Current through Register Vol. 35, No. 18, September 24, 2024
The HCA will publish clearly written rules of procedure for
disqualification hearings, and will make these procedures available to any
interested party.
A.
HCA
conducted hearings: When the HCA has sufficient documentary evidence
indicating that an individual may have committed an intentional program
violation (IPV), action will be taken to conduct an administrative
disqualification hearing.
(1)
Consolidation of ADH with fair hearing: An administrative
disqualification hearing and a fair hearing may be combined into a single
hearing if the factual issues arise out of the same or related, circumstances
and the household receives prior notice that the hearing will be combined.
(a)
Time frames: If a
disqualification hearing and fair hearing are combined, the HCA will follow the
time frames for conducting disqualification hearings.
(b)
Claims and IPV
determination: If the hearings are combined for the purpose of settling
the amount of the claim at the same time as determining whether or not
intentional program violation has occurred, the household will lose its right
to a subsequent fair hearing on the amount of the claim.
(c)
Waiving the 30-day advance
notice: The HCA will allow, upon household request, a household to waive
the required 30-day advance notice of hearing when the disqualification hearing
and fair hearing are combined.
(2)
Administrative disqualification
hearing procedures:(a)
Hearing
officers: The HCA may use the same hearing official for disqualification
hearings and fair hearings or may designate hearing officials to conduct only
disqualification hearings.
(b)
Advising household or representative: At the disqualification
hearing the hearing official will advise the household member or representative
that they may refuse to answer questions during the hearing.
(c)
Time limits for decision:
Within 90 days of the date the household member is notified in writing that the
hearing has been scheduled the HCA will conduct the hearing, arrive at a
decision, and notify the household member and local agency of the
decision.
(d)
Postponing the
scheduled hearing: The household member or representative is entitled to
a postponement of the scheduled hearing provided that the request for
postponement is made at least 10 days in advance of the date of the scheduled
hearing. The hearing will not be postponed for more than a total of 30 days and
the HCA may limit the number of postponements to one. If the hearing is
postponed the time limits above may be extended for as many days as the hearing
is postponed.
(3)
Advance notice of hearing: The HCA will provide written notice to
a household member suspected of intentional program violation at least 30 days
in advance of the date a disqualification hearing which is initiated by HCA has
been scheduled.
(a) If mailed, the notice will
be sent either first class mail or certified mail-return receipt requested. The
notice may also be provided by any other reliable method. If no proof of
receipt is obtained, a showing of non-receipt by the household member will be
considered good cause for not appearing at the hearing.
(b) The notice will contain, at a minimum:
(i) the date, time and place of the
hearing;
(ii) the charge(s) against
the household member;
(iii) a
summary of the evidence, and how and where the evidence can be
examined;
(iv) a warning that the
decision will be based solely on information provided by the county office if
the household member fails to appear at the hearing;
(v) a statement that the household member or
representative will have 10 days from the date of the scheduled hearing to
present good cause for failure to appear in order to receive a new
hearing;
(vi) a warning that a
determination of IPV will result in disqualification periods as determined by
8.139.647.8 NMAC; and a statement
of which penalty HCA believes is applicable to the case scheduled for a
hearing;
(vii) a listing of the
household's member's rights;
(viii)
a statement that the hearing does not preclude the state or federal government
from prosecuting the household member for IPV in civil or criminal court
action, or from collecting the over-issuance;
(ix) the name of an individual or
organization, if any, that provides free legal representation;
(x) the date that the signed waiver must be
received by the hearing official to avoid holding the hearing;
(xi) a statement of the accused individual's
right to remain silent concerning the charge(s), and that anything said or
signed by the individual concerning the charge(s) can be used against him/her
in a court of law;
(xii) the
telephone number and, if possible, the name of the person to contact for
additional information; and
(xiii)
the fact that the remaining household members, if any, will be held responsible
for repayment of the resulting claim.
(4)
Scheduling the hearing: The
time and place of the hearing will be arranged so that the hearing is
accessible to the household member suspected of IPV.
(5)
Failure to appear: If the
household member or representative cannot be located or fails to appear at a
hearing initiated by the HCA without good cause, the hearing will be conducted
without the household member being represented. Even if the household member is
not represented, the hearing official is required to carefully consider the
evidence and determine if intentional program violation was committed based on
clear and convincing evidence. If the household member is found to have
committed intentional program violation but a hearing official later determines
that the household member or representative had good cause for not appearing,
the previous decision shall no longer remain valid and the HCA will conduct an
new hearing. The household member has 10 days from the date of the scheduled
hearing to present reasons indicating a good cause for failure to appear. The
good cause decision will be documented into the case record.
