SubPart 358-4 - RIGHTS AND OBLIGATIONS OF SOCIAL SERVICES AGENCIES

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Statutory Authority: 
Social Services Law, Sections 20(3)(d), 22(8), 34(3)(f)

Section 358-4.0 - Introduction.

Section 358-4.0 Introduction. The rights and obligations of social services agencies are governed by this Subpart.

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Section 358-4.1 - Proposed actions.

358-4.1 Proposed actions. (a) A social services agency proposing to approve, deny, discontinue, suspend, or reduce a public assistance grant, medical assistance authorization, food stamp benefits, or services, or to increase a public assistance grant or food stamp benefits or a medical assistance spenddown, or to change the amount of one of the items used in the calculation of a public assistance grant, food stamp benefits or a medical assistance spenddown, or to accept or deny an application for HEAP benefits, or to discharge a resident of a tier II facility involuntarily as defined in Part 900 of this Title, must review or cause to be reviewed the intended action to determine whether the intended action is correct on the basis of the available evidence included in the applicant's or recipient's case record.

(b) Where it is determined that the intended action is correct after review, the social services agency must send to the applicant/recipient a notice which meets the requirements of section 358-3.3 of this Part.

 

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Section 358-4.2 - Prehearing responsibilities.

358-4.2 Prehearing responsibilities. (a) When requested, the social services agency must provide assistance to applicants and recipients in making a request for a fair hearing.

(b) (1) Upon notification by the department that a fair hearing has been requested and that the appellant's public assistance, medical assistance, food stamp benefits, or services must be continued or reinstated in accordance with section 358-3.6 of this Part until the fair hearing decision is issued, the social services agency, except as provided in section 358-3.6(b) and (c) (6) of this Part, must take immediate action to assure that the appellant's public assistance, medical assistance, food stamp benefits and services continue unchanged until the fair hearing decision is issued.

(2) Upon receipt of such notification, if public assistance, medical assistance, food stamp benefits or services already have been discontinued, reduced, restricted or suspended, the social services agency must take whatever action is necessary to restore the appellant's public assistance, medical assistance, food stamp benefits or services to their previous level. Such action must be taken as soon as possible but no later than five business days from notification that appellant's public assistance, medical assistance, food stamp benefits or services must continue or be reinstated.

(c) Upon oral or written request, including request by telephone, the social services agency must provide to the appellant and the appellant's authorized representative copies of the documents to be presented at the fair hearing. Such copies must be provided at a reasonable time before the date of the hearing. If the request for copies of documents is made less than five business days before the hearing, the social services agency must provide the appellant and the appellant's authorized representative such copies no later than at the time of the hearing. Such documents must be provided without charge and must be provided to the appellant and the appellant's authorized representative by mail within a reasonable time from the date of the request if the appellant or the appellant's authorized representative request that such documents be mailed; provided however, if there is insufficient time for such documents to be mailed and received before the scheduled date of the hearing such documents may be presented at the hearing instead of being mailed.

(d) Upon oral or written request, including request by telephone, the social services agency must provide to the appellant and the appellant's authorized representative copies of any documents from appellant's case file which the appellant or the appellant's authorized representative identifies and requests for purposes of hearing preparation. Such copies must be provided at a reasonable time before the date of the hearing. If the request for copies of documents is made less than five business days before the hearing, the social services agency must provide the appellant and the appellant's authorized representative such copies no later than at the time of the hearing. Such documents must be provided without charge and must be provided to the appellant and the appellant's authorized representative by mail within a reasonable time from the date of the request if the appellant or the appellant's authorized representative request that such documents be mailed; provided however, if there is insufficient time for such documents to be mailed and received before the scheduled date of the hearing such documents may be presented at the hearing instead of being mailed.

(e) The social services agency must encourage the use of agency conferences to settle disputes and complaints concerning actions regarding an applicant's or recipient's public assistance, medical assistance, food stamp benefits, HEAP benefits or services so as to eliminate the need to hold fair hearings wherever the dispute can be resolved by scrutiny of documents and/or thorough investigation.

