16 Del. Admin. Code § 5000-5401

Current through Register Vol. 28, No. 7, January 1, 2025

Section 5000-5401 - Conducting Hearings on State Actions

7 CFR 7 CFR 271.7(f)7 CFR 273.15(a), 42 CFR 431.220, 45 CFR 205.10 (a)(5)

This policy applies to DSS hearing officers any time an appellant/claimant requests a hearing due to an agency action.

1. Hearing Officers Conduct Hearings on Agency Actions

A. Food Supplement Program Hearings

DSS will provide a fair hearing to any household aggrieved by any action of the State agency which affects the participation of the household in the Program.

Exception: DSS is not required to hold fair hearings unless the request for a fair hearing is based on a household's belief that: A. Its benefit level was computed incorrectly B. The rules were misapplied or misinterpreted

Exception: DSS may deny fair hearings to those households who are merely disputing the fact that a reduction, suspension or cancellation was ordered as a result of an order issued by the Food and Nutrition Service.

B. Cash Assistance and Child Care Hearings

Upon request, a hearing will be held when:

1. An applicant's claim for services is denied or is not acted upon with reasonable promptness.

2. An applicant's claim for financial assistance is denied.

3. A recipient is aggrieved by any agency action resulting in suspension, reduction, discontinuance, or termination of assistance.

4. A recipient is aggrieved by any agency action resulting in a determination that a protective, vendor, or two-party payment should be made or continued.

Exception: The agency does not have to grant a hearing when either State or Federal law requires automatic grant adjustments for classes of recipients unless the reason for an individual appeal is incorrect grant computation

C. Medical Assistance Hearings

The State agency must grant an opportunity for a hearing when:

1. An applicant's claim for services is denied or is not acted upon with reasonable promptness.

2. A recipient believes the agency has taken an action erroneously.

3. A resident believes a nursing facility has erroneously determined that he or she must be transferred or discharged.

4. An individual believes the State has made an erroneous PASRR determination.

5. A hearing request is received from any prepaid ambulatory health plan (PAHP) enrollee who is entitled to a hearing under 42 CFR 431 subpart E.

6. A hearing request is received from any managed care organization (MCO) or prepaid inpatient health plan (PIHP) enrollee who is entitled to a hearing under 42 CFR 438 subpart F.

7. A hearing request is received from any enrollee who is entitled to a hearing under 42 CFR 438 subpart B.

Exception: The agency need not grant a hearing if the sole issue is a Federal or State law requiring an automatic change adversely affecting some or all recipients.

16 Del. Admin. Code § 5000-5401

15 DE Reg. 86 (07/01/11) (Final)