(6)
Participation while awaiting a
hearing: A pending disqualification hearing will not affect the
individual's or household's right to be certified and participate the food
stamp program. Since a household member cannot be disqualified for IPV until a
hearing official finds that individual has committed IPV, the HCA will
determine eligibility and benefit amount of the household in the same manner it
would be determined for any other household. Household benefits will be
terminated if the certification period has expired and the household, after
receiving its notice of expiration, fails to reapply. The household benefits
will be reduced or terminated if the HCA has documentation which substantiates
that the household is ineligible or eligible for fewer benefits, even if these
facts led to the suspicion of intentional program violation and resulting
disqualification hearing, and the household fails to request a fair hearing and
continuation of benefits pending the hearing. For example, the HCA may have
documentation which substantiates that a household failed to report a change in
circumstances even though the HCA has not yet demonstrated that the failure to
report involved an act of intentional program violation.
(7)
Criteria for determining
IPV: The hearing officer will base the determination of IPV on clear and
convincing evidence which demonstrates that the household member(s) committed,
and intended to commit, intentional program violation as defined in Subsection
D of 8.139.647.8 NMAC.
(8)
Imposition of disqualification
penalties:
(a)
Beginning the
disqualification: The period of disqualification will begin with the
first month which follows the date the household member receives written
notification of the disqualification. If the act of IPV which led to the
disqualification occurred prior to the disqualification periods specified in
Subsection B of
8.139.647.8 NMAC, the household
member will be disqualified in accordance with the disqualification periods in
effect at the time of the offense.
(b)
No further appeal: No
further administrative appeal procedure exists after an ADH conducted by the
HCA. The determination of IPV made by a hearing officer cannot be reversed by a
subsequent fair hearing decision. The household member, however, is entitled to
seek relief in a court having appropriate jurisdiction. The period of
disqualification may be subject to stay by a court of appropriate jurisdiction
or other injunctive remedy.
(c)
Ineligibility at disqualification: If the individual is not
certified to participate in the food stamp program at the time the
disqualification period is to begin, the disqualification penalty will be
imposed immediately upon a determination of IPV, as though the individual was a
participant in the FSP.
(d)
Disqualification period continues: Once a disqualification penalty
has been imposed against a currently participating household member, the period
of disqualification will continue uninterrupted until completed, regardless of
the eligibility of the disqualified member's household. The disqualified
member's household will continue to be responsible for repayment of the
over-issuance which resulted from the disqualified member's intentional program
violation, regardless of the household's eligibility for food stamp
benefits.
(9)
Notification of disqualification: If the hearing officer finds
that the household member committed IPV, HCA will provide written notice to a
household member prior to disqualification.
(a) The notice will inform the household
member of the decision; the reason for the decision; and the date the
disqualification penalty begins and ends.
(b) Written notice will also be provided to
any remaining household members of the benefit amount they will receive during
the period of disqualification or that they must reapply because the
certification period has expired. A written demand letter for restitution will
also be provided.
B.
Waived hearings: The HCA will
provide written notification to the household member suspected of intentional
program violation that the member can waive their right to an administrative
disqualification hearing. Prior to providing written notification to the
household member, the evidence must be reviewed by the office of inspector
general (OIG). OIG must have made a determination that such evidence warrants
scheduling a disqualification hearing.
(1)
Contents of written notice: The written notification provided to
the household member will include, at a minimum:
(a) The date that the signed waiver must be
received by the HCA to avoid the holding of a hearing and a signature block for
the accused individual along with a statement that the head of household must
also sign the waiver if the accused individual is not the head of household,
with an appropriately designated signature block;
(b) A statement of the accused individual's
right to remain silent concerning the charge(s), and that anything said or
signed by the individual concerning the charge(s) can be used against him/her
in a court of law;
(c) The fact
that a waiver of the disqualification hearing will result in disqualification
and a reduction in benefits for the period of disqualification, even if the
accused individual does not admit to the facts as presented by the
HCA;
(d) An opportunity for the
accused individual to specify whether or not they admit to the facts as
presented by the HCA. This opportunity will consist of the following
statements:
(i) "I admit to the facts as
presented, and understand that a disqualification penalty will be imposed if I
sign this waiver;" and
(ii) "I do
not admit that the facts as presented are correct; however, I have chosen to
sign this waiver and understand that a disqualification penalty will
result."
(e) The
telephone number and if possible the name of the individual to contact for
additional information;
(f) The
fact that the remaining household members if any will be held responsible for
repayment of the resulting claim.
