Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Part 1 - GENERAL INFORMATION › Section 144-332-1-7 - ADMINISTRATIVE HEARINGS

Current through 2024-29, July 17, 2024
An Administrative Hearing (Hearing) is an informal
					 conference held by the Commissioner of the Department, or a Hearing Officer, to
					 review the action taken by the Department in order to ensure that Federal and
					 State policy have been applied correctly. This right is basic throughout all of
					 the public assistance programs. (Administrative Hearings regulations for all of
					 DHHS is found at 10-144 in the Code of Maine Regulations Chapter 1). If the
					 Commissioner authorizes another agent to handle the hearing, the Hearing
					 Officer must be:
I. impartial and not
				  have participated in the action causing dissatisfaction;
II. sufficiently skilled in interviewing to
				  obtain evidence and the facts necessary for a fair determination; and
III. qualified to evaluate all evidence
				  fairly and realistically, to explain to the individual the policies under which
				  the Department operated and to interpret and inform the Department of any
				  evidence of unsound, unclear or inequitable policies or practices.
Written notification of the right to a hearing is given to
					 all interested parties through the use of pamphlets and informational
					 materials.
Every written notification of Department action on
					 eligibility will include:
I. the right
				  to a hearing;
II. the method by
				  which a hearing can be obtained; and
III. the right to be represented by legal
				  counsel, relative, friends, or other persons. The Department cannot pay for
				  legal services.
Section 7.1
:
				  Requesting an Administrative Hearing
Federal and State laws assure that any individual or the
					 individual's representative who believes that proper consideration has not been
					 given to circumstances surrounding a request for assistance may request a
					 hearing.Any oral or written request made by the individual or their
					 representative to the Department that they want an opportunity to present the
					 case to a higher authority is a request for a hearing.
All complaints which are not clear requests for a hearing
					 will be answered by a personal contact or in writing by the Eligibility
					 Specialist, Supervisor, or member of Central Office staff and will explain the
					 individual's right to a hearing. If the individual is satisfied with the
					 adjustment or explanation, activity on the complaint will end. If not, the
					 individual will be offered the opportunity for a hearing.
The Department must assure that the individual understands
					 the process. When a request is made, the Department will not limit or interfere
					 with the individual's rights in any way. In fact, the emphasis of the
					 Department will be on helping the individual submit the request and prepare the
					 case. The Department's regional office will provide information regarding legal
					 services available in the community to assist the individual in representation
					 at hearings.
The Department may request that the Division of
					 Administrative Hearings deny or dismiss a request for a hearing when:
I. the request is withdrawn in writing by the
				  individual or individual's representative;
II. the sole issue is one of State or Federal
				  law requiring automatic adjustment for groups of individuals unless the reason
				  for an individual's appeal is disagreement of facts affecting eligibility (such
				  as incorrect computation); or
III.
				  the hearing is abandoned. Abandonment occurs when the individual or the
				  individual's representative fails to appear at the hearing without a reason
				  acceptable to the Hearing Officer.
The Department may respond to a series of individual
					 requests for hearings by requesting the Division of Administrative Hearings
					 conduct a single group hearing. The Department will consolidate only cases in
					 which the sole issue involved is one of a single policy issue. If individuals
					 request a group hearing on such an issue, the Department will grant it. In all
					 group hearings, the policies governing hearings will be followed. Thus,
					 individuals will be permitted to present their own cases and to be represented.
					 If, at any time, an individual scheduled for a group hearing wants to withdraw
					 and have an individual hearing, the request must be made to the Division of
					 Administrative Hearings.
Any request for a hearing must be received by the local
					 office within thirty days (plus two days for mail) starting with the date on
					 the written notice of eligibility unless the Department decides to grant an
					 extension of time.
The hearing process will take no longer than sixty days
					 from the date of the initial request for the hearing except when the individual
					 requests a delay. If the request for a delay is granted, additional time may be
					 added to the sixty days.
A request for a hearing will be acknowledged in writing
					 within five days of its receipt by the local office. The notice will be sent at
					 least ten days prior to the hearing to allow for preparation of the
					 case.
When additional medical information is requested by the
					 individual, it will be obtained at Department expense from a medical source
					 satisfactory to the individual. The Hearing Officer can also consider the
					 physician's report or can request additional evidence. The medical report will
					 be made in writing or by personal testimony for the hearing record. When the
					 hearing involves medical issues, a medical assessment other than that of the
					 persons involved in making the original decision will be obtained and made a
					 part of the record if the Hearing Officer or the individual considers it
					 necessary.