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CONNECTICUT DEPARTMENT OF SOCIAL SERVICESPRIVATE UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.25 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 A. Notification of the Requester
1. The Department notifies the requester in writing regarding the time and place of the Fair Hearing, as follows:
a. for all issues except emergency housing at least 10 days in advance;
b. for emergency housing issues at least one business day prior to the hearing.
2. The Department's notice:
a. advises the requester or the requester's representative of the name, address, and telephone number of the person to notify if the requester is unable to attend the Fair Hearing; and
b. states that the Department will dismiss the Fair Hearing request if neither the requester nor his or her representative appears at the Fair Hearing without good cause; and
c. describes Departmental Fair Hearing procedures and any other information which would assist the requester in presenting his or her case; and
d. explains that the assistance unit or its representative has the right to examine the case record prior to the Fair Hearing.
B. Scheduling and Location of Fair Hearing
1. The Department schedules the Fair Hearing to be held:
a. during normal working hours; and
b. for all issues except emergency housing - within 30 days from the date the request is received; and
c. for emergency housing issues - within 4 business days from the date the request is received; and
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-46 1570.25 page 2 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 B. Scheduling and Location of Fair Hearing (continued)
d. at a reasonable location accessible to the requester. If the requester is disabled, the hearing is held at his or her home if he or she so requests.
2. The requester has the right to request and receive a postponement of the scheduled Fair Hearing.
a. In the Food Stamp program, the postponement cannot exceed 30 days.
b. In the money payment and Medicaid programs, the postponement can be for any reasonable time period if the Department determines there is good cause for the delay. Good cause includes, but is not limited to:
(1) serious illness or injury of the requester; or
(2) inability by the requester, despite a good faith effort, to secure medical records or other information necessary in presenting its case.
c. The time limit for action on the decision is extended for as many days as the Fair Hearing is postponed.
C. Administrative Duties of Fair Hearing Official
1. The Department designates an employee of the Department who meets the qualifications described in this chapter to conduct the Fair Hearing.
2. The Fair Hearing official:
a. makes decisions regarding the scheduling of the hearing;
b. administers oaths or affirmations;
c. determines the issue of the hearing;
d. considers all relevant issues;
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 1570.25 page 3 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 C. 2. Administrative Duties of Fair Hearing Official (continued)
e. determines who may be a party to a hearing requested by another;
f. determines who may be an intervenor;
g. limits intervenor's participation in a hearing to issues in which he or she has stated an interest in a written request;
h. requests, receives, and makes part of the Fair Hearing record all evidence necessary to decide the issues being raised;
i. regulates the conduct and course of the Fair Hearing consistent with due process to insure an orderly Fair Hearing;
j. maintains a Fair Hearing record;
k. renders a Fair Hearing decision in the name of the Department, in accordance with the criteria in this chapter, to resolve the dispute.
D. Non-Administrative Duties of Fair Hearing Official
1. The Fair Hearing official orders, when relevant and useful, an independent medical assessment or professional evaluation from a source mutually satisfactory to the assistance unit and the Department.
a. this occurs if the dispute involves a medical issue such as that concerning a diagnosis, and examining physicians report, or a medical review board decision;
b. the Department pays for this independent assessment.
2. The Fair Hearing official adjusts the modifies the results of the assessment of spousal assets when:
a. either MCCA spouse requests a hearing regarding the assessment; and
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 1570.25 page 4 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________ 1570.25 D. Non-administrative Duties of Fair Hearing Official (continued)
b. the Fair Hearing official determines the results of the assessment were incorrectly determined (Cross Reference 1507).
3. The official increases the community spouse's MMNA previously determined by the Department if either MCCA spouse establishes that the community spouse has exceptional circumstances resulting in significant financial duress, and the MMNA previously calculated by the Department is not sufficient to meet the community spouse's monthly needs as determined by the hearing official.
a. Exceptional circumstances are those that are severe and unusual and that:
(1) prevent the community spouse from taking care of his or her activities of daily living; or
(2) directly threaten the community spouse's ability to remain in the community; or
(3) involve the community spouse's providing constant and essential care for his or her disabled child, sibling or other immediate relative (other than institutionalized spouse).
b. Significant financial duress is an expense or set of expenses that:
(1) directly arises from the exceptional circumstances described in subparagraph a above; and
(2) is not already factored into the MMNA; and
(3) cannot reasonably be expected to be met by the community spouse's own income and assets.
c. Expenses that are factored into the MMNA, and thus do not generally qualify as causing significant financial duress, include, but are not limited to:
(1) shelter costs such as rent or mortgage payments;
(2) utility costs;
(3) condominium fees; CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-03 Transmittal: UP-03-28 1570.25 page 5 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 D. 3. c. Non-administrative Duties of Fair Hearing Official (continued)
(4) real estate and personal property taxes;
(5) real estate, life and medical insurance;
(6) expenses for the upkeep of a home such as lawn maintenance, snow removal, replacement of a roof, furnace or appliance;
(7) medical expenses reflecting the normal frailties of old age.
d. In order to increase the MMNA, the Fair Hearing official must find that the community spouse's significant financial duress is a direct result of the exceptional circumstances that affect him or her.