(2)
Imposition of disqualification
penalties: If the household member suspected of IPV signs the waiver of
right to an ADH and the signed waiver is received within the time frames
specified by the HCA, the household member will be disqualified in accordance
with the disqualification periods in Subsection B of
8.139.647.8 NMAC above.
(a)
Beginning the
disqualification: The period of disqualification will begin with the
first month following the date the household member receives written
notification of the disqualification. If the act of IPV which led to the
disqualification occurred prior to the written notification of the
disqualifications specified in Subsection B of
8.139.647.8 NMAC, the household
member will be disqualified in accordance with the disqualification period in
effect at the time of the offense. The same act of IPV repeated over a period
of time will not be separated so that separate penalties can be
imposed.
(b)
No further
appeal: No further administrative appeal procedure exists after an
individual waives their right to an administrative disqualification hearing and
a disqualification penalty has been imposed. The disqualification penalty
cannot be changed by a subsequent fair hearing decision. The household member
is entitled to seek relief in a court having appropriate jurisdiction. The
period of disqualification may be subject to stay by a court of appropriate
jurisdiction or other injunctive remedy.
(c)
Ineligibility at
disqualification: If the individual is not certified to participate in
the program at the time the disqualification period is to begin, the
disqualification penalty will be imposed immediately upon a determination of an
IPV, as though the individual was a participant in the FSP.
(d)
Disqualification continues:
Once a disqualification penalty has been imposed against a currently
participating household member, the period of disqualification will continue
uninterrupted until completed regardless of the eligibility of the disqualified
members household. The disqualified member's household will continue to be
responsible for repayment of the over-issuance which resulted from the
disqualified member's IPV regardless of the household's eligibility for program
benefits.
(3)
Written notification: Written notice will be provided to the
household member prior to disqualification. Written notice will also be
provided to any remaining household members of the allotment they will receive
during the period of disqualification or that the household must reapply
because the certification period has expired. A written demand letter for
restitution, will also be provided.
C.
Court referrals: The HCA will
refer cases of alleged IPV for prosecution in accordance with an agreement with
prosecutors or state law. The agreement will include the understanding that
prosecution will be pursued in cases where appropriate. The agreement will also
include information on how and under what circumstances cases will be accepted
for possible prosecution and any other criteria set by the prosecutor for
accepting cases for prosecution. The HCA is encouraged to refer for prosecution
under state or local statutes those individuals suspected of committing IPV,
particularly if large amounts of food stamp benefits are suspected of having
been obtained by IPV, or the individual is suspected of committing more than
one act of IPV.
(1)
Imposition of
disqualification penalties: The HCA will disqualify an individual found
guilty of IPV for the length of time specified by the court. If the court fails
to impose a disqualification period, the HCA will impose a disqualification
period in accordance with the provisions in Subsection B of
8.139.647.8 NMAC, unless contrary
to the court order. If disqualification is ordered but a date for initiating
the disqualification period is not specified, the HCA will initiate the
disqualification period for currently eligible individuals within 45 days of
the date the disqualification was ordered. Any other court-imposed
disqualification will begin within 45 days of the date the court found a
currently eligible individual guilty of civil or criminal misrepresentation or
fraud.
(2)
Beginning the
disqualification: If the individual is not certified to participate in
the program at the time the disqualification period is to begin, the
disqualification penalty will be imposed immediately upon a determination of
IPV, as though the individual was a participant in the FSP.
(3)
Disqualification continues:
Once a disqualification penalty has been imposed against a currently
participating household member, the period of disqualification will continue
uninterrupted until completed regardless of the eligibility of the disqualified
member's household. The disqualified member's household will continue to be
responsible for repayment of the over-issuance which resulted from the
disqualified members IPV regardless of the household's eligibility for program
benefits.
(4)
Notification of
disqualification: If the court finds that the household member committed
IPV the HCA will provide written notice to the household member. The notice
will be provided prior to disqualification, whenever possible. The notice will
inform the household member of the disqualification and the date the
disqualification will take effect. The HCA will provide written notice to the
remaining household members, if any, of the benefit amount they will receive
during the period of disqualification or that they must reapply because the
certification period has expired. The HCA will provide a written demand letter
for restitution.
D.
Deferred adjudication: The HCA may allow individuals to sign
disqualification consent agreements in cases referred for prosecution. The HCA
may use this option for those cases in which a determination of guilt is not
obtained from a court due to the accused individual having met the terms of a
court order or which are not prosecuted due to the accused individual having
met the terms of an agreement with the prosecutor.
(1)
Advance notification:
(a) The HCA will enter into an agreement with
the state's attorney general's office or where necessary, with county
prosecutors which provides for advance written notification to the household
member of the consequences of consenting to disqualification in cases of
deferred adjudication.
