Pennsylvania Code
Title 55 - HUMAN SERVICES
Part II - Public Assistance Manual
Subpart H - Appeal and Fair Hearing
Chapter 275 - APPEAL AND FAIR HEARING AND ADMINISTRATIVE DISQUALIFICATION HEARINGS
Subchapter A - APPEAL AND FAIR HEARING
GENERAL PROVISIONS
Section 275.1 - Policy
Universal Citation: 55 PA Code ยง 275.1
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Right to appeal and have a fair hearing. The policy with regard to the right to appeal and have a fair hearing will be as follows:
(1) The freedom of the applicant or recipient
to request a hearing is a fundamental right and is not to be limited or
interfered with in any way.
(2) The
regulations contained in this chapter, in accordance with the law, afford every
person applying for or receiving a money payment, medical assistance, food
stamps or services the right to appeal from a Departmental action or failure to
act and to have a hearing if he is dissatisfied with a decision refusing or
discontinuing assistance in whole or in part.
(3) As used in this chapter, the term
departmental includes, in addition to County Assistance Offices, agencies which
administer or provide social services under contractual arrangements with the
Department.
(4) The term assistance
as used in this chapter means a money payment, medical assistance, food stamps
and services.
(i)
Right of
appeal. Therefore, the opportunity for a hearing will include the
right of appeal from the following:
(A) A
denial, suspension or discontinuance in whole or in part.
(B) A change in the amount of
payment.
(C) A denial,
discontinuance, reduction or exclusion from a Departmental service program
including the failure to take into account the client's choice of a service or
a determination that he must participate in a service program.
(D) The manner or form of payments, including
restricted or protective payments. Exception: When the Department denies or
discontinues a protective or vendor payment the right of appeal in this clause
will not apply.
(E) Undue delay in
making a payment adjustment or acting upon a request or application.
(F) Overpayment and reimbursement claims,
including the computation of the amount of the claim and collection
procedures.
(G) An action taken
under the Child Support Enforcement Program (IV-D), that is, assignment or
reassignment of support orders, reimbursement of delayed support payments,
arrearages and the like.
(H) A
denial of a request for a correction or a deletion in the case file.
(ii)
No right of
appeal. An appeal will be dismissed by the Office of Hearings and
Appeals under the following circumstances:
(A)
A person will not have the right to appeal from the following:
(I) A decision by the Department to initiate
prosecution proceedings under §
255.4 (relating to
procedures).
(II) When the decision
does not involve food stamps and the sole issue is one of State or Federal law
requiring automatic grant adjustments for classes of recipients, unless there
is an error in the mathematical computation of the grant. There is always a
right to appeal a food stamp decision.
(III) Where a decision has been rendered
after a WIN hearing before the manpower agency that a participant has, without
good cause, refused to accept employment or participate in the WIN Program, or
has failed to request such a hearing after notice of intended action for the
refusal.
(IV) When a reimbursement
claim has been collected by the Bureau of Claims Settlement, a client who
desires to have money returned to him which has been reimbursed to the
Department must petition the Department of Treasury, Board of Finance and
Revenue.
(B) A client
will be notified in writing of his right to request a hearing when a decision
is made on eligibility and when a change in eligibility occurs. The written
notices of this right appear on the Form PA 5-M, Form PA 162, Form PA 162-A,
and Form PA 162-C.
(b) Objectives of appeals and fair hearings. The objectives of appeals and fair hearing will be as follows:
(1) To afford applicants and
recipients an opportunity for an impartial, objective review of decisions,
actions and delays, or in actions made by County Assistance Offices and the
Department.
(2) To settle the issue
or issues raised by the client in requesting a hearing and to produce a clear
and definitive decision setting forth the findings of the Department.
(3) To contribute to uniformity in the
application of Departmental regulations.
(4) To reveal aspects of Departmental
regulations that are deficient, inequitable, or constitute a misconstruction of
law.
The provisions of this §275.1 issued under sections 403(b) and 423 of the act of June 13, 1967 (P. L. 31, No. 21) (62 P. S. §§ 403(b) and 423).
This section cited in 55 Pa. Code § 105.5 (relating to access by an individual to his case file); 55 Pa. Code § 165.51 (relating to compliance review); 55 Pa. Code § 275.4 (relating to procedures); and 55 Pa. Code § 291.23 (relating to requirements).
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