0110 COMPLAINTS AND HEARINGS
0110.05 DHS ADMINISTRATIVE AUTHORIZATION
REV:10/2006
0110.05 DHS ADMINISTRATIVE AUTHORIZATION REV: 08/2006
The Department of Human Services (DHS), through federal/state programs established by the Social Security Act of 1935, as amended, the Rehabilitation Act of 1973, as amended, and through state/local programs established by Title 40, of the General Laws of Rhode Island, as amended, is the Department in the Rhode Island State Government authorized by law and designation to administer on a statewide basis, the following public financial, medical, vocational and social services programs:
Family Independence Program (FIP); Food Stamp Program; Supplemental Security Income (SSI) Program; Medical Assistance (MA); RIte Care; Office of Child Support Services; Pathways to Independence Program; General Public Assistance (GPA) Program; Social Services Program; Office of Rehabilitation Services' Vocational Rehabilitation (VR)Program and Services for the Blind and Visually Impaired (SBVI) Program; and Veterans' Affairs (VA) Program.
Specific policies and procedures are set forth under the law to provide equitable treatment for all applicants and recipients.
0110.10 EXPRESSIONS OF DISSATISFACTION
REV:08/1987
Expressions of dissatisfaction may arise in the administration of DHS programs for a variety of reasons. The agency provides a method for receiving:
- Complaints from certain applicants/recipients or their designated representatives questioning the application of policy with respect to such applicants/recipients; (See 0110.20)
- Appeals by an applicant/recipient or his/her designated representatives concerning:
- A particular decision or delay in a decision rendered by an agency representative;
- The manner in which agency services have been delivered; and/or
- Some aspect of the financial, medical, social services, or food stamp programs. (See 0110.25)
- Requests for a hearing by an individual claimant or a group, relating to more general issues of agency policy and/or the adequacy of agency standards. (See 0110.65)
The agency has interpreters available for individuals needing such services. (See Section 0124)
0110.15 DEFINITION OF A COMPLAINT
REV:03/2007
A complaint is any oral or written expression of dissatisfaction made to staff workers either in the field or office; to Central Office personnel; or Department officials by an applicant/recipient or his/her authorized representative questioning the administration of agency policies and programs with respect to the treatment and/or eligibility of said claimant to receive an assistance payment, medical assistance, social services, Child Support Services or food stamps.
0110.15.05 The Complaint Process
REV:03/2007
Complaints received from an applicant/recipient or his/her designated representative, either in the field or at Central Office, are referred to the appropriate supervisor for follow- up.
If the complaint involves a question of eligibility or need:
- The complaint is referred to the appropriate agency representative;
- The agency representative has the responsibility to contact the individual to discuss with him/her the details of the complaint.
If the complaint relates to social services:
- The complaint is referred by the service supervisor to the appropriate social worker;
- The social worker then contacts the individual in order to discuss the complaint.
When the issue cannot be resolved by the agency representative, the claimant is informed of his/her right to:
- Discuss the issue with the assigned supervisor;
- Have an adjustment conference;
- Request a hearing.
If the complaint relates to Child Support:
- The complain is referred by the supervisor to the appropriate child support agent.
- The child support agent then contacts the individual to discuss the complaint.
If further information/documentation is required concerning the situation from alternate sources, the claimant may obtain the necessary information or may request the agency representative to obtain this information.
A complaint is any oral or written expression of dissatisfaction made to staff workers either in the field or office; to Central Office personnel; or Department officials by an applicant/recipient or his/her authorized representative questioning the administration of agency policies and programs with respect to the treatment and/or eligibility of said claimant to receive an assistance payment, medical assistance, social services, Child Support Services or food stamps.
0110.20 DEFINITION OF AN APPEAL
REV:03/2007
A written request by a claimant (or his/her authorized representative) stating that s/he wants an opportunity to present his/her case to higher authority may be considered an appeal. The appeal must be filed within:
- Ten (10) days from the date of the notice of action if it pertains to General Public Assistance;
- Ninety (90) days when it concerns Food Stamps;
- Forty-five (45) days when it involves issues pertaining to the Office of Rehabilitation Services; and
- Thirty (30) days from the date of any child support service.
- Thirty (30) days from the date of the notice when it involves any other DHS program.