(b) The
written notification provided to the household member which informs him/her of
the consequences of consenting to disqualification as a part of deferred
adjudication will include, at a minimum:
(i) a
statement for the accused individual to sign that the accused understands the
consequences of consenting to disqualification, along with a statement that the
head of household must also sign the consent agreement if the accused
individual is not the head of household, with an appropriately designated
signature block;
(ii) a statement
that consenting to disqualification will result in disqualification and a
reduction in benefits for the period of disqualification, even though the
accused individual was not found guilty of civil or criminal misrepresentation
or fraud;
(iii) a warning that the
disqualification periods for IPV under the food stamp program are as specified
in Subsection B of
8.139.647.8 NMAC, and a statement
of which penalty will be imposed as a result of the accused individual having
consented to disqualification;
(iv)
a statement of the fact that the remaining household members, if any will be
held responsible for repayment of the resulting claim, unless the accused
individual has already repaid the claim as a result of meeting the terms of the
agreement with the prosecutor or the court order.
(2)
Imposition of
disqualification penalties: If the household member suspected of IPV
signs the disqualification consent agreement, the household member will be
disqualified in accordance with the disqualification periods specified in
Subsection B of
8.139.647.8 NMAC, unless contrary
to the court order. The disqualification period will begin within 45 days of
the date the household member signed the disqualification consent agreement.
However, if the court imposes a disqualification period or specifies the date
for initiating the disqualification period, the HCA will disqualify the
household member in accordance with the court order.
(3)
Beginning the
disqualification: If the individual is not certified to participate in
the program at the time the disqualification period is to begin, the
disqualification penalty will be imposed immediately upon a determination of
IPV, as if the individual was a participant in the FSP.
(4)
Disqualification continues:
Once a disqualification penalty has been imposed against a currently
participating household member, the disqualification period will continue
uninterrupted until completed regardless of the eligibility of the disqualified
member's household. The disqualified member's household will continue to be
responsible for repayment of the over-issuance which resulted from the
disqualified member IPV regardless of the household's eligibility for program
benefits.
(5)
Notification of
disqualification: If the household member suspected of IPV signs the
disqualification consent agreement, the HCA will provide written notice to the
household member. The notice will be provided prior to disqualification
whenever, possible. The notice will inform the household member of the
disqualification and the date the disqualification will take effect. The HCA
will also provide written notice to the remaining household members, if any, of
the benefit amount the household will receive during the disqualification
period or that the household must reapply because the certification period has
expired. The HCA will provide a written demand letter for
restitution.
E.
Reporting requirements:
(1) The
HCA will report to food and consumer services (FCS) information concerning
individuals disqualified for IPV based on the determination of an
administrative disqualification hearing official or a court of appropriate
jurisdiction, and those individuals disqualified as a result of signing either
a waiver of right to a disqualification hearing or a disqualification consent
agreement in cases referred for prosecution. The information must be submitted
so that it is received by FCS no later than 30 days after the effective date of
the disqualification.
The HCA will submit required information on each individual
disqualified for IPV through a reporting system in accordance with procedures
specified by FCS. The following information concerning the individual will be
reported to FSC:
(a) social security
number, date of birth, full name;
(b) the type and number of the
disqualification (1st, 2nd, 3rd);
(c) the state and county in which the
disqualification took place;
(d)
the date on which the disqualification took effect;
(e) the length of the disqualification period
imposed.
(2)
Availability to all state agencies: All data submitted will be
available for use by any state welfare agency. The data will be used, at a
minimum, for the following:
(a) to determine
eligibility of individual program applicants prior to certification in cases
where there is reason to believe a household member is subject to
disqualification in another political jurisdiction and
(b) to ascertain the appropriate penalty to
impose, based on past disqualifications in a case under
consideration.
(c)
Other
uses: The HCA may also use the data in other ways, such as the
following:
(i) to screen all program
applicants prior to certification, and
(ii) to periodically match the entire list of
disqualified individuals against their current caseloads.
(3)
Disqualification valid
in all political jurisdictions: The disqualification of an individual
for IPV in one political jurisdiction will be valid in another. However, one or
more intentional program violations which occurred prior to the implementation
of the disqualification periods specified in Paragraph 1 of Subsection B of
8.139.647.8 NMAC will be considered
as only one previous disqualification when determining the appropriate penalty
to impose in a case under consideration, regardless of where the
disqualification(s) took place. The HCA is required to identify any individuals
disqualified for fraud prior to implementation of this rule and to submit the
information required by this section on such individuals.
(4)
Court reversal of the
disqualification: In cases where the disqualification for IPV is
reversed by a court of appropriate jurisdiction, the HCA will submit a report
to purge the file of the information relating to the disqualification which was
reversed. In cases where the determination of IPV is reversed by a court of
appropriate jurisdiction, the HCA will reinstate the individual in the program
if the household is eligible. Food stamp benefits that were lost as a result of
the disqualification will be restored.