reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-5 - THE FAIR HEARING PROCESS › Section 358-5.9 - Fair hearing procedures

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Burden
			   of Proof.
(1) Appellant. At a fair hearing
			   concerning the denial of an application for or the adequacy of public
			   assistance, medical assistance, HEAP, supplemental nutrition assistance program
			   (SNAP) benefits or services, or an exemption from work activity requirements,
			   the appellant must establish that the social services agency's denial of
			   assistance or benefits was not correct, or that the appellant is eligible for a
			   greater amount of assistance or benefits, or is exempt from work requirements
			   pursuant to Part 385 of this Title.
(2) Social Services Agency. Except where
			   otherwise established by law or regulation, at a fair hearing, the social
			   services agency must establish that its actions were correct regarding:
(i) the source of funding and the amount
			   deducted from the initial payment of supplemental security income as
			   reimbursement of public assistance; or
(ii) the discontinuance, reduction, or
			   suspension of public assistance, medical assistance, or SNAP benefits or
			   services.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-5 - THE FAIR HEARING PROCESS › Section 358-5.10 - Consolidated fair hearings

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			   OAH may consolidate fair hearings where two or more persons request fair
			   hearings in which the individual issues of fact are not disputed and the sole
			   issue in each request is an objection to:
(1)
			   Federal or State law or regulation, or local policy; or
(2) a change in Federal or State
			   law.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-5 - THE FAIR HEARING PROCESS › Section 358-5.11 - The hearing record

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Fair hearing
			   record. Only the OAH may record the fair hearing. A written transcript or
			   recording of the fair hearing testimony and exhibits, or the hearing officer's
			   official report together with the recommended decision of the hearing officer,
			   all papers and requests filed in the proceeding prior to the close of the fair
			   hearing and the fair hearing decision, constitute the complete and exclusive
			   record of the fair hearing. Where a decision without hearing is issued in
			   accordance with section
			   358-6.2 
			   of this Part, the documents submitted by the appellant and the social services
			   agency constitute the complete and exclusive record of the fair
			   hearing.
(b) Review of record. The
			   exclusive record of the fair hearing is confidential; however, the exclusive
			   record may be examined by either party or their authorized representative at
			   the OAH, or upon request at some other location subject to the approval of the
			   OAH.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-5 - THE FAIR HEARING PROCESS › Section 358-5.12 - Telephone Hearings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) OAH
			   may provide that a fair hearing held pursuant to Part 398 of this Title be
			   conducted by means of telephone. When a hearing is conducted by telephone, the
			   parties and the hearing officer need not be physically present at the same
			   location.
(b) All provisions of
			   this Part, which are not inconsistent with the specific provisions of this
			   section and Part 398 of this Title, shall apply to hearings conducted by
			   telephone.
(c) The hearing will be
			   held by means other than telephone in the following circumstances:
(1) when the applicant or recipient makes a
			   request for an in-person hearing;
(2) when, in the judgment of OAH or the
			   hearing officer, a party's due process rights would best be served by
			   conducting a hearing in person; or
(3) when, in the judgment of OAH or the
			   hearing officer, there are circumstances presented by the appellant which make
			   proceeding with the hearing by telephone fundamentally unfair.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-5 - THE FAIR HEARING PROCESS › Section 358-5.13 - Video Hearings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) OAH
			   may provide that a fair hearing held pursuant to this Part be conducted by
			   means of video equipment. When a hearing is conducted us- ing video equipment,
			   the parties and the hearing officer need not be physi- cally present at the
			   same location.
(b) All provisions
			   of this Part, which are not inconsistent with the specific provisions of this
			   section, shall apply to hearings conducted using video equipment.
(c) An appellant who objects to OAH
			   conducting the fair hearing by video equipment should notify OAH at the
			   earliest possible opportunity before the time set for the hearing, but no later
			   than at the commencement of the hearing. The request must be made in writing,
			   in person, by video equipment, or by telephone.
(d) A fair hearing, with the appellant and the hearing officer
			   physically present at the same location, will be held in the following
			   circumstances:
(1) when, in the judgment of
			   OAH, an appellant's due process rights would best be served by conducting a
			   hearing in-person; or
(2) when, in
			   the judgment of OAH, there are circumstances presented by the appellant which
			   make proceeding with the hearing by video equip- ment fundamentally
			   unfair.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.0 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
All decisions of the appropriate commissioner issued
				after a request for fair hearing are governed by this
				Subpart.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.1 - All decisions