0110.20.05 The Appeal Process
REV:03/2007
The intent of the appeal process is to protect a needy individual's right to assistance, social services, child support services and food stamps.
An appeal generally can be resolved through a discussion with the staff member who made the decision. If a claimant determines it is necessary to go beyond that staff member to be assured that s/he is receiving equitable treatment, s/he must be informed of the following alternative agency provisions for hearing his/her complaint:
- A discussion of the disputed issue(s) can be arranged for the individual with the appropriate agency representative and his/her supervisor in the district or regional office; or,
- If the individual prefers, instead of the supervisory conference, or following it, an 'Adjustment Conference' can be arranged with the regional manager. This is an informal hearing in which an individual has an opportunity to state his/her dissatisfaction with agency action. The agency representative presents the facts upon which action was based. The regional manager determines whether or not the staff decision was made in accordance with agency policy; or,
- Since the individual has a right to request and receive a hearing unconditionally, s/he can proceed directly to a full hearing review of his/her complaint.
0110.25 LEGAL BASIS FOR APPEALS AND/OR HEARINGS
REV:03/2007
Procedures are available for applicants and/or recipients who are aggrieved because of an agency decision or delay in making such a decision. Entitlements to appeals, reasonable notice and opportunity for a fair hearing, are provided by:
- Title 40 of the General Laws of Rhode Island, as amended;
- Family Independenc Program (FIP, as authorized under Title IV-A of the Social Security Act;
- Medical Assistance (MA) Program, as authorized under Title XIX of the Social Security Act;
- Supplemental Security Income (SSI) Program, as authorized under Title XVI of the Social Security Act;
- Social Services Program, as authorized under Title XX of the Social Security Act;
- The Vocational Rehabilitation Act of 1972, as amended; and
- The Food Stamp Act of 1977, as amended.
- Title 15 of the R.I. General Laws
0110.30 DEFINITION OF A HEARING
REV:08/1987
A hearing is an opportunity provided by the agency for responding to an appeal. It is an instrument by which a dissatisfied individual may assert his/her right to financial assistance, medical assistance, social services, and/or food stamps; and, to secure in an administrative proceeding before an impartial appeals officer, equity of treatment under state law and policy and the agency's standards and procedures.
An opportunity for a hearing is granted to an applicant/recipient or his/her designated representative, when:
- His/Her claim for assistance or social services is denied,
- Is not acted upon with reasonable promptness, or
- S/He is aggrieved by any other agency action resulting in suspension, reduction, discontinuance, or termination of assistance or social services.
A hearing need not be granted:
- If a change in benefits is due to an automatic payment adjustment required by either state or federal law for classes of recipients;
- Unless the reason for an individual appeal is a challenge of the correctness of the computation of his/her assistance payment.
0110.30.05 The Right to Request a Hearing
REV:03/2007
Assistance, social services, child support services and food stamp application forms include a statement regarding the right to request a hearing.
The opportunity for a hearing is not an actuality unless the individual is fully aware of its availability. At the time of application, and at the time of any action affecting his/her claim for assistance or social services, the individual is informed, in writing, of:
- His/Her right to request and receive a hearing;
- The method of obtaining it; and
- His/Her right to be represented by others or to represent himself/herself.
A hearing request remains valid until:
- The claimant voluntarily withdraws it and such withdrawal is confirmed by the appeals officer in writing;
(For Food Stamp Program benefit hearing requests, upon receipt of an oral request to withdraw a hearing, the appeals officer must send written notice within ten (10) days confirming such withdrawal and providing the household with an opportunity to request or reinstate the hearing within ten (10) days of the confirmation notice.) or - The claimant or his/her representative fails to appear at a scheduled hearing, without good cause (abandonment); or
- A hearing has been held and a decision made.
0110.30.10 Method of Processing Hearing Requests
REV:03/2007
The hearing process begins when a written request is received in the regional or district office, child support office or the hearing office at Central Office. When a request is received, it is referred to the appropriate agency representative. The following requirements must be met:
- The decision at issue must be reviewed with the individual to help him/her understand the provisions in state law and/or agency policy on which the decision was based.
- The individual must be informed of the total complaint procedure including adjustment opportunities available with the appropriate supervisor.