(f) The social services agency must hold agency conferences when such conference is requested as provided for in section 358-3.8 of this Part. The conference may not be used to inhibit the appellant's right to a fair hearing. Agency conferences must be scheduled before the date of the fair hearing. If the appellant is contesting a denial of expedited participation in the Food Stamp Program, the conference must be scheduled within two business days of the conference request, unless the appellant requests a later date.

(g) The social services agency must bring the necessary information and documentation to any agency conference, including a telephone conference, to explain the reason for the agency determination and to provide a meaningful opportunity to resolve the problem.

(h) Except for telephone agency conferences approved pursuant to subdivision (i) of this section, a representative of the social services agency must appear with the case record at the agency conference. Such representative must have reviewed the case and must have the authority to make binding decisions on behalf of the social services agency, including the authority to withdraw the intended action.

(i) Social services agencies may provide telephone conferences upon prior approval of the Office of Administrative Hearings of the department. The Office of Administrative Hearings may approve such requests in its discretion, where holding an in-person conference is not feasible.

(j) The social services agency must send copies of all correspondence relating to the conference and fair hearing to the authorized representative of the appellant.

 

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Section 358-4.3 - Responsibilities and rights in the fair hearing process.

358-4.3 Responsibilities and rights in the fair hearing process. (a) The social services agency must provide complete copies of its documentary evidence to the hearing officer at the fair hearing and also to the appellant or appellant's authorized representative, where such documents were not provided previously to the appellant's authorized representative in accordance with sections 358-3.7 and 358-4.2(c) of this Part. Such documents must be provided without charge.

(b) Except as provided in subdivision (c) of this section, a representative of the social services agency must appear at the hearing along with the case record and a written summary of the case. Such representative must:

(1) have reviewed the case; and

(2) be prepared to present evidence in support of the action, including:

(i) the case number;

(ii) the applicable category or categories or type of public assistance or care, medical assistance, food stamp benefits or services involved;

(iii) the names, addresses, relationships and ages of persons affected;

(iv) the determination regarding which the hearing request was made;

(v) a brief description of the facts, evidence and reasons supporting such determination, including identification of the specific provisions of law, department regulations and approved local policies which support the action;

(vi) the relevant budget or budgets prepared by the social services agency for the appellant or the household of such appellant, including printouts of relevant budgets produced on the Welfare Management System

(WMS); and

(vii) a copy of the applicable action taken notice, adverse action notice, expiration notice or notice of action, including an notices produced on the Client Notices System when that system is operational.

(3) have the authority to make binding decisions at the hearing on behalf of the social services agency, including the authority to withdraw the action or otherwise settle the case.

(c) (1) No later than five calendar days before the hearing date, the social services agency may make application to the Office of Administrative Hearings of the department to appear at a hearing on papers only. The Office of Administrative Hearings may approve such application in its discretion where the rights of the appellant can be protected and the personal appearance of the agency is neither feasible nor necessary.

(2) Notwithstanding paragraph (1) of this subdivision, a hearing officer may require the appearance of a representative of a social services agency where such appearance is necessary to protect the due process rights of the appellant.

(d) Upon request of the appellant, the social services agency must provide necessary transportation and transportation expenses to and from the fair hearing for the appellant and appellant's representatives and witnesses and payment for appellant's necessary child care costs and for any other necessary costs and expenditures related to the fair hearing.

(e) Social services agencies have those hearing rights which appellants have as set forth in sections 358-3.4(d) (adjournment), 358-3.4(e)

(representation), 358-3.4(g) (present evidence, question witnesses, examine documents), and 358-3.4(h) (bring witnesses), and 358-3.4 (k)

(removal of hearing officer) of this Part.

 

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Section 358-4.4 - Compliance with fair hearing decision.

358-4.4 Compliance with fair hearing decision. A social services agency must comply with fair hearing decisions in accordance with section 358-6.4 of this Part.

 

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