Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 10 - EOHHS General Provisions › Subchapter 05 - Consumer Rights, Responsibilities, and Protections › Part 2 - Appeals Process and Procedures for EOHHS Agencies and Programs › Section 210-RICR-10-05-2.3 - Administrative Fair Hearing Process

Current through June 14, 2024
2.3.1
GENERAL
				  PROVISIONS
A. The administrative
				  hearing process is initiated when an agency or the EHO receives an appeal
				  request.
B. The EHO is responsible
				  for scheduling the date for the appeal hearing. Upon scheduling a hearing, the
				  EHO must send a written notice to the appellant of the date, time, and location
				  or format of the hearing, no later than fifteen (15) days prior to the hearing
				  date. The EHO must also notify all other affected parties including any
				  authorized representatives of the hearing date.
C. The EHO must assure that the appellant is
				  sent an evidentiary packet, upon request, at least three (3) days in advance of
				  the hearing date, except when using the expedited appeal process. The evidence
				  packet shall, at a minimum, include:
1. Except
				  for HSRI, in eligibility cases, the appellant's original application, the
				  eligibility decision, and, if available, verification results from third party
				  data sources used to make the eligibility determination;
2. In all other cases, any documents provided
				  to the agency by or on behalf of the appellant that were material to the action
				  taken by the agency;
3. Any
				  documents and explanations provided by the appellant;
4. The agency response where
				  applicable;
5. All associated
				  notices.
D. The evidence
				  packet is available to all parties in attendance at the hearing. All parties
				  may request an opportunity to view the evidence packet prior to the hearing,
				  with sufficient advance notice prior to the scheduled hearing. Requests to
				  review the evidence packet should be made to the EHO.
E. The appellant and/or an authorized
				  representative of the appellant must appear for the hearing at the scheduled
				  time, date, and location. Hearings are held typically on the EHO or agency
				  premises or may be conducted by telephone.
1.
				  Request for continuance - If the appellant or an authorized representative is
				  unable to appear for the hearing, the appellant must contact the EHO prior to
				  the hearing date to report that he or she will not be able to appear, explain
				  the reason, and request a continuance/postponement of the hearing.
a. No more than two (2) requests for
				  continuances are permitted, unless the EHO allows, in its discretion, to permit
				  an additional continuance subsequent to a valid claim of good cause as
				  indicated below in §2.3.1(E)(3) of this Part.
b. A SNAP household may receive one
				  postponement of no more than 30 days.
c. A hearing may be held open to a later
				  date, at the discretion of the hearing officer, if an appellant requests
				  additional time in which to submit relevant documents.
2. Dismissal for Failure to Appear - If the
				  appellant or an authorized representative does not provide prior notification
				  to the agency or the EHO of an inability to appear, the appeal is dismissed
				  unless there is an approved claim of good cause. If good cause is found, the
				  dismissal is vacated and the hearing is rescheduled as below.
3. Good Cause for Failure to Appear - Good
				  cause for failure to attend a hearing is liberally interpreted in the
				  appellant's favor. EHO staff may assist the appellant in the establishment of
				  good cause, and when necessary, forward determining information to the hearing
				  officer. If the hearing officer determines that good cause exists, the hearing
				  is rescheduled within thirty (30) days of the request and
				  benefits/assistance/services must be reinstated without undue delay if
				  terminated due to dismissal of the appeal. Good cause claims include, but are
				  not, limited to:
a. Sudden and unexpected
				  event (such as loss or breakdown of transportation, illness or injury, or other
				  events beyond the individual's control) which prevents the appellant's
				  appearance at the hearing at the designated time and place; or appearance at
				  the wrong office;
b. Disabilities,
				  such as linguistic and behavioral health limitations, that may affect the
				  appellant's ability to attend;
c.
				  Injury or illness of appellant or household member that reasonably prohibits
				  the individual from attending the hearing; and
d. Death in family.