- If the individual decides to continue the appeal, the hearing process must be reviewed with him/her to help the individual understand what s/he might expect and what is to be expected of him/her.
0110.30.15 The DHS-121 Request for Hearing
REV:03/2007
The individual is requested to submit his/her appeal to the appropriate office on a DHS-l2l (Request for Hearing) or DHS- 121F (Request for hearing-Child Support) and is provided such assistance as is needed in completing this form.
When the individual sends the DHS-l2l or DHS-121F directly to Central Office, a copy of the form is sent to the appropriate office for completion of Sec. III. The DHS-12l or DHS-121F must be returned to the hearing office at Central Office within seven (7) days. If the district office determines during the period that the individual does not wish to proceed with the hearing, the hearing office must be notified. The individual is requested to put his/her decision in writing to the hearing office.
When an individual who has submitted a written request for a hearing does not submit a DHS-l2l or DHS-121F within a seven (7) day period, the agency representative must complete the DHS-l2l or DHS-121F with the exception of Sec. II, staple the written request to the form and submit it to the appeals officer.
Section III of the DHS-121 of DHS-121F is prepared by the agency representative and transmitted to the hearing office at Central Office, setting forth clearly and concisely the policy on which the decision at issue was based.
0110.30.20 The Hearing Request/Advance Notice Period
REV:03/2007
If a written request for a fair hearing is made within the 10 day advance notice period, the agency assists the individual in deciding whether to continue to receive the current amount of FIP, Medical Assistance, and/or food stamps until a hearing decision is made. Only at the client's specific request will the agency representative discontinue such assistance and/or food stamps.
Unless the recipient requests the discontinuance of his/her assistance, such assistance will be continued until a hearing decision is rendered, unless:
- a determination is made at the hearing that the sole issue is one of state or federal law or policy or change in state or federal law and not one of incorrect computation of the assistance payment; or,
- another change affecting the individual's assistance or services occurs while the hearing decision is pending and the individual fails to request a hearing on the second issue after notice of that change; or,
- the assistance affected by the aggrieved action is Pathways Supportive Services and/or Child Care Services.
For fair hearing requests pertaining to General Public Assistance, a written request for hearing must be made within the 10 day advance notice period and must be accompanied by or include a written request for continuation of GPA to stay the reduction, suspension, or discontinuance until the fair hearing decision is issued. Only at the client's specific written request will the agency representative continue GPA benefits.
If the recipient requests the continuance of his/her GPA, such assistance may be continued, except in the following instances:
- a determination is made at the hearing that the sole issue is one of state law or policy or change in state law and not one of incorrect computation of the assistance payment; or,
- another change affecting the individual's assistance occurs while the hearing decision is pending and the individual fails to request a hearing on the second issue after notice of that change.
The client indicates the request for discontinuance of FIP, MA, and/or FS or continuance of GPA, as appropriate, in either Section II of the DHS-121 or Section I of the INRHODES Request for Hearing together with the recipient's statement of complaint. This section must be signed by the recipient.
When an individual requests a hearing via the DHS-121F to contest an administrative lien, the lien on the bank account, insurance settlement or real property shall remain in full force and effect until the hearing decision is rendered.
When a hearing is requested after the advance notice period, the action is completed and remains in force until the decision is altered or reversed at the hearing, or is changed by another change in circumstances relating to the individual's assistance or services.
0110.30.25 Rights of the Individual
REV:01/1990
The individual is informed of his/her right to be represented by legal counsel and/or such witnesses as s/he may deem necessary to support the appeal. The agency representative assists the individual to obtain legal services, if desired, by helping him/her to arrange an appointment with available community resources such as Rhode Island Legal Services.
If needed, transportation is arranged for the individual.
- The individual is informed that s/he is given opportunity and time to examine documents and records used at the hearing, at a reasonable time before the hearing, and during the hearing.
- The individual is informed of his/her right to: present his/her own case or enlist the aid of an authorized representative; to bring witnesses; to establish pertinent facts and circumstances; to advance arguments without undue interference; and, during the hearing, to question or refute any testimony or evidence including opportunity to confront and cross-examine adverse witnesses.
- The individual is informed of his/her right to judicial review if dissatisfied with the hearing decision.