Current through Register Vol. 46, No. 28, July 10, 2024
(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 or Part 385 of this Title 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 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
			   OAH's assistance in obtaining compliance with the decision.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.2 - Decision without hearing

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			   Upon the commissioner's own motion or upon request of an appellant in cases in
			   which there is no material issue of fact to be resolved, a decision may be
			   issued without a hearing. The determination to issue a decision without a
			   hearing rests solely within the discretion of the commissioner.
(b) A request for a decision without a
			   hearing must be accompanied by sufficient information to enable the
			   commissioner to ascertain whether any unresolved material issue of fact exists,
			   and should contain a full and clear statement of the issues and of the
			   appellant's position on these issues.
(c) When the commissioner determines that a
			   decision without hearing is appropriate, the OAH will send the request for a
			   decision without hearing, or the request for a hearing, along with any
			   supporting documents to the social services agency involved. Within 10 business
			   days of receipt of these documents, the social services agency must forward to
			   OAH, the appellant, and the appellant's representative, a response containing
			   sufficient information to ensure resolution of the dispute.
(d) Within 10 business days of the receipt of
			   the documents submitted by the social services agency, the appellant or
			   authorized representative may submit comments or rebuttal to the OAH with
			   copies to the other parties.
(e) At
			   any point after a request for a decision without a hearing has been made, if it
			   appears that there is a material and unresolved issue of fact relating to the
			   issue or issues upon which the hearing was requested, the appellant and the
			   social services agency will be informed that a fair hearing will be scheduled
			   upon notice to all parties.
(f) A
			   decision without a hearing will be issued by the commissioner based upon the
			   papers submitted in accordance with this section.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.3 - Direction relative to similar cases

Current through Register Vol. 46, No. 28, July 10, 2024
When a fair hearing decision indicates that a social
				services agency has misapplied provisions of law, regulations, or such agency's
				own State-approved policy, OAH'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.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.4 - Compliance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For all
			   decisions, except those involving food stamp issues only, definitive and final
			   administrative action must be taken promptly, but in no event more than 90 days
			   from the date of the request for a fair hearing.
(b)
(1) For
			   all cases involving food stamp issues only the decision must be issued and the
			   parties notified of the decision within 60 days of receipt of the request for
			   the fair hearing by OAH.
(2) If the
			   decision will result in an increase in household food stamp benefits, social
			   services agencies must reflect such increase in the coupon allotment within 10
			   days of the receipt of the hearing decision; however, the increase may occur
			   later than 10 days after the decision if the social services agency decides to
			   make the decision effective in the household's normal issuance cycle and the
			   issuance will occur within 60 days from the household's request for a hearing.
			   Decisions which result in a decrease in household benefits must be reflected on
			   the next scheduled issuance following receipt of the fair hearing
			   decision.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.5 - Compliance with direction relative to similar cases

Current through Register Vol. 46, No. 28, July 10, 2024
When a direction has been given to a social services
				agency to correct a misapplication of law, 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 commissioner or OAH within 30 days after
				receipt of the direction. The social services agency must make such additional
				reports as the commissioner may require.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 358 - Fair Hearings: Family Assistance, Safety Net Assistance, Medical Assistance, Emergency Assistance to Aged, Blind or Disabled Persons, Emergency Assistance to Needy Families With Children, Supplemental Nutrition Assistance Program, Home Energy Assistance, and Services Funded through the Department of Family Assistance › Subpart 358-6 - Decision And Compliance › Section 358-6.6 - Corrected decisions and reopened hearings

Current through Register Vol. 46, No. 28, July 10, 2024
(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.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.0 - Scope

