SR 13-19 Dated 09/13

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases an increase in the number of days a recipient of any category of assistance is provided to request a continuation of benefits when the recipient has requested an administrative appeal. A recipient now has 15 days from the date on the notice of the action being appealed to request continuation of their benefits.

Policy remains unchanged that:

·      if requested within the 15 days from the date on the notice of the action being appealed, recipients’ benefits may, under certain circumstances, be continued or reinstated at the previous level until the decision on the appeal is reached, and/or, if receiving Food Stamp benefits, until the Food Stamp certification period ends; and

·      if the appeals officer agrees that the Department’s action was correct, the recipient household will owe the Department the value of the extra Food Stamp benefits and/or the extra cash, medical, or child care assistance benefits that were received as a result of the continued benefits.

As a result of this change, DFA Form 810, Notice of Rights and Responsibilities, and its associated Spanish translation, DFA Form 810(Sp), were revised.

This SR additionally releases the obsolescence of DFA Form 810(Bo), Bosnian Version of DFA Form 810.

BACKGROUND

The Centers for Medicare and Medicaid Services (CMS) adopted final rules in which they indicated that Medicaid benefits must be reinstated if the recipient requests an administrative appeal within 10 days from receipt of the notice of the action. CMS has defined the “date that the notice is received,” in revisions to 42 CFR 431.231, as 5 days from the date on the notice, unless the individual shows that he or she did not receive the notice within the 5-day period. This essentially provides Medicaid recipients with 15 days from the date on the notice of decision to request an appeal and continuation of benefits. To reduce recipient confusion and keep the policy uniform, the new Medicaid requirement has been adopted for all programs so that the 10-day clock to appeal a decision and obtain continued benefits starts on the date the notice is received, assuming the receipt date is 5 days from the date of the notice.

POLICY

If requested within 15 days from the date on the notice of the action being appealed, a recipient’s benefits may, under certain circumstances, be continued or reinstated at the previous level until the decision on the appeal is reached, and/or, if receiving Food Stamp benefits, until the Food Stamp certification period ends.

Note: Continuation of benefits pending an appeal is also dependent upon current policy that may be unrelated to the time period in which the recipient requests an appeal of a Department action. For example, certain APTD cash assistance recipients may not be allowed to have their benefits continued pending an appeal. See Adult Assistance Manual 315.11, Denial or Termination of Assistance.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

The administrative appeal text on notices of decisions was altered effective October 1, 2013 to read as follows:

If you think we made a mistake: Your Right to an Administrative Appeal (“Hearing”)

You can appeal our decision. For example, you can appeal if you think we made a mistake on things like your household size, income, citizenship, immigration status, or residency. You can also appeal what services you get or did not get or how much you get in benefits, if you think we made a mistake in the action we took. To ask for an appeal, call the District Office at the telephone number printed at the bottom of the first page of this Notice. Always call your District Office first when you have a question or a problem with your case. You can also write your own letter to ask for an appeal and send it to the address at the top of the first page of this Notice. Or you can call the Administrative Appeals Unit directly at 1-800-852-3345, extension 4292 (toll-free in NH) or 603-271-4292. You must ask for an appeal by a certain time. The enclosed Notice of Rights and Responsibilities tells you more about when you must ask for an appeal. If you are already getting benefits and you ask for an appeal, you can also ask to keep getting the same benefits while you wait for the decision on your appeal. If you want to do this, you must ask for your benefits to continue within 15 days of the date on the notice of the action you are appealing.

Once you ask for an appeal, we will try to see if we can fix the problem over the phone or by meeting with you. If a phone call or meeting does not fix the problem, you can have a hearing. A hearing is a meeting between you, someone from DHHS, and an appeals officer. At the hearing, you can explain why you think we made a mistake. To get ready for your hearing, you can:

·      Ask for a copy of your file before the hearing.

·      Bring someone with you to the hearing, like a friend, relative, or lawyer, or, come by yourself. DHHS will not pay for the cost of any legal services you may want, but there are free and reduced cost legal services available in NH.

·      Bring documents, information, or witnesses to show us where you think we made a mistake.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 810, Notice of Rights and Responsibilities, and its Spanish translation, DFA Form 810(Sp), were altered to reflect the new 15-day time frame in which a recipient of any category of assistance may request continuation of benefits when appealing a Department action, and to specify that if the appeals officer finds in favor of the Department, all continued cash, medical, and child care benefits must be repaid. This form is also being translated into Nepali. Since there are no changes associated with the use of this form, the instructions did not require revisions and will not be re-released with this SR.

The current English version of this form will be used until the supply is exhausted, at which point the new version will be printed. This Form will also be available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The Spanish and Nepali versions may be reordered by contacting the Policy Unit Supervisor directly. The forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

DFA Form 810(Bo), Bosnian Version of DFA Form 810, is obsolete with the release of this SR. The Office of Minority Health and Refugee Affairs (OMHRA) has informed DFA that the Bosnian population in NH has greatly diminished. Because of this, OMHRA indicated that there is no longer a need for DFA forms to be translated into Bosnian. As such, DFA Form 810(Bo) will not be updated with the changes made to the English version but instead is obsolete. A Certificate of Destruction has been included with this SR.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 101.01 Individual Rights

Section 109.03 Processing a Filed Application

Section 141.01 Administrative Appeal Requests and the ANP

PART 143  COMPLAINTS AND ADMINISTRATIVE APPEALS

PART 149  MASS CHANGES

Section 311.15 Refusal to Cooperate

Section 315.09 Administrative Appeals

Section 709.01 What Benefits May Be Replaced

Revised Adult Assistance Manual Topics

Section 101.01 Individual Rights

Section 109.03 Processing a Filed Application

PART 137  COMPLAINTS AND ADMINISTRATIVE APPEALS

PART 147  MASS CHANGES

PART 707  REPLACING FINANCIAL ASSISTANCE BENEFITS

Revised Food Stamp Manual Topics

Section 101.01 Individual Rights

Section 109.03 Processing a Filed Application

Section 141.01 Administrative Appeal Requests and the ANP

PART 143  COMPLAINTS AND ADMINISTRATIVE APPEALS

PART 149  MASS CHANGES

Section 315.09 Administrative Appeals

Section 709.01 What Benefits May Be Replaced

New Medical Assistance Manual Topics

Section 101.01 Individual Rights

Section 137.01 Administrative Appeal Requests and the ANP

PART 139  COMPLAINTS AND ADMINISTRATIVE APPEALS

PART 149  MASS CHANGES

IMPLEMENTATION

The policy in this SR is effective September 13. 2013. The current version of DFA Form 810 is to be used until the supply is exhausted, at which point the new version will be printed. This Form is also available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The forms are also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

CLIENT NOTIFICATION

DFA Form 810 has been revised to reflect the new timeframes. This form is provided with every notice of decision (NOD) generated. No other special client notification is planned.

TRAINING

No special training is planned.

FORMS MANUAL POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at www.dhhs.nh.gov/DFA/publications.htm, effective October 28, 2013. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Family Assistance, Adult Assistance, Food Stamp, and Forms Manuals.

DFA/JBV:s