0110.35 HEARING OFFICE ACTION
REV:12/1995
When a completed hearing form is received at Central Office, the the Appeals Office schedules the date, time, and place of the hearing. A hearing is generally held at the regional or district office, or in an individual's home when circumstances require.
Official notice of the hearing is sent to all parties involved at least five days (ten (10) days for food stamp hearings/issues.
See Section 1032.25.20.) before the scheduled hearing date.
- The individual is notified by use of a DHS-l2lB Hearing Appointment form with an attached copy of the completed DHS-l2l. Also enclosed is a form entitled Information about Hearings for Applicants and Recipients of Financial Assistance, Food Stamps, Medical Assistance and Social Services (DHS-l2lA), which explains the purpose of the hearing and the basic procedures followed in conducting it.
If an individual chooses to have legal representation at the hearing, e.g., be represented by an attorney, paralegal, or legal assistant, the representative must file a written Entry of Appearance with the Appeals Office at or before the hearing. The Entry of Appearance acts as a release of confidential information, allowing the legal representative access to the agency case record. (See DHS Manual Section 0102 regarding confidentiality of information.) The Entry of Appearance is also needed for the Appeals Office to confirm the representation for purposes of follow-up, review, requests for continuances, etc. - The agency representative whose decision is being appealed receives a copy of the DHS-l2lB and the completed DHS-l2l.
- All participants must be promptly notified if the demands of the agency and/or the convenience of the individual make a postponement or other adjustment in the date, time, and/or place of a hearing necessary.
0110.40 ABANDONMENT OF THE HEARING REQUEST
REV:11/2003
If an individual wishes to continue the request for a hearing and reschedule, s/he must call the appeals office before the time of the hearing. A food stamp household may request and receive a postponement in accordance with Section 1032.10.05.
A hearing request may be denied or dismissed when it is determined that it has been abandoned. Abandonment may occur when, without good cause, an individual or her/his authorized representative fails to appear at a hearing.
If the individual or authorized representative does not appear and has not notified the appeals office up to the time of the hearing to request a continuance or report that s/he is unable to appear, the appeals officer notifies the individual, in writing, that the hearing request is considered abandoned.
The appeals officer advises the claimant/legal representative to contact the appeals office within ten (10) days if s/he wishes to reschedule the hearing and can demonstrate good cause (as described in Section 0110.40.05) for failing to keep the appointment.
0110.40.05 Good Cause for Failure to Appear at Hearing
REV:11/2003
A hearing is not considered abandoned as long as the individual has either 1) requested a postponement or continuance before the time of the hearing, or 2) notified the appeals office up to the time of the hearing that s/he is unable to keep the appointment and still wishes a hearing.
If the individual or authorized representative does not appear and has not notified the appeals office up to the time of the hearing to request a continuance or report that s/he is unable to appear, the appeals officer notifies the individual, in writing, that the hearing request is considered abandoned.
Staff should assist the claimant in the establishment of good cause, and when necessary, forward determining information to the hearing officer.
Good cause for failure to attend a hearing includes, but is not limited to:
- Sudden and unexpected event (such as loss or breakdown of transportation, illness or injury, or other events beyond the individual's control) which prevents the individual's appearance at the hearing at the designated time and place; or appearance at the wrong office.
- Injury or illness of claimant or household member which reasonably prohibits the individual from attending the hearing.
- Death in family.
If the hearing officer determines that good cause exists, the hearing is rescheduled. The benefit shall be reinstated if it was terminated because of the abandonment.
0110.45 TIME LIMITS IN THE HEARING PROCESS
REV:08/1987
It is the intention of the agency to meet requests for hearings promptly. The hearing process, therefore, is subject to the following time schedule:
- The claimant and all interested parties must be given at least five days notice, in writing, of the date, time, and place of the hearing (DHS-l2lB).
- The entire hearing process, including the reporting of an action required to make the decision effective, must be completed whenever possible within thirty (30) days of the receipt of a request, but in no case is to exceed a maximum of ninety (90) days, unless the individual requests in writing a delay to prepare his/her case.
- In food stamp hearings, final administrative action cannot be any later than sixty (60) days from the date of the hearing request.
0110.50 THE APPEALS OFFICER
REV:08/1987
The hearing is held by an impartial designee of the Director of DHS. No person who has participated in the issue under review is eligible to serve as an appeals officer.