Current through Register Vol. 46, No. 28, July 10, 2024
This Part prescribes the processes and procedures that
			   must be followed when a public assistance recipient is accused of intentionally
			   violating the requirements of the public assistance programs in a fraudulent
			   manner or a food stamp recipient is accused of intentionally violating the
			   requirements of the food stamp program in a fraudulent manner. If such a
			   recipient is found to have committed an intentional program violation, the
			   recipient may be disqualified from participation in such program for the
			   periods of time set forth in this Part.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Intentional
			 program violation in the public assistance programs (public assistance-IPV)
			 means the commission of one or more acts in violation of standards for the
			 public assistance programs described in section
			 359.3(a) 
			 of this Part.
(b) Intentional
			 program violation in the Food Stamp program (FS-IPV) means the commission of
			 one or more acts in violation of standards for the Food Stamp program described
			 in section
			 359.3(c) 
			 of this Part.
(c) Administrative
			 disqualification hearing means a hearing scheduled by the office, at the
			 request of a social services district, upon the submission by the district of
			 sufficient documentary evidence to establish that an individual has committed
			 one or more acts in violation of program standards described in section
			 359.3  of
			 this Part.
(d) Waiver of
			 administrative disqualification hearing means an election of an individual, in
			 compliance with the provisions of section
			 359.8 
			 of this Part, to accept the imposition of an appropriate penalty contained in
			 section
			 359.9  of
			 this Part without a hearing.
(e)
			 Disqualification consent agreement (DCA) means a document signed by an accused
			 individual in which an individual or any caretaker relative or head of
			 household admits to committing an intentional program violation and consents,
			 as described in section
			 359.4(b) 
			 of this Part, to the imposition of an appropriate disqualification penalty, as
			 set forth in section
			 359.9  of
			 this Part, without a trial.
(f)
			 Caretaker relative means a parent or other relative, as defined in section
			 369.1  of
			 this Title, with whom a child eligible for ADC is living.
(g) Head of household means a person as
			 defined in section
			 387.1(s) 
			 of this Title.
(h) For the purposes
			 of this Part, office means the Office of Temporary and Disability
			 Assistance.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The department
			 and social services districts have the responsibility for investigating the
			 alleged commission of intentional program violations and ensuring that the
			 procedures set forth in this Part are followed.
(b) Subject to the provisions of section
			 399.11 
			 of this Title, any matters or procedures commenced pursuant to Part 399 of this
			 Title prior to the effective date of this Part will be continued in accordance
			 with the provisions of this Part as if the matter had been commenced in
			 accordance with this Part.
(c)
			 Administrative hearings for public assistance IPVs and FS-IPVs may be scheduled
			 by the office, provided that not more than six years have elapsed between the
			 month an individual committed an intentional program violation and the date on
			 which the social services district discovered the intentional program
			 violation, and the office determines that there is evidence to substantiate
			 that an intentional program violation has occurred.
(d) Unless specifically granted written
			 authorization to proceed directly on an FS-IPV by either a social services
			 official or his or her authorized representative or the appropriate district
			 attorney, or by any other prosecutor authorized to act on the matter, on the
			 grounds that to do otherwise would prejudice the prosecution of an FS-IPV
			 allegation, a social services district must initially treat the allegation as
			 an inadvertent household error in accordance with Part 387 of this Title prior
			 to either referring the case to the district attorney or processing the
			 allegation for an administrative disqualification hearing. A social services
			 district's failure to comply with the provisions of this subdivision will not
			 affect the department's determination at a hearing conducted pursuant to this
			 Part or a court's determination when an allegation is referred by a social
			 services district to the appropriate district attorney or any other prosecutor
			 for prosecution. Noncompliance with the provisions of this section will not
			 affect the amount of any food stamp allotment reduction authorized in section
			 359.9(f) 
			 of this Part after a hearing decision is issued that an FS-IPV has
			 occurred.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.3 - Standards

Current through Register Vol. 46, No. 28, July 10, 2024
The standards for determining whether an individual has
			   committed an intentional program violation are:
(a) A public assistance-IPV occurs when an
			 individual, for the purpose of establishing or maintaining the eligibility of
			 the individual or of the individual's family for public assistance or of
			 increasing or preventing a reduction in the amount of such public assistance,
			 individually, or as a member of a family, applies for or receives public
			 assistance and is found to have intentionally:
(1) made a false or misleading statement, or
			 misrepresented, concealed or withheld facts concerning the individual's, or the
			 individual's family's eligibility for public assistance;
(2) committed any act intended to mislead,
			 misrepresent, conceal, or withhold facts or propound a falsity concerning the
			 individual's, or the individual's family's eligibility for public assistance;
			 or
(3) engaged in any conduct
			 inconsistent with the requirements of Part 350, 351, 352, 369 or 370 of this
			 Title.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.4 - Referral to prosecuting authorities