4. Vacating a Dismissal - Upon determining
				  that good cause exists, the dismissal is vacated, the hearing is rescheduled,
				  and the EHO provides appropriate notification to the affected parties and
				  agency. If the EHO finds that good cause does not exist, timely written notice
				  of the denial of a request to vacate a dismissal is sent to the appellant. In
				  HSRI appeal cases, the appellant must be advised in the notice in either case -
				  denial or approval of request to vacate a dismissal - of the right to pursue
				  the appeal at the federal level. An appellant choosing to exercise this right
				  must make a request to the federal DHHS appeal entity in no more than thirty
				  (30) days from the date of the EHO notice indicating whether the dismissal is
				  vacated.
F. The appellant
				  may designate anyone, including someone who is not licensed to practice law, to
				  serve as an authorized representative during the appeal process. The appellant
				  may make this designation to the EHO or the agency in-person or in writing by
				  fax, email or U.S. mail or, as appropriate, the state's web-based IES.
1. Role of the Authorized Representative -
				  Once the designation has been recognized by the EHO, the authorized
				  representative is copied on all correspondence pertaining to the appeal that is
				  provided to the appellant. Although the authorized representative may act on
				  behalf of the appellant in all matters leading up to, and including, formal
				  adjudication in a fair hearing, the appellant may opt to participate on his or
				  her own in any dispute resolution proceeding.
2. Legal representation - In situations in
				  which the appellant chooses to engage a licensed attorney to serve as an
				  authorized representative, the EHO must be notified in advance that the
				  attorney intends to make an appearance on the appellant's behalf. Such
				  notification must be provided directly to the EHO by the attorney.
3. Authorized representatives who are
				  out-of-state attorneys must file a pro hac vice motion in Rhode Island Supreme
				  Court to request to be temporarily admitted to practice prior to providing
				  legal representation in the administrative appeal process. In addition, all
				  out-of-state attorneys must meet the requirements of the Rhode Island Supreme
				  Court's Article II, Rule 9 (requirements for non-resident attorneys).
4. If an appellant chooses to have legal
				  representation at the hearing, the representative shall file a written "Entry
				  of Appearance" with the EHO at or before the hearing. The Entry of Appearance
				  acts as a release of confidential information, allowing the legal
				  representative access to the appeal record. The Entry of Appearance is also
				  needed for the EHO to confirm the representation for purposes of follow-up,
				  review, requests for continuances, etc.
G. Persons attending the hearing typically
				  include the appellant, the appellant's authorized representative, the EOHHS
				  Hearing Officer, state attorneys, and one or more representatives from the
				  agency that took the action on appeal. In instances in which the subject on
				  appeal is a change in agency policy, other affected parties may also have
				  representatives in attendance.
1. Agency
				  representatives attending the hearing must be prepared to answer questions
				  related to the action on appeal.
2.
				  It is the responsibility of the hearing officer to record the attendance of all
				  persons who were involved in the relevant action under appeal.
H. All parties, authorized
				  representatives, witnesses, and other persons present at a hearing must conduct
				  themselves with the same decorum commonly observed in any Rhode Island court.
				  Where such decorum is not observed, the hearing officer may take any
				  appropriate actions to restore order, including ejection of parties or
				  adjournment, as appropriate.
I. No
				  person who is a party to or a participant in any proceeding before the agency
				  or EHO or the party's counsel, employee, agent, or any other individual, acting
				  on the party's or their own or another's behalf, is permitted to communicate ex
				  parte with the hearing officer. The hearing officer must not request or
				  entertain any such ex parte communications. These prohibitions do not apply to
				  those communications that relate solely to general matters of procedure and
				  scheduling.
J. Hearing officers
				  hear the case de novo (or with no prior knowledge of the specific issue) and
				  base decisions on applicable laws, regulations, rules and procedures.
K. Persons with disabilities must have access
				  to services and processes necessary to ensure their full participation in the
				  hearing process.
L. In compliance
				  with state and federal statutes and regulations, EHO must have interpreters
				  available for persons with limited English proficiency and other persons
				  needing such services, such as a telephonic interpreter service or a language
				  line.