4. The Fair Hearing official increases the Community Spouse Protected Amount (CSPA) if either MCCA spouse establishes that the CSPA previously determined by the Department is not enough to raise the community spouse's income to the MMNA (Cross References 4022.05 and 4025.67).
a. For applications filed prior to 10-1-03, in computing the amount of the community spouse's income, the Fair Hearing official first allows for a diversion of the institutionalized spouse's income in the following situations:
(1) the community spouse is not expected to outlive the institutionalized spouse (including situations in which the community spouse actually dies while the institutionalized spouse's Medicaid application is pending); or
(2) the CSPA previously determined by the Department is less than the spousal share, as determined by the Department; or
(3) either spouse has transferred assets within the look-back period and the transfer led to a penalty period; or
(4) the community spouse has written the institutionalized spouse out of his or her will, or left the spouse with only the statutory amount required under State law.
For applications filed on or after 10-1-03, in computing the amount of the community spouse's income, the Fair Hearing official first allows for CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-03 Transmittal: UP-03-28 1570.25 page 6 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 D. 4. b. Non-administrative Duties of Fair Hearing Official (continued)
a diversion of the institutionalized spouse's income in all cases.
c. In determining the amount of assets needed to raise the community spouse's income to the MMNA, the Fair Hearing official computes the amount of assets that would generate the required income, assuming the asset is producing income at the higher of the following rates: the current average rate of return generated by a 12 month certificate of deposit as determined by the Department as of the date of the Fair Hearing; or the rate that is actually being generated by the asset.
E. Attendance at Fair Hearing
1. The following persons attend the Fair Hearing:
a. Fair Hearing official; and
b. representative from the Department; and
c. representative of the local Job Connection office, when appropriate, if the dispute involves a work registration requirement, exemption determination, or finding of failure to appear for an appraisal interview; and
d. assistance unit member and/or conservator if the requester is incapable of representing himself or herself; and
e. authorized representatives, if the unit so chooses. At a Food Stamp hearing, the requester may choose to have the authorized representatives attend the hearing in his or her place; and
f. legal counsel for requester, if there is such counsel; and
g. friends or relatives of the requester if the requester so chooses; and
h. parties to the hearing; and
i. intervenors; and
j. any other individuals being given an opportunity to present relevant oral or written statements, at the discretion of the Fair Hearing official. CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-03 Transmittal: UP-03-28 1570.25 page 7 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 E. Attendance at Fair Hearing (continued)
2. The Department limits the number of persons attending the Fair Hearing if the Fair Hearing location has limited space, or under other circumstances which the Hearing official determines to justify limiting attendance.
F. Matters Considered at the Fair Hearing
The Department considers the following issues:
1. an action by the Department or failure by the Department to act, within the appropriate time limits described in this section, on the application for benefits, including:
a. undue delay in reaching a decision on eligibility or in providing benefits; and
b. refusal to consider a request for or undue delay in making an adjustment in the amount of benefits; and
c. discontinuance, termination, or reduction of benefits.
2. decisions by the Department regarding:
a. eligibility for benefits in both initial and subsequent determinations; and
b. amount of benefits or change in amount of benefits; and
c. the manner or form in which benefits are issued, including protective payments (cross reference: Section 6505); and
d. the assessment of spousal assets (Cross Reference 1507.05).
G. Rights of the Requester at the Fair Hearing
1. The requester or his or her representative has the right to:
a. examine, at a reasonable time before the Fair Hearing and during the Fair Hearing, the case record and all documents and records to be used by the Department at the Fair Hearing. This right is subject to the Department's policies regarding Disclosure of Information, as described in Section 1015; and CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-03 Transmittal: UP-03-28 1570.25 page 8 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 G. 1. Rights of the Requester at the Fair Hearing (continued)
b. present its case or have it presented by legal counsel or another person; and
c. bring witnesses; and
d. establish all pertinent facts and circumstances; and
e. present an argument without undue interference; and
f. question or refute testimony or evidence, including the opportunity to confront and cross-examine adverse witnesses.
2. A party to a hearing requested by another has the same rights as the requester at a Fair Hearing.
H. Intervenor's Participation at the Fair Hearing
1. The intervenor's participation is limited to issues in which he or she has stated a particular interest on the written request to be an intervenor.