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The social services district must refer a
			 case involving a public assistance-IPV, or FS-IPV in which it believes the
			 facts warrant civil or criminal prosecution to the appropriate district
			 attorney, or to any other prosecutor authorized to act on the matter, and not
			 to the office for an administrative disqualification hearing. This subdivision
			 will not apply in instances in which the social services district has received
			 prior notification from the district attorney or other equivalent prosecutor
			 that the amount of any overpayment or over-issuance determined by the district
			 to exist is less than the amount which the appropriate official has deemed
			 sufficient for prosecution, provided that the social services district has not
			 been notified by any other prosecutor authorized to act on the matter that such
			 prosecutor intends or desires to prosecute such matter. The office may not
			 reverse a determination following an administrative disqualification hearing
			 for lack of compliance with the provisions of this subdivision.
(b) Disqualification consent agreement (DCA).
(1) A DCA must be in a format prescribed by
			 the department and must include:
(i)
			 notification to the accused individual of the consequences of signing the
			 agreement and consenting to a disqualification penalty;
(ii) a statement for the accused individual
			 to sign indicating that he or she understands the consequences of signing the
			 agreement, along with a statement that any caretaker relative or head of
			 household must also sign the agreement if the accused individual is not the
			 caretaker relative or head of household;
(iii) a statement that signing the agreement
			 will result in disqualification of the accused individual and reduction or
			 discontinuance of assistance or food stamps for the disqualification period,
			 even if the accused individual was not found guilty of civil or criminal
			 misrepresentation or fraud;
(iv) a
			 statement describing the disqualification period which will be imposed as a
			 result of the accused individual's signing the agreement; and
(v) a statement that the remaining members of
			 the household or assistance unit, if any, will be held responsible for
			 repayment of the overpayment or over-issuance, unless the accused individual
			 has already repaid the overpayment or over-issuance as a result of meeting the
			 terms of any agreement with the prosecutor or any court order.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.5 - Commencement of the administrative disqualification hearings process

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Upon
			 discovering and determining that an intentional program violation may have
			 occurred, the social services district must document the determination and
			 reach a conclusion as to whether the documented acts constitute an intentional
			 program violation in accordance with the standards described in section
			 359.3  of
			 this Part.
(b) If the social
			 services district concludes that the documented acts resulted in an intentional
			 program violation and that referral, in accordance with section
			 359.4 
			 of this Part, to the appropriate prosecutor authorized to act on the matter, is
			 not warranted or not possible due to the amount in issue, the social services
			 district may process the case for an administrative disqualification
			 hearing.
(c) If, pursuant to
			 section
			 359.4 
			 of this Part, the social services district refers an overpayment or
			 over-issuance to the appropriate prosecutor authorized to act on the matter,
			 and that prosecutor declines to prosecute or fails to take action on the
			 referral within a reasonable period of time, and the social services district
			 elects to initiate the process for an administrative disqualification hearing
			 pursuant to this section, the social services district must formally withdraw
			 in writing the referral to the prosecutor before referring the case to the
			 department. Failure to present evidence of such a formal written withdrawal
			 either in its evidentiary transmittal to the department or at the hearing may
			 result in an administrative disqualification hearing decision adverse to the
			 social services district.
(d)
(1) If the social services district elects to
			 process a case for an administrative disqualification hearing, it must assemble
			 documentary evidence which the district believes is sufficient on its face to
			 support its determination of intentional program violation and forward the
			 evidence in the form of an evidentiary packet to the Office of Administrative
			 Hearings, New York State Department of Social Services, with a request that the
			 department schedule an administrative disqualification hearing.
(2) If the social services district processes
			 a case for an administrative disqualification hearing for an FS-IPV and the
			 factual issues arise from the same or related circumstances as a case for a
			 public assistance-IPV, the cases must be consolidated and the social services
			 district must submit with the evidentiary packet required by this subdivision,
			 a statement of the particular intentional program violation(s) being alleged
			 and the sanction sought to be imposed for each such intentional program
			 violation being alleged.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.7 - Administrative disqualification hearing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Following a determination that the
			 evidentiary packet is sufficient and the scheduling of an administrative
			 disqualification hearing, an administrative disqualification hearing will be
			 conducted in accordance with the requirements of this section.
(b) Where factual issues arise from the same
			 or related circumstances, a consolidated administrative disqualification
			 hearing will be held for an FS-IPV and a public assistance-IPV. All evidence,
			 testimony and proof relating to the consolidated cases will be presented
			 together, but separate findings will be made with respect to each separately
			 alleged intentional program violation.
(c) An administrative disqualification
			 hearing scheduled pursuant to this Part will be adjourned when:
(1) the request for such adjournment is made
			 at least 10 days in advance of the scheduled hearing date; or
(2) the request for such adjournment is made
			 less than 10 days prior to the scheduled hearing date and the individual
			 demonstrates good cause for requesting the adjournment.
The hearing cannot be adjourned for more than a total of
			   30 days.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.8 - Waiver of an administrative disqualification hearing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An administrative disqualification
			 hearing is waived when a waiver of administrative hearing document which is
			 sent by the department to an individual for whom the department has scheduled
			 an administrative disqualification hearing is properly executed by the
			 individual or any caretaker relative or head of household, if the accused
			 individual is not the caretaker relative or head of household, and received by
			 the department.
(b) The department
			 will send written notification to the social services district which had
			 requested the hearing that it may impose the appropriate penalty contained in
			 section
			 359.9  of
			 this Part upon sending a notice of disqualification to the individual, as
			 described in section
			 359.10 
			 of this Part. A waiver of an administrative disqualification hearing must
			 comply with the provisions of section
			 359.6(d)(15) 
			 of this Part.
(c) A
			 disqualification penalty which has been imposed following a waiver of an
			 administrative disqualification hearing cannot be changed in a subsequent fair
			 hearing held pursuant to Part 358 of this Title. There is no right to appeal
			 the penalty by a fair hearing.
(d)
			 Upon timely receipt of a properly executed waiver, the department will notify
			 the social services district in writing of the cancellation of the scheduled
			 administrative disqualification hearing and of the social services district's
			 responsibility to proceed with the recovery of any overpayment or over-issuance
			 in accordance with the provisions of section
			 352.31
			 or
			 387.19 
			 of this Title.
(e) When an
			 individual waives his or her right to appear at an administrative
			 disqualification hearing, the disqualification and appropriate reduction or
			 discontinuance of assistance or food stamps must result regardless of whether
			 the individual admits or denies the charges made by the district.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.9 - Penalties

