Current through Register Vol. 63, No. 9, September 1, 2024
(1) A
claimant (see OAR
461-025-0305) has the right to a
contested case hearing in the following situations upon the timely completion
of a request for hearing:
(a) Except as
provided in subsection (o) of this section, the Department has not approved or
denied a request or application for public assistance or medical assistance
within 45 days of the application.
(b) The Department has not acted timely on an
application as follows:
(A) An application
for SNAP program benefits, within 30 days of the filing date.
(B) An application for a JOBS support service
payment, within the time frames established in OAR
461-115-0190(3).
(c) The Department acts to deny,
reduce, close, or suspend SNAP program benefits, a grant of public
assistance, a grant of aid, a support service payment
authorized in the JOBS program by OAR
461-190-0211, medical
assistance, or child care benefits authorized under Division 160 or 165 of this
chapter of rules in the ERDC or TANF child care programs. When used in this
subsection, grant of public assistance and grant of
aid mean the grant of cash assistance calculated according to the
claimant's need.
(d) The Department
has sent a decision notice (see OAR
461-001-0000) that the
claimant is liable for an overpayment (see
OAR 461-195-0501).
(e) The Department modifies a grant
of public assistance or a grant of aid; or the
claimant claims that the Department previously underissued
public assistance, medical assistance, or SNAP program benefits and the
Department denies, or denies in part, that claim.
(f) The household disputes its current level
of SNAP program benefits.
(g) The
filing group (see OAR
461-110-0370) is aggrieved by
any action of the Department that affects the participation of the filing group
in the SNAP program.
(h) The
claimant asks for a hearing to determine if the waiver of an
Intentional Program Violation hearing was signed under duress.
(i) A child care provider is disputing an
allegation of an overpayment of child care provided under Chapter 461 or "a
finding of suspended" established under Chapter 461.
(j) In the Pre-TANF program, the Department
denies payment for a basic living expense (see OAR
461-135-0475) or other support
service payment in the JOBS program (see subsection (c) of this
section).
(k) In the TA-DVS
program, when OAR 461-135-1235 provides a right to
a hearing.
(l) A service
re-assessment of a claimant conducted in accordance with OAR
Division 411-015 has resulted in a reduction or termination of nursing facility
services or home and community-based care (see OAR
461-001-0030).
(m) The claimant's benefits are changed to
vendor, protective, or two-party payments.
(n) Department has issued a notice seeking
repayment under ORS 411.892 to an employer
participating in the JOBS program.
(o) In the OSIP and OSIPM programs, when the
Department has not approved or denied an application within the time frames
established in OAR 461-115-0190.
(p) The right to a hearing is otherwise
provided by statute or rule.
(q) To
resolve a grievance under 45
CFR 261.70 against an employer. A hearing
request under this subsection must be in writing with the claimant's name,
address, and daytime phone number (if available). The hearing request must be
received by the Department within 45 days of the alleged violation or within 30
days after completion of an employer grievance process.
(2) A claimant is not
entitled to a hearing on the question of the contents of a case
plan (defined in OAR
461-190-0151) unless the right
to hearing is specifically authorized by the Department's rules. For a dispute
about an activity in the JOBS program, the claimant is
entitled to use the Department's re-engagement process (see OAR
461-190-0231). In the TA-DVS
program, a dispute about the contents of a TA-DVS case plan is resolved through
re-engagement if there is no right to a hearing under OAR
461-135-1235.
(3) A request for hearing is complete:
(a) In public assistance and SNAP programs,
when the Department's Administrative Hearing Request form (form DHS 443) is:
(A) Completed;
(B) Signed by the claimant,
the claimant's attorney, or the claimant's authorized
representative (see OAR
461-115-0090); and
(C) Received by the Department. OAR
137-003-0528(1)(a)
(which allows hearing requests to be treated as timely based on the date of the
postmark) does not apply to hearing requests contesting a decision
notice (see OAR
461-001-0000). The Department
has adopted the exception to the Attorney General's model rules set out in this
paragraph due to operational conflicts.
(b) In the SNAP program, when the Department
receives an oral or written statement from the claimant, the
claimant's attorney, or the claimant's authorized
representative that the claimant wishes to appeal a
decision affecting the claimant's SNAP program benefits to a higher
authority.
(c) In the case of a
provider of child care, when a written request for hearing from the provider
about an action or decision taken under Chapter 461 is received by the
Department.
(d) For medical
assistance, when a hearing request is made in a manner permitted under OAR
410-200-0145 or this
section.
(4) In the
event a request for hearing is not timely, the Department may issue an order of
dismissal if there is no factual dispute about whether sections (7) and (10) of
this rule provide a right to a hearing. The Department may refer an untimely
request to the Office of Administrative Hearings for a hearing on the question
of timeliness.
(5) In the event the
claimant has no right to a contested case hearing on an issue,
the Department may enter an order accordingly. The Department may refer a
hearing request to the Office of Administrative Hearings for a hearing on the
question of whether the claimant has the right to a contested
case hearing.
