12 Fair Hearings,2605(b)(13) - Assurance 13

12.1 How many fair hearings did the Grant recipient have in the prior federal Fiscal Year? 7 12.2 How many of those fair hearings resulted in the initial decision being reversed? 0 12.3 Describe any policy and/or procedural changes made in the last federal Fiscal Year as a result of fair hearings? N/A 12.4 Describe your fair hearing procedures for households whose applications are denied and/or not acted upon in a timely manner. Your Right to a Hearing - You can ask for a hearing if you do not agree with a decision HCA has made regarding your application/ benefits. A hearing will give you a chance to explain why you do not agree. Any time you disagree with a decision taken on your case, you have the right to request a fair hearing with an official who is required by law to review the facts of every case in a fair and objective manner and give you a chance to explain why you do not agree. In what situations can you ask for a fair hearing? You apply for benefits and are denied, or • You disagree with a decision on your case, or • You believe your benefits were not calculated correctly, or • A change was made that you do not agree with. • By when must you ask for a fair hearing? You have 90 days from the date of notice to ask for a hearing. If you ask for a hearing within 13 days from the date of this notice, you will continue to get the same amount of benefits you received before we took the action in this notice. You will continue to get these benefits until the Department decides your case, unless another change is made to your case. Changes in benefits may be made after you have asked for a hearing if the reason for the change is not the same as the reason for the hearing. If you lose the hearing, you may have to pay back any benefits you received while the Department decided your case. You do not have a right to a fair hearing if the Department’s decision which you are challenging was the result of a Federal or State mass change. (Revised 7/15/14) How do you request a fair hearing? Complete and return the bottom of a notice, or • Write or call your local HCA office, or Customer Service Center at 1-800-283-4465 • Write the Department’s Fair Hearing’s Bureau at HCA, P.O. Box 2348, Santa Fe, N.M. 87504-2348, or by calling 505-476-6213. If you disagree with a decision by the New Mexico Health Insurance Exchange (NMHIX), you may appeal the action by contacting the NMHIX at 1-800-31802596 and inform the NMHIX that you believe their action should be reconsidered. You may authorize someone else to represent you in the appeals process. • After you ask for a fair hearing, HCA or the NMHIX will send you a letter telling you the date, time and place where your hearing will be held. HCA hearings are usually at the ISD office. The hearing will be conducted by a hearing officer from the HCA Fair Hearings Bureau or the NMHIX. Prior to the hearing, you or your representative can look at your case record and any proof that will be used to decide your case. You will tell why you believe the HCA or NMHIX decision to be wrong. You may bring witnesses and present proof. You may question the county office or the NMHIX about the action taken and the proof presented. You may represent yourself or you may be represented by a friend, household member or an attorney. For information on where you can get free legal help, call 1-833-LGL-HELP (1-833-545-4357). • After the hearing, the hearing officer will make a report. The HCA Division Director or the NMHIX Director will decide whether the action was right or wrong. After your case has been decided, you will be sent a letter telling you about the decision and why the decision was made. (Revised 8/30/17) • • 12.5 When and how are applicants informed of these rights? Applicants are informed during initial application process. If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.