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Individuals
			 found to have committed a public assistance-IPV, either through an
			 administrative disqualification hearing or by a court of appropriate
			 jurisdiction, or who have signed either a waiver of right to an administrative
			 disqualification hearing or a disqualification consent agreement, will be
			 ineligible, individually or as a member of an assistance unit, to receive
			 public assistance:
(1) for six months for the
			 commission of a first public assistance-IPV; or
(2) for 12 months for the commission of a
			 second public assistance-IPV or when the offense results in the wrongful
			 receipt of benefits in an amount between $1,000 and $3,900; or
(3) for 18 months for the commission of a
			 third public assistance-IPV or when the offense results in the wrongful receipt
			 of benefits in an amount in excess of $3,900; or
(4) for five years for the commission of a
			 fourth or subsequent public assistance-IPV.
Findings of the commission of intentional program
			   violations in the ADC and HR programs prior to August 20, 1997 must be
			   considered in determining the sanction to be imposed for a public
			   assistance-IPV.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 1 - Determination of Eligibility-General › Part 359 - Disqualification For Intentional Program Violation › Section 359.10 - Notice of disqualification

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
			 The social services district will provide a written notice of disqualification
			 to an individual who:
(1) has been found,
			 after an administrative disqualification hearing, to have committed an
			 intentional program violation;
(2)
			 has waived his or her right to appear at an administrative disqualification
			 hearing in accordance with section
			 359.8 
			 of this Part;
(3) has signed a
			 disqualification consent agreement in which he or she admits committing an
			 intentional program violation in accordance with section
			 359.4 
			 of this Part; or
(4) has been
			 determined by a court to have engaged in conduct that would constitute an
			 intentional program violation in accordance with section
			 359.9(d) 
			 of this Part.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-1 - Introduction And Definitions › Section 360-1.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
(a) What is in this
			   Part. This Part describes who is eligible for medical assistance, how to apply,
			   how eligibility is determined, and what eligible recipients are entitled
			   to.
(b) Related regulations.
			   Regulations at Subchapter E (Parts 500 through 541) of this Title establish
			   policies and standards for provision of medical assistance services, list fees
			   and reimbursement for specific medical assistance services, and set forth
			   requirements for authorization of medical care and billing for provided
			   services.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-1 - Introduction And Definitions › Section 360-1.2 - Applicability of other rules and regulations to medical assistance (MA)