(6) For medical
assistance, to be timely, a hearing request must be received by the Department
or the OHP Customer Service in the time frame set out in OAR
410-200-0015 and
410-200-0145. In other programs,
to be timely, a completed hearing request must be received by the Department
not later than:
(a) Except as provided in
subsection (b) of this section, the 45th day following the date of the
decision notice (see OAR
461-001-0000) in public
assistance programs.
(b) The 90th
day following the effective date of the reduction or termination of benefits in
a public assistance program if the reduction or termination of aid is a result
of a JOBS disqualification (see OAR
461-130-0330) or a penalty for
failure to seek treatment for substance abuse or mental health (see OAR
461-135-0085).
(c) The 90th day following the date of the
decision notice in the SNAP program, except:
(A) A filing group may
submit a hearing request at any time within a certification
period (see OAR
461-001-0000) to dispute its
current level of benefits.
(B) A
filing group may submit a hearing request within 90 days of
the denial of a request for restoration of benefits if not more than twelve
months has expired since the loss of benefits.
(d) The 30th day following the date of notice
from the Oregon Department of Revenue in cases covered by ORS
293.250.
(e) In a case described in subsection (1)(h)
of this rule, the request must be made within 90 days of the date the waiver
was signed.
(7) When the
Department receives a completed hearing request that is not filed within the
timeframe required by section (6) of this rule but is filed no later than 120
days after a decision notice became a final order:
(a) The Department refers the hearing request
to the Office of Administrative Hearings for a contested case hearing on the
merits of the Department's action described in the notice:
(A) If the Department finds that the
claimant and claimant's representative did not receive the
decision notice and did not have actual knowledge of the
notice; or
(B) If the Department
finds that the claimant did not meet the timeframe required by
section (6) of this rule due to excusable mistake, surprise, excusable neglect
(which may include neglect due to significant cognitive or health issues),
good cause (see OAR
461-025-0305), reasonable
reliance on the statement of a Department employee relating to procedural
requirements, or due to fraud, misrepresentation, or other misconduct of the
Department.
(b) The
Department refers the request for a hearing to the Office of Administrative
Hearings for a contested case proceeding to determine whether the
claimant is entitled to a hearing on the merits if there is a
dispute between the
claimant and the Department about either
of the following paragraphs.
(A) The
claimant or claimant's representative received the
decision notice or had actual knowledge of the
decision notice. At the hearing, the Department must show that
the claimant or claimant's representative had actual knowledge
of the notice or that the Department mailed or electronically mailed the notice
to the correct address of the claimant or claimant's
representative, as provided to the Department.
(B) The claimant qualifies
for a contested case hearing on the merits under paragraph (a)(B) of this
section.
(c) The
Department may only dismiss such a request for hearing as untimely without a
referral to the Office of Administrative Hearings if the following requirements
are met:
(A) The undisputed facts show that
the claimant does not qualify for a hearing under this
section; and
(B) The
decision notice was served personally or by registered or
certified mail.
(8) In computing the time periods provided by
this rule, see OAR 461-025-0300(1).
(9) In the REF and REFM programs, a
claimant is not eligible for a contested case hearing when
assistance is terminated because the eligibility time period imposed by OAR
461-135-0900 has been reached.
If the issue is the date of entry into the United States the Department
provides for prompt resolution of the issue by inspection of the individual's
documentation issued by the US Citizenship and Immigration Services (USCIS) or
by information obtained from USCIS, rather than by contested case
hearing.
(10) If the Department
receives a hearing request more than 120 days after an overpayment notice
became a final order by default:
(a) The
Department verifies whether its records indicate that the liable adult
requesting the hearing was sent the overpayment notice.
(b) If no overpayment notice was sent to that
liable adult, the overpayment hearing request is timely. The Department will
send the claimant a decision notice or a
contested case notice.
(c) If the
Department determines that an overpayment notice was sent to the liable adult,
there is no hearing right based on the issue of whether or not the overpayment
notice was received.
(d) Any
hearing request is treated as timely when required under the Servicemembers
Civil Relief Act.
(e) The
Department may dismiss a request for hearing as untimely if the
claimant does not qualify for a hearing under this
section.
(11) If the
Department receives a hearing request more than 120 days after a
decision notice (other than an overpayment notice) became a
final order by default:
(a) Any hearing
request is treated as timely when required under the Servicemembers Civil
Relief Act.
(b) The Department may
dismiss a request for hearing as untimely if the claimant does
not qualify for a hearing under subsection (a) of this section.
(12) Notwithstanding sections (7),
(10), and (11) of this rule, for medical assistance, the time frame is the same
as the one in OAR 410-200-0146 instead of 120
days.
Forms referenced are available from the
agency.
Statutory/Other Authority: ORS
411.060,
411.095,
411.404,
411.408,
411.816,
411.892,
412.014 &
412.049
Statutes/Other Implemented: ORS
411.060,
411.095,
411.404,
411.408,
411.816,
411.892,
412.014,
412.049,
411.103,
412.009,
412.069 &
412.072
