whose
			 appeals are related to services delivered through a managed care entity must
			 utilize the complaint, grievance, and appeal process required by the Department
			 and the managed care contractor. (3-17-22)
b. Participants whose appeals are related to
			 services delivered through a Managed Care Entity (MCE) must follow the appeals
			 process in 42 CFR
			 438.402 through
			 42 CFR
			 438.408. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.400 - DIVISION OF HEALTH: LABORATORIES

Current through August 31, 2023
A notice of grounds for denial, suspension, revocation or
				renewal becomes final and effective unless the applicant or responsible party
				files a written appeal by registered or certified mail within fourteen (14)
				days of receipt of the notice. A hearing will be held not more than
				twenty-eight (28) days from receipt of the appeal. The applicant or responsible
				person will receive at least fourteen (14) days of notice of the hearing date.
				If the Department finds that the public health, safety or welfare imperatively
				requires emergency action, and incorporates the findings to that effect in its
				notice of denial, suspension or revocation, summary suspension of the approval
				may be ordered. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.401 - DIVISION OF HEALTH: REPORTABLE DISEASES

Current through August 31, 2023
An order for isolation or quarantine is a final agency action
				as set forth in Section
				56-1003(7), Idaho
				Code. Other orders or restrictions as specified in IDAPA 16.02.10, "Idaho
				Reportable Diseases," become final and effective unless an appeal is filed
				within five (5) working days after the effective date of the order or
				restriction. (3-17-22)
01.
Conduct of Hearing
. The Department may take whatever precautions
			 and make whatever arrangements are necessary for the conduct of such hearing to
			 insure that the health of participants and the public is not jeopardized.
			 (3-17-22)
02.
Review
.
			 Any person directly affected by an order or restriction may file exceptions to
			 the Director's determination, which will be reviewed by the Board. The order or
			 restriction remains effective unless rescinded by the Board.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.402 - DIVISION OF HEALTH: FOOD ESTABLISHMENTS

Current through August 31, 2023
Appeal procedures will be as provided under IDAPA 16.02.19,
				"Idaho Food Code," Section
				861. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.500 - DIVISION OF FAMILY AND COMMUNITY SERVICES: CHILD PROTECTION CENTRAL REGISTRY ADMINISTRATIVE REVIEW

Current through August 31, 2023
A substantiated incident of child abuse, neglect, or
				abandonment will automatically become effective and be placed on the Child
				Protection Central Registry unless the individual identified in the
				notification files a request for an administrative review within twenty-eight
				(28) days from the date on the notification. The request for an administrative
				review must be mailed to the Family and Community Services (FACS) Division
				Administrator. (3-17-22)
01.
Content of Request
. The request for an administrative review must
			 identify the notification being protested and explain the reasons for
			 disagreement. Additional information may be provided for the Administrator's
			 consideration. (3-17-22)
02.
Administrative Review
. The FACS Division Administrator will consider all
			 available information and determine whether the incident was erroneously
			 determined to be "substantiated." The Administrator will furnish a written
			 decision to the individual. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.03 - CONTESTED CASE PROCEEDINGS AND DECLARATORY RULINGS › Section 16.05.03.501 - DIVISION OF FAMILY AND COMMUNITY SERVICES: INTENSIVE BEHAVIORAL INTERVENTION (IBI) ADMINISTRATIVE REVIEW

Current through August 31, 2023
01.
Request
			 for Administrative Review
. An action relating to certification, billing,
			 or reimbursement is final and effective unless the provider requests in writing
			 an administrative review within twenty-eight (28) days after the notice is
			 mailed. The request must be signed by the provider, identify the challenged
			 decision, and state specifically the grounds for its contention that the
			 decision was erroneous. The parties must clarify and attempt to resolve the
			 issues at the review conference, which must be held within twenty-eight (28)
			 days after the request for the administrative review. If the Department
			 determines that additional documentation is needed to resolve the issues, a
			 second session of the conference may be scheduled. The Department will provide
			 a written decision to the facility or provider. (3-17-22)
02.
Scope of Appeal Hearing
. If
			 the Department's decision after the administrative review is appealed, only
			 issues and documentation that were presented in the administrative review will
			 be admissible in the appeal hearing. (3-17-22)