M. The EHO administrative
				  hearing officer is an impartial designee of the Secretary of EOHHS.
				  Accordingly, a person who has participated in any way in the matter on appeal -
				  either in an official or unofficial capacity - is prohibited from serving as a
				  hearing officer. The hearing officer is responsible for eliciting all relevant
				  facts bearing on the appellant's claim and agency rules, regulations, policies,
				  and/or procedures pertinent to the matter in dispute.
N. The EHO maintains an official transcript
				  of oral presentations made in the hearing. If not transcribed, any tape
				  recording and any memorandum prepared by a presiding official summarizing the
				  contents of those presentations shall be maintained on file. This is the
				  official record for matters appealed from the EOH. Any person who testifies at
				  the hearing shall be sworn in by the hearing officer. An orderly procedure must
				  be followed that includes but is not limited to the following:
1. A statement by the hearing officer
				  reviewing the agency's purpose relative to the hearing; the reason for the
				  hearing; the hearing procedures; the basis upon which the decision will be
				  made, and the manner in which the individual is informed of the
				  decision.
2. A statement by the
				  appellant and/or authorized representative outlining the appellant's
				  understanding of the matter in dispute.
3. A statement by an agency representative,
				  setting forth the legal basis for the agency's action that specifies applicable
				  rules, regulations, policies, and/or procedures.
4. A full and open discussion of all facts
				  and policies at issue by participants under the active leadership of the
				  hearing officer.
O. The
				  hearing may be adjourned from day to day or, within reason, held open to a
				  later date at the discretion of the hearing officer if the appellant has reason
				  to believe that he or she will obtain further relevant information to present
				  at the hearing.
P. The appellant
				  may submit supporting documents into evidence in-person at the time of the
				  hearing, by mail, or by fax, the time frame for such being at the discretion of
				  the EHO.
Q. The EHO must provide
				  the appellant with the opportunity to:
1.
				  Review the appeal record, including all documents and records to be used by
				  agency at a reasonable time of no less than 72 hours before the date of the
				  hearing, as well as during the hearing;
2. Bring witnesses to testify;
3. Establish all relevant facts and
				  circumstances;
4. Be informed of
				  the right to judicial review, if dissatisfied with the hearing
				  decision;
5. Present an argument
				  without undue interference;
6.
				  Question or refute any testimony or evidence, including the opportunity to
				  confront and cross-examine adverse witnesses;
7. Testify telephonically upon request of the
				  appellant and/or at the discretion of the EHO;
8. For HSRI actions, an appellant shall be
				  informed of the right to appeal further to the federal HHS, if dissatisfied
				  with the hearing decision; and
9.
				  For appeals related to HSRI and MAGI Medicaid, an appellant must be informed
				  that a hearing decision affecting one household member may require eligibility
				  re-determinations for other household members.
R. The EOHHS Hearing Officer considers all
				  relevant evidence presented during the course of the appeals process, including
				  any evidence introduced at the formal hearing. Only information bearing
				  directly on the issue under review and the policy, regulation or law put forth
				  as supporting the agency action may be presented by the agency. The hearing
				  officer is prohibited from reviewing any information that is not made available
				  to all parties to the appeal. Further, the hearing officer is prohibited from
				  reviewing any records or evidence that have not been introduced at the
				  hearing.
S. When a hearing involves
				  medical documentation required by federal or state law, such as a diagnosis, a
				  physician's report, or a medical review team's decision, a medical assessment
				  from a qualified person (other than the person(s) involved in the original
				  decision) may be obtained at the expense of the agency and integrated into the
				  appeal record if the hearing officer deems it necessary.
T. No evidence is admitted after completion
				  of a hearing or after a case is submitted on the record, unless the hearing
				  officer allows the record to remain open for such limited purpose, or the
				  hearing officer reopens the hearing, or the parties agree to the submission,
				  and all the parties have been notified of allowing the record to remain open or
				  said reopening.