2. On these issues, the intervenor may participate as follows:
a. inspect and copy records, papers, documents, and physical evidence;
b. introduce evidence;
c. present arguments;
d. cross examine witnesses.
3. The Fair Hearing official may further restrict the participation of an intervenor to promote the orderly conduct of the hearing proceedings.
I. The Fair Hearing Record
1. The Fair Hearing record consists only of:
a. transcript or recording of testimony and exhibits, or an official report containing the substance of what happened at the Fair Hearing; and
all papers and requests filed in the proceeding; and
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-03 Transmittal: UP-03-28 1570.25 page 9 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 I. 1. The Fair Hearing Record (continued)
c. the decision made by the Fair Hearing official.
2. The Department maintains the Fair Hearing record as well as the assistance unit's case record.
3. The Department makes the Fair Hearing record available to the person who requests the Fair Hearing or his or her representative at any reasonable time for copying and inspection. This right is subject to the Department's policies regarding Disclosure of Information, as described in Section 1015.
J. The Fair Hearing Decision
1. The time limit for issuing a decision after a Fair Hearing depends on the issue.
a. For emergency housing issues, a Fair Hearing decision is rendered no later than 3 business days after the hearing.
b. For Food Stamp issues, a Fair Hearing decision must be rendered in time to enable final administrative action to be taken on the contested issue within 60 days of the date of the request for the hearing.
c. For all other issues, a Fair Hearing decision must be rendered no later than 60 days after the hearing.
2. The Fair Hearing decision is based exclusively on evidence introduced at the Fair Hearing, as contained in the Fair Hearing record.
3. The decision itself is a written document which becomes part of the Fair Hearing record.
4. The decision:
a. summarizes the facts; and
b. identifies the evidence and regulations supporting the decision.
5. The decision is binding upon the Department.
6. Unless the requester appeals to the court of jurisdiction, as described in this chapter, the decision serves as a final resolution of the issue being contested. CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 10-1-89 Transmittal: UP-01-04 1570.25 page 10 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 J. The Fair Hearing Decision (continued)
7. Both the requester and the Department are notified in writing of the Fair Hearing decision. The notice contains:
a. the decision; and
b. the reasons for the decision; and
c. a statement of requester's right to appeal to the court of jurisdiction, and that such appeal may result in a reversal of the decision; and
d. a description of how the unit's benefits will be affected by the decision.
8. All Fair Hearing decisions are indexed by name and subject.
9. The Fair Hearing record, including the decision, is available for public inspection and copying, subject to the Department's policies regarding Disclosure of Information, as described in Section 1015.
K. Reconsideration
1. Up to fifteen days from the date of receipt of a Fair Hearing decision, the requester may request reconsideration of the decision.
2. Reconsideration may be requested for the following reasons:
a. an error was made in the interpretation or application of a law, or in the facts of the case;
b. new evidence has been discovered which affects the merits of the case and which for a good reason was not presented at the hearing;
c. there is other good cause for reconsideration.
3. Within twenty-five days of receipt of a request for reconsideration, the Department decides whether to reconsider.
4. If the Department decides reconsideration is not warranted, no further action is required.
CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL _____________________________________________________________________________ Date: 2-1-97 Transmittal: UP-01-04 1570.25 page 11 ______________________________________________________________________________ Section: Type: The Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC Fair Hearings AABD _______________________________________________________________ MA Subject: FS Hearing Procedures ______________________________________________________________________________
1570.25 K. Reconsideration (continued)
5. Regardless of a request for reconsideration, the Department may decide, within forty days, to reconsider a hearing decision.
6. If the Department decides that reconsideration is warranted, it proceeds in a reasonable time to conduct additional proceedings, as may be necessary, to render a decision to modify, affirm, or reverse the hearing decision.
L. Implementation of Fair Hearing Decision
1. The Department makes the appropriate changes in the assistance unit's case as mandated by the Fair Hearing decision within the time limits specified in this chapter.
2. If the decision favors the requester or if the Department resolves the dispute in favor of the requester prior to the Fair Hearing, the Department promptly makes a corrective payment to the unit, if necessary.
a. The payment is retroactive to the date the Department made the incorrect action or inaction.
b. In the Food Stamp program, if the decision results in an increase in the assistance unit's benefits, the increase is reflected in the unit's food stamp allotment within 10 days of the date the Department receives the Fair Hearing decision.
3. If the decision upholds the Department, the Department takes action to recover any benefits which the assistance unit improperly received.
a. The beginning date of the overpayment is retroactive to the date that the assistance unit first received benefits to which it was not entitled.
b. In the Food Stamp program, if the decision results in a decrease in benefits, the decrease is reflected in the next scheduled issuance after the date the Department receives the Fair Hearing decision.
(Cross Reference: Benefit Error, Section 7000)