Current through Register Vol. 46, No. 28, July 10, 2024
All departmental regulations relating to public
				assistance and care apply to medical assistance except those that are
				inconsistent with the laws and regulations governing the medical assistance
				program found at:
(a) title 11 of
			   article 5 of the Social Services Law; and
(b) Part 360 and Parts 500 through 541 of
			   this Title.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-1 - Introduction And Definitions › Section 360-1.3 - Brief overview of eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) As
			   a general rule, a person who is eligible for the home relief, aid to dependent
			   children, or supplemental security income programs or who is a recipient of
			   foster care maintenance payments or adoption assistance payments under title
			   IV-E of the Social Security Act is eligible for medical assistance. In
			   addition, certain other categories of people are eligible for medical
			   assistance if their income and resources are insufficient to meet the cost of
			   necessary medical care and supplies. Some of these categories include persons
			   under the age of 21, persons 65 years of age or older, pregnant women, persons
			   who are certified blind or certified disabled, and persons who would be
			   eligible for aid to dependent children if they has less income or resources. A
			   complete list of eligible groups is found in section
			   360-3.3  of
			   this Part.
(b) Types of services
			   provided under the medical assistance program. The medical assistance program
			   provides payment for medically necessary services and supplies. These include:
			   the services of qualified physicians, dentists, optometrists and nurses;
			   laboratory, physical therapy and X-ray services; care in hospitals and
			   residential health care facilities; home health and personal care services; and
			   supplies such as drugs, eyeglasses, prosthetic appliances and other medical or
			   surgical supplies. Complete lists of covered care, services and supplies are
			   found in Parts 505 through 510 of this Title.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-1 - Introduction And Definitions › Section 360-1.4 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
When used in this Part, unless expressly stated
				otherwise or unless the context of subject matter requires a different
				interpretation:
(a) ADC means aid to
			   dependent children under title 10 of article 5 of the Social Services Law and
			   under Part 369 of this Title.
(b)
			   Allocation means an amount of income set aside, when computing the net
			   available income of an aged, certified blind or certified disabled MA applicant
			   or recipient, to meet the needs of certain other household members.
(c) Chronic care budgeting is a budgeting
			   procedure used for individuals who are in permanent absence status, as defined
			   in subdivision (k) of this section. For recipients in permanent absence status,
			   chronic care budgeting will begin on the first day of the calendar month
			   following the month in which the applicant/recipient is determined to be in
			   permanent absence status.
(d) Days
			   means calendar days.
(e) Deeming
			   refers to a budgeting procedure used in determining the medical assistance
			   eligibility of an aged, certified blind, or certified disabled
			   applicant/recipient, in which certain income and resources of legally
			   responsible relatives are considered available to the applicant/recipient.
			   Legally responsible relative is defined in subdivision (h) of this
			   section.
(f) Homestead means the
			   primary residence occupied by a medical assistance applicant/recipient and/or
			   members of his/her family. Family members may include the
			   applicant's/recipient's spouse, minor children, certified blind or certified
			   disabled children, and other dependent relatives. The homestead includes the
			   home, land and integral parts such as garages and outbuildings. The homestead
			   may be a condominium, cooperative apartment or mobile home. Vacation homes,
			   summer homes or cabins are not considered to be homesteads.
(g) HR means home relief provided under title
			   3 of article 5 of the Social Services Law and under Part 370 of this
			   Title.
(h) Legally responsible
			   relative means a person who is legally responsible for the support and care of
			   one or more relatives. For medical assistance purposes, a legally responsible
			   relative is:
(1) a spouse of a medical
			   assistance applicant or recipient; or
(2) a parent of a child under the age of 21.
			   A parent is not financially liable for a certified blind or certified disabled
			   child expected to be living separately from the parental household for 30 days
			   or more, even if the child returns to the parental household for periodic
			   visits.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-2 - Application Process › Section 360-2.1 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
This Subpart explains the application/recertification
				process for MA including:
(a) the
			   applicant's/recipient's obligations in verifying eligibility and continuing
			   eligibility;
(b) the social
			   services district's obligation in verifying eligibility and continuing
			   eligibility;
(c) the requirement
			   that the social services district explain the MA program to
			   applicants/recipients and inform them of other assistance and services for
			   which they may be eligible; and
(d)
			   the responsibility of the social services district to make prompt eligibility
			   decisions and to notify applicants/recipients of decisions.
New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-2 - Application Process › Section 360-2.2 - Applying for MA

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
ADC and
			   HR applicants.
Persons applying for ADC or HR on the State-prescribed
				form are not required to make a separate application for MA.
(1) Persons determined to be eligible for ADC
			   or HR are automatically eligible for MA if they meet the general conditions for
			   MA eligibility in section
			   360-3.2 
			   of this Part.
(2) Persons
			   determined to be ineligible for ADC or HR will have their MA eligibility
			   determined separately, unless they have stated in writing that they do not want
			   their MA eligibility determined.