Current through Supplement No. 394, October, 2024
1. A notice is
adequate if it includes:
a. An explanation of
the type of proposed action;
b. An
explanation of the reason for the proposed action and the regulation or law
upon which the action is based; and
c. An explanation of the person's right to
request corrective action from the county agency and the department, the
person's right to request a fair hearing, and the circumstances under which
assistance will be continued if a fair hearing is requested.
2. Except as provided in
subsection 6, a notice is timely if mailed at least five days prior to the date
of action based on subsection 3, and at least ten days prior to the date of any
other action.
3. Except in
supplemental nutrition assistance program cases, if facts indicate that
assistance should be discontinued, suspended, terminated, or reduced because of
suspected fraud by the recipient, and, where possible, such facts have been
verified through collateral sources, notice of a benefit adjustment is timely
if mailed at least five days prior to the effective date of the proposed
action.
4. If county agency or
department action results in a denial of Medicaid, children's health insurance
program, economic assistance programs, autism voucher, intellectual
disabilities - developmental disabilities program management services, or
Medicaid eligibility, an adequate written notice must be sent to the person
affected.
5. Except as provided in
subsection 6, if county agency or department action results in a
discontinuance, termination, suspension, withholding, or reduction of Medicaid,
children's health insurance program, economic assistance programs, autism
voucher, intellectual disabilities - developmental disabilities program
management services, or Medicaid eligibility benefits, a timely and adequate
written notice must be sent to the person affected.
6. If county agency or department action
results in a discontinuance, termination, suspension, withholding, or reduction
of Medicaid, children's health insurance program, economic assistance programs,
autism voucher, intellectual disabilities - developmental disabilities program
management services, or Medicaid eligibility benefits, an adequate written
notice must be sent to the person affected no later than the date of action if:
a. The county agency or department has
factual information confirming the death of the person affected or for
temporary assistance for needy families factual information exists confirming
the death of the payee when there is no other relative to serve as a new
payee;
b. The county agency or
department receives a clear written statement signed by the person affected
that the person no longer wishes assistance; or that gives information which
requires discontinuance or reduction of assistance and the person has
indicated, in writing, that the person understands that this must be the
consequence of supplying such information;
c. The person affected has been admitted or
committed to an institution, and further payments to that individual do not
qualify for federal financial participation under the state plan;
d. The person affected has been placed in a
nursing facility or is receiving long-term hospitalization. A ten-day notice is
required for supplemental nutrition assistance program when the individual
moves to a long-term care facility, basic care, or institution within the
county;
e. The whereabouts of the
person affected are unknown and mail directed to the person has been returned
by the post office indicating no known forwarding address;
f. A temporary assistance for needy families
child is removed from the home as a result of a judicial determination, or
voluntarily placed in foster care by the child's parent or legal
guardian;
g. The person affected
has been accepted for assistance in new jurisdiction and that fact has been
established by the county previously providing assistance;
h. A change in level of medical care is
prescribed by the recipient patient's physician or other practitioner of the
healing arts;
i. A special
allowance granted for a specific period is terminated and the recipient has
been informed in writing at the time of initiation that the allowance shall
automatically terminate at the end of the specified period;
j. The state or federal government initiates
a mass change which uniformly and similarly affects all similarly situated
applicants, recipients, and households;
k. A determination has been made, based on
reliable information, that all members of a household have died;
l. A determination has been made, based on
reliable information, that the household has moved from the project
area;
m. The household has been
receiving an increased allotment to restore lost benefits, the restoration is
complete, and the household was previously notified in writing of when the
increased allotment would terminate;
n. The household's allotment varies from
month to month within the certification period to take into account changes
anticipated at the time of certification, and the household was so notified at
the time of certification;
o. The
household jointly applied for public assistance and supplemental nutrition
assistance program benefits and has been receiving supplemental nutrition
assistance program benefits pending the approval of the public assistance grant
and was notified at the time of certification that supplemental nutrition
assistance program benefits would be reduced upon approval of the public
assistance grant;
p. A household
member is disqualified for an intentional program violation, or the benefits of
the remaining household members are reduced or terminated, to reflect the
disqualification of that household member;
q. The household contains a member subject to
a lockout or strike or signs a waiver of its right to notice of adverse action
for purposes of receiving a longer certification period than is otherwise
allowed for such households;
r. The
county agency or department has elected to assign a longer certification period
to a household certified on an expedited basis and for whom verification was
postponed, provided the household has received written notice that the receipt
of benefits beyond the month of application is contingent on its providing the
verification which was initially postponed and that the county agency or
department may act on the verified information without further
notice;
s. The action is based upon
information the recipient furnished in a monthly report;
t. The action is taken because the recipient
has failed to submit a complete or timely monthly report without good
cause;
u. A special item or need or
job opportunities and basic skills program supportive service is terminated at
the end of a specified period;
v.
Benefits are reduced or terminated following the imposition of a child support
or job opportunities and basic skills program sanction;
w. Upon receipt of factual information
confirming the household is no longer a resident of the state;
x. If household is entitled to a supplemental
nutrition assistance program underpayment and has chosen monthly installments
instead of a lump sum and the household was previously notified in writing when
the monthly installments would terminate;
y. Joint temporary assistance for needy
families and supplemental nutrition assistance program application results in
the receipt of supplemental nutrition assistance program pending temporary
assistance for needy families grant approval and household is notified at the
time of certification that supplemental nutrition assistance program benefits
would be reduced upon receipt of a grant; or
z. For supplemental nutrition assistance
program, changing a household from cash repayment to allotment reductions as a
result of failure to make the agreed payments.
7. In any case where assistance has been
discontinued, suspended, withheld, or reduced without timely notice, if the
person affected requests a fair hearing within ten days of the mailing of the
notice of action, assistance must be reinstated retroactively and the
provisions of subsection 9 shall apply.
8. If, within the timely notice period, the
person affected indicates a wish for a conference, that person or that person's
authorized representative will be given an opportunity by the county to discuss
the problems, and will be given an explanation of the reasons for the proposed
action, and will be permitted to show that proposed action is incorrect.
a. During this conference, the person
affected will be permitted to represent himself or herself or be represented by
legal counsel or by a friend or other spokesman.
b. The conference does not diminish the
person's right to a fair hearing.
9. Where the person affected is a recipient
and has filed a request for a fair hearing within the timely notice period, the
assistance will be continued without implementation of the proposed action,
until the fair hearing decision is rendered, unless:
a. Prior thereto the claimant unconditionally
withdraws or abandons the fair hearing request;
b. Prior thereto the department reverses the
proposed action without a hearing;
c. The department determines, based upon the
record of the claimant's fair hearing, that the issue involved in such hearing
is one of state or federal law or change in state or federal law and not one of
incorrect benefit computation;
d. A
change affecting the recipient's benefits occurs before the decision on the
request for fair hearing and the recipient fails to file a timely request for a
fair hearing after notice of such change; or
e. A supplemental nutrition assistance
program household's certification period expires.
10. Any assistance continued under subsection
9 is subject to recovery if the claimant does not prevail in the claimant's
appeal.
11. Any notice that is the
subject of a request for fair hearing may be supplemented at any time before
the conclusion of the hearing. The information in any supplemental notice must
be considered in determining the adequacy of the notice unless the claimant
shows that the claimant is prejudiced by that consideration.
General Authority: NDCC 28-32-02,
50-06-16
Law Implemented: NDCC
50-06-05.1