The appeals officer endeavors to bring out all relevant facts bearing on the individual's situation at the time of the questioned agency action or inaction and on agency policies pertinent to the issue. The hearing must not be closed until the appeals officer is satisfied that all facts needed for a decision have been assembled.
0110.55 THE HEARING PROCEDURE
REV:08/1987
The hearing is recorded on tape. Any person who testifies at the hearing will be sworn in by the appeals officer. An orderly procedure will be followed that includes the following:
- A statement by the appeals officer reviewing the agency's purpose relative to the hearing; the reason for the hearing; the hearing procedures; the basis upon which the decision will be made, and the manner in which the individual is informed of the decision.
- A statement by the claimant, or his/her authorized representative outlining his/her understanding of the problem at issue.
- A statement by the agency representative setting forth the agency policies under which action was taken or denied.
- A full and open discussion of all facts and policies at issue by participants under the active leadership of the appeals officer.
The hearing may be adjourned from day to day or to a designated day when either the appeals officer and/or the individual needs time to obtain further information.
0110.55.05 Admissible Information
REV:08/1987
Only information bearing directly on the issue under review and the supporting policy may be introduced from agency records. The appeals officer will not review any information that is not made available to the individual or his/her authorized representative(s).
0110.55.10 Hearing Attendance
REV:08/1987
Attendance at hearings is restricted to individuals directly concerned with the issue(s) and the appeals officer. If, at any time, the appeals officer finds that the number or the conduct of persons in attendance limits or prevents an orderly process to the hearing of the complaint, s/he may adjourn the hearing and reschedule it at a later date and time.
The Director of Human Services may, at his/her discretion, appoint three official auditors to attend all hearings as observers. The auditors should include a recipient, a member of the DHS Advisory Group and a representative of the public at large.
The agency representative who made the decision being appealed must attend the hearing prepared to answer questions pertinent to his/her decision. The appropriate supervisory person who reviewed the decision must support his/her findings. The agency representative has the obligation to secure, if possible, the attendance of all persons believed by the individual to be necessary to support his/her claim.
0110.55.15 Right to Legal Counsel
REV:12/1995
The individual must be informed at all times of his/her right to legal counsel in the preparation and/or presentation of his/her complaint, and the availability of such counsel through Rhode Island Legal Services and other community resources.
If the individual chooses to have legal representation, e.g., be represented by an attorney, paralegal, or legal assistant, the representative must file a written Entry of Appearance with the Hearing Office at or before the hearing. The Entry of Appearance acts as a release of confidential information, allowing the legal representative access to the agency case record. (See DHS Manual Section 0102 regarding confidentiality of information.) The Entry of Appearance is also needed for the Appeals Office for purposes of follow-up, review, requests for continuances, etc.
0110.55.20 Medical Assessment
REV:08/1987
When the hearing involves medical issues such as those concerning a diagnosis, an examining physician's report, or a medical review team's decision, a medical assessment from someone other than the person or persons involved in the original decision is obtained, at agency expense, and made part of the hearing record, if the appeals officer considers it necessary.
0110.55.25 The Hearing Record
REV:08/1987
The tape recording, together with all papers and documents introduced, constitute the complete and exclusive record for decision. This record will be available to the individual or his/her representative(s), within a reasonable time.
0110.60 THE HEARING DECISION
REV:08/1987
The full responsibility of the agency in the hearing process is discharged only when a definite decision has been made, in writing, by the appeals officer and the required action, if any, is carried out in the district. No adjournment for further information limits the appeals officer's responsibility to make such a decision.
Any decision in favor of the individual applies retroactively to the date of the incorrect action. All decisions made in the hearing process are binding upon all agency personnel who have responsibility for carrying them out. This in no way, however, limits any new action in a situation which is based upon changed conditions.
0110.60.05 Discharge of the Hearing Responsibility
REV:08/1987
The hearing responsibility cannot be considered discharged until the following steps have been taken:
- A decision based exclusively on evidence and other material introduced at the hearing has been rendered, in writing, in the name of the agency by the person who conducted the hearing.
- Copies of the decision, setting forth the issue, the relevant facts brought out at the hearing, the pertinent provisions in the law and agency policy, and the reasoning which led to the decision, have been sent to the individual, the staff member involved, and the appropriate supervisor; and
- Action required by the decision, if any, has been completed by the agency representative and confirmed in writing to the appeals officer.
