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 358-2 - Definitions › Section 358-2.2 - Adequate notice

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except as
			   provided in subdivision (b) of this section, an adequate notice means a notice
			   of action or an adverse action notice or an action taken notice which sets
			   forth all of the following:
(1) the action the
			   social services agency proposes to take or is taking, and if a single notice is
			   used for all affected assistance, benefits or services, the effect of such
			   action, if any, on a recipient's other assistance, benefits or services.
			   Otherwise the notice shall state that there will be a separate notice for other
			   affected assistance, benefits or services. In addition, in the case of:
(i) a reduction of public assistance or food
			   stamp benefits: both the dollar amount of assistance or benefits prior to the
			   reduction and the reduced amount must be specified;
(ii) an increase in the amount of a medical
			   assistance spenddown: the amount of the spenddown, if any, prior to the
			   increase and the spenddown amount after the increase must be specified. In
			   addition, such notice must include an explanation of the procedures to be
			   followed for meeting the spenddown;
(iii) a recoupment: the total amount to be
			   recouped and the rate of recoupment must be specified. In addition, in the case
			   of a recoupment of a public assistance grant, the right to claim that the rate
			   of recoupment will cause undue hardship must be specified;
(iv) an acceptance of a food stamp
			   application:
(a) the benefit level, including
			   variations based on changes anticipated and at the time of certification, the
			   date when benefits become available and the dates covering the
			   certification/eligibility period must be specified. In addition, if the initial
			   allotment contains benefits for both the month of application and the current
			   month, the notice must explain that the initial allotment includes more than
			   one month's benefits, and must indicate the monthly allotment amount for the
			   remainder of the certification period;
(b) when an application is approved on an
			   expedited basis without verification, the notice must explain that the
			   household must provide the verification which was postponed and any special
			   conditions applicable to the household if a normal certification period was
			   assigned to such household;
(v) a denial of a food stamp application:
			   when a household is potentially categorically eligible for food stamp benefits
			   but is denied food stamp benefits, the notice must ask the applicant to inform
			   the social services agency if the applicant is approved to receive family
			   assistance, federally funded safety net assistance or supplemental security
			   income benefits;
(vi) a notice of
			   authorization of a public assistance grant: the amount of the grant must be
			   specified;
(vii) an increase in a
			   public assistance grant or food stamp benefits: the new amount of the grant or
			   benefits must be specified;
(viii)
			   a restriction of a medical assistance authorization: the date the restriction
			   will begin, the effect and scope of the restriction, the reason for the
			   restriction, the right of the recipient to select a primary care provider
			   within two weeks of the date of the notice of intent to restrict, if the social
			   services agency provides a limited choice of providers to the recipient; the
			   right of the social services agency to select a primary provider for the
			   recipient, if a list of primary care providers is not provided or where the
			   recipient fails to select a primary care provider within two weeks if the
			   recipient is given a choice; and the right of the recipient to change providers
			   every three months, or sooner for good cause shown; the right of the recipient
			   to explain and present documentation, either at a conference or by submission,
			   showing the medical necessity of the services cited in the recipient
			   information packet; the right of the recipient to examine records maintained by
			   the social services agency which identify medical assistance services paid for
			   on behalf of the recipient (i.e., claim detail of recipient profile
			   information), must be specified;
(ix) an acceptance of an application for
			   services: the type of services to be provided, the duration of services
			   planned, the name of the worker or unit responsible for the case and such
			   person's telephone number, and the right of the applicant and recipient to
			   accept or reject the services shall be specified. In addition, the notice must
			   include a statement regarding the continuing responsibility of the recipient to
			   report any changes in status;
(x) a
			   determination that an applicant is eligible for the HEAP program: if Federal
			   funds are available, the amount of benefits must be specified. If Federal funds
			   are unavailable, a statement shall be included that HEAP benefits will be
			   provided if sufficient Federal funds become available;
(xi) an acceptance of an application for
			   medical assistance: the extent of coverage, including what care and services
			   are authorized as well as any limitations, must be specified. In addition, if
			   only part of the cost of a particular service will be allowed, such limitation
			   must be specified. If the notice of acceptance indicates a spenddown liability,
			   such notice must include an explanation of the procedures to be followed for
			   meeting the spenddown;
(xii) a
			   disqualification of a food stamp household, or a member of such household for
			   failure to comply with food stamp registration or work requirements: the
			   particular act of noncompliance, the proposed period of disqualification and
			   that the household or individual may reapply in order to resume participation
			   in the food stamp program at the end of the disqualification period as well as
			   information about avoiding or ending the disqualification, must be
			   specified;
(xiii) a notice of
			   action taken in the food stamp program when a member of the applicant household
			   has without good cause failed to comply with work registration requirements:
			   the particular act of noncompliance, the proposed period of disqualification,
			   that the individual or household may reapply in order to participate at the end
			   of the disqualification period as well as information about ending the
			   disqualification, must be specified; and
(xiv) a disqualification of a household from
			   the food stamp program based upon the voluntary termination of employment by
			   the head of household: the proposed period of disqualification, the household's
			   right to reapply in order to resume participation at the end of the
			   disqualification period as well as information about ending the
			   disqualification, must be specified.