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
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 358-2.2
Current through Register Vol. 46, No. 39, September 25, 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.
(2) except in the case of a denial, the
effective date of the action;
(3)
except in the case of an acceptance of an application for a covered program or
service, the specific reasons for the action;
(4) the specific laws and/or regulations upon
which the action is based;
(5) the
applicant's or recipient's right to request an agency conference and fair
hearing;
(6) the procedure for
requesting an agency conference or fair hearing, including an address and
telephone number where a request for a fair hearing may be made and the time
limits within which the request for a fair hearing must be made;
(7) an explanation that a request for a
conference is not a request for a fair hearing and that a separate request for
a fair hearing must be made. Furthermore, that a request for a conference does
not entitle one to aid continuing, and that a right to aid continuing only
arises pursuant to a request for a fair hearing;
(8) when the agency action or proposed action
is a reduction, discontinuance, restriction or suspension of public assistance,
medical assistance, food stamp benefits or services, the circumstances under
which public assistance, medical assistance, food stamp benefits or services
will be continued or reinstated until the fair hearing decision is issued; that
a fair hearing must be requested separately from a conference; and a statement
that when only an agency conference is requested and there is no specific
request for a fair hearing, there is no right to continued public assistance,
medical assistance, food stamp benefits or services; and that participation in
an agency conference does not affect the right to request a fair
hearing;
(9) the right of the
applicant or recipient to review the applicant's or recipient's case record and
to obtain copies of documents which the agency will present into evidence at
the hearing and other documents necessary for the applicant or recipient to
prepare for the fair hearing at no cost. The notice must contain an address and
telephone number where the applicant or recipient can obtain additional
information about: the applicant's or recipient's case; how to request a fair
hearing; access to the case file; and/or obtaining copies of
documents;
(10) the right to
representation by legal counsel, a relative, friend or other person or to
represent oneself, and the right to bring witnesses to the fair hearing and to
question witnesses at the hearing;
(11) the right to present written and oral
evidence at the hearing;
(12) the
liability, if any, to repay continued or reinstated assistance and benefits, if
the recipient loses the fair hearing;
(13) information concerning the availability
of community legal services to assist an applicant or recipient at the
conference and fair hearing;
(14) a
copy of the budget or the basis for the computation, in instances where the
social services agency's determination is based upon a budget computation;
and
(15) when an action concerning
medical assistance is based on a change in law, a statement of the
circumstances under which a hearing may be obtained and assistance continued.
Such statement must advise the recipient that although the recipient has the
right to have a hearing scheduled, the hearing officer at the hearing may
determine that the recipient did not have a right to a hearing or continuation
of assistance if the sole issue is a Federal or State law requiring an
automatic change adversely affecting some or all medical assistance
recipients.
(b) Where an automatic public assistance grant adjustment is required for a class of recipients because of a change in either State or Federal law, the notice provided to a member of such class will be adequate if it includes:
(1) a statement of the intended
action;
(2) the reasons for such
intended action;
(3) a statement of
the specific change in the law requiring such action;
(4) a statement of the circumstances under
which a hearing may be obtained and assistance continued. Such statement must
advise the recipient that although the recipient has the right to have a
hearing scheduled, the hearing officer at the hearing may determine that the
recipient did not have a right to a hearing or continuation of assistance
unless the reason for the appeal is the incorrect computation of the grant;
and
(5) the liability, if any, to
repay continued or reinstated assistance, if the recipient loses the fair
hearing.
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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