- The individual must be notified of the right to judicial review.
0110.65 MEETING COMMUNITY DISSATISFACTION
REV:08/1987
Beyond the complaint and appeal process which pertains to the application of agency policy with respect to a particular individual, or, to a specific decision or delay in a decision in an individual case, the agency provides a method by which individuals and/or groups in the community may express concern and/or dissatisfaction.
When individuals have the same complaint against an agency policy and they file a request for a group hearing, they may be given one. If there is a disagreement between the agency and the individual as to whether the appeal concerns policy or the facts of an individual's situation and thus whether it is to be included in the group hearing, the agency makes the decision.
The appeals officer may limit the discussion to the sole issue under appeal. When an individual's request for a hearing involves issues in addition to the one serving as the basis for the group hearing, his/her appeal must be severed from the group's appeal and handled separately. A person scheduled for a group hearing may withdraw and request an individual hearing.
0110.70 PUBLIC ACCESS TO HEARING DECISIONS
REV:07/2000
The Department's hearing decisions rendered on and after April 1, 1987, are available for examination at the Hearing Office, Louis Pasteur Building, 600 New London Avenue, Cranston, Rhode Island, between the hours of 9:00 A.M. to 11:00 A.M. and l:00 P.M. to 3:00 P.M., Monday through Friday. An index of decisions is available to facilitate this examination.
0110.75 OCSS QUARTERLY NOTICE AND HEARING PROCEDURES
REV:07/2007
The Office of Child Support Services (OCSS) shall provide a quarterly notice (computer generated) to FIP recipients and non- recipients for whom a child support obligation has been established and for whom a child support collection has been made. The quarterly notice shall specify at a minimum the amount of support paid, the date such payment was made, the date such payment was received by DHS or R.I. Family Court, the date and amount of pass-through and/or child support paid to the client, and an explanation of the recipient's rights to a hearing which must be requested within 30 days of the date of the notice. When a pass-through payment is not sent to a recipient in a particular month, the quarterly notice will include an explanation as to why it was not made. A hearing request form is enclosed with the quarterly notice. The following constitute the OCSS hearing procedures:
- The recipient of the quarterly notice will mail the request form to the OCSS Accounting office, 110 Eddy Street, Providence, RI 02903. The form will be date stamped and logged in a central location by the Business office. The Business Agent shall research the records to determine all pass-through payments made for the months the recipient was on FIP (if applicable). In most cases it will not be necessary to refer the matter to obtain the FIP payroll card because the recent FIP on/off dates are on the IV-A system to which the agents have access. The agent shall refer the hearing request form packet to the legal unit for scheduling of a hearing indicating in their log the date the matter was so referred.
- Clerical staff will date stamp the packet, log the case in a central log and schedule the matter for hearing. A notice shall be mailed to the client advising him/her of the hearing date. Notice of scheduled hearings shall be given to the business office on a weekly schedule.
- The hearing will be conducted in the same manner as the income tax intercept hearings. The business officer or other OCSS representative will be present and will be available to answer the client's relevant questions relating to the information provided to the client in the quarterly notice. The client will then have an opportunity to present why s/he believes s/he should have received a child support payment and/or pass-through in a given month. The business officer or other OCSS representative will then be given an opportunity to respond by presenting testimony and/or evidence with respect to the child support and/or pass-through payments and periods contested by the client.
- The hearing officer may, in his or her discretion, grant a continuance to any party for good cause, including, but not limited to, a party's reasonable request to obtain, review, and present additional relevant evidence. The client will be advised s/he will receive a written decision by mail within 30 days next following the close of the hearing.
- A decision letter will be prepared by the hearing officer. The original will be sent to the client, with copies to his/her representative, masterfile, hearing file, and business office.
- Any person who has exhausted all available administrative remedies and who is aggrieved by a final order of the agency is entitled to judicial review pursuant to Section 42-35-15 of the R.I. General Laws. If a client appeals the decision of the hearing officer to the Superior Court, the hearing officer will be responsible to obtain a transcript of the hearing, assemble the evidence (Exhibits) and forward the material to the Chief Legal Counsel, OCSS.