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Staff Tools | Generic Program Elements | I. Hearings
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DHS home | SPD
Staff Tools | Generic Program Elements | I. Hearings
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A hearing is a formal proceeding through which the Department makes a final decision regarding a client's right to benefits when the client has disputed a decision made by branch staff. Hearings are also held to resolve other issues (see section 2 below). Administrative Law Judges from the Office of Admiistrative Hearings preside over each hearing, and the Department's position in the hearing is explained by the Department hearing representative. The hearing is conducted in accordance with state statutes and the Attorney General's Model Rules of Procedure for Contested Cases at 137-003-0501 and following. Department rules about Medicaid, GA, and Food Stamp case hearings are 461-025-0300 and following. The Department staff continue to work as appropriate with a client who has requested a hearing, following applicable rules including those on client confidentiality.
Clients are given the right to a hearing by the U. S. Constitution, federal law, state statute, and the Department's administrative rules (see 461-025-0310). Most but not all hearings are requested after a client has received a notice that benefits will be denied, reduced, or closed. A person also has a right to a hearing when the Department claims an overpayment, when it denies a listing requested by a child care provider, and when the Department claims the client committed an IPV.
See 461-025-0316 for information on IPV hearing requests.
In some situations, clients will have a right to continued benefits. A client who is entitled to continuing benefit notice may receive continued benefits until a final order has been issued. To be entitled continuing benefits, the client must complete the hearing request not later than the later of:
There is no right to a hearing to dispute a program requirement established by law. Examples are the closure of a program or a change to a payment standard.
Many hearings cases can be resolved informally, prior to the hearing itself, when branch staff explain the situation to the client, without appearing to be defensive about the situation or "talking the client out of the hearing." The Department hearing representative will often use an informal prehearing conference to resolve a case. Keys to successfully resolving cases informally are creating an opportunity to exchange information with and explain the policy to the client. The hearing process is not adversarial.
Hearing Representatives will offer clients who are going through the Presumptive Medical Process an opportunity to enter into a Dispute Resolution Process when appropriate. The Dispute Resolution Process creates a postponement of the hearing while additional information is gathered. The client or the Department can choose to end the process at any time and the hearing request can either be withdrawn or submitted to the Office of Administrative Hearings. This process allows the Department to stay within the 90 days timeframe the department has to issue a final order. Click here to link to a copy of the notice.
Local office staff may become involved in the hearing process at several points - before, during, or after the hearing. While a Department heaing representative handles most hearings for the Department, branch staff are responsible for some. For instance, expedited hearings are usually handled by branch staff.
Clients have the right to expedited hearings in four different situations:
See 461-025-0315 regarding the first three types and 410-141-0265 regarding expedited medical hearings. OMAP provides a representative for the expedited medical hearings.
Before the hearing: Branch staff may become involved when a client wants to request a hearing. Some hearing requests must be submitted on an DHS 0443, (Administrative Hearing Request-see below), some may be requested orally, and some may be requested in writing without the use of a form. Department staff are obliged to assist a client complete a hearing request, for instance by providing the client with the correct form, accepting a written request, or notifying the appropriate case manager that the client needs assistance making the request. In the Food Stamp Program, clients may request hearings orally, in which case Department staff must initiate a written request.
Note: Submit a copy of the notice with the DHS 0443.
All requests for a hearing must be submitted to the Department within specified time periods, and once the Department has received the request it must complete the whole hearing process within specified time periods, so it is important both to assist a client who wishes to file a hearing request and to transmit the request rapidly to SPD Field Services.
Branch staff frequently provide assistance to the Department Representative in assembling information needed for the hearing and taking care of some aspects of the prehearing process. The Department Representative or branch staff usually take care of the client's access and interpreter needs (see ORS 183.418 and 183.421).
During the hearing: Most hearings are handled by a Department Representative, but other branch staff often provide support, for instance, by making sure a room is available for the hearing and directing the client, the client's representative, and witnesses to the hearing room. In some cases, the participants need a speaker phone with conferencing capability or a personal computer during the hearing.
Note: If an individual from the branch is acting as the Department representative,
they are responsible for providing all necessary substantiation on the Department
behalf. This includes but is not limited to case documentation, payment information
and making sure that the appropriate people are available at the hearing. For
example, if a client has an authorized representative that has provided the
Department with information, it is important that they attend the hearing. This
can be especially important in cases where the authorized representative is
a facility, as they may be responsible for any overpayments.
After the hearing: Many clients have an ongoing relationship with the agency during and after a hearing, and the Department continues to serve them while some issues are being resolved through the hearing process. The final order issued after a hearing is sent to the Department representative and to the branch so that appropriate action can be taken. If it is not clear to branch staff what action to take, the Program Support Specialist or a hearing representative can assist.
The Department is required to offer an expedited hearing:
A client may have the right to an expedited medical hearing when the client believes his or her medical or dental problem cannot wait for the normal review process. This type of hearing is handled by OMAP. See 410-141-0265 regarding expedited medical hearings.
This segment is completed by branch personnel. It is critical that accurate information be entered in each field because this document is used to start federally-mandated time lines for hearing decisions.
Date of Notice: Enter the date notice was sent or given to the claimant which prompted the hearing request.
Date of Initial Hearing Request: Enter the date the claimant made the agency aware of the desire for a hearing, whether by written or in-person expression. IT IS ESSENTIAL THAT YOU ENTER THIS DATE IMMEDIATELY UPON THE CLAIMANT'S REQUEST, before you give the DHS 0443 to the claimant for completion. (For the food stamp program, this is the date the 90-day decision deadline begins to run. Enter it in all cases).
Date 443 Rec'd by DHS: Enter the date the claimant returned the completed DHS 443 to the agency. This is a critical date for the hearing representatives, please be sure to complete.
Program: Enter the program number (for example, "A1" for OSIPM-OAA, "6" for food benefits, etc.). Use the specific program in which the hearing issue arose. If a request involves both public assistance and food stamps, enter BOTH numbers, e.g. "2/6" or "5/6", etc. DO NOT use such codes as "NA", "PA", etc.
Cost Center: Enter appropriate number for your branch.
Case Number: Enter the number your branch uses to find this file. Do NOT use SSN.
Claimant's Name: Use the name of the person who requests the hearing, even if that is different than the case name. Enter as it appears on agency records.
Address: Enter all components of the most current address available for claimant. Please use the client's mailing address.
Communication preferences: Be sure to complete the section.
This segment is completed by the claimant or claimant's representative. Workers should offer to assist as appropriate.
Reason: Should match the action taken by the agency (i.e., denial, reduction, etc.). If claimant is uncertain about the date of the notice, the worker should assist in clarifying what action is contested.
Explanation: This should be in the claimant's own words. Workers can write for the claimant, but should phrase the explanation in the terms used by the claimant as much as possible.
Continuation of Benefits: Explain to the claimant that if the hearing is requested within 10 days of the notice of action they have the option to request that their benefits continue pending the hearing decision. If the client does not check yes or no, contact the client to see if s/he wants continuing benefits. Explain the risk to the client, and narrate the answer that s/he gives you. For Food Benefits, you can ask for continuing benefits on the DHS 443, by phone, in writing, or by asking a DHS staff member in person. Further details are explained on the back of the form.
Legal Representative: Help the claimant provide as much information as possible. Make sure the claimant understands that a legal representative is NOT required.
Form of Hearing: Most hearings are held by teleconference.
Prehearing conference: Explain to the claimant that prehearing conferences are scheduled by hearing representatives at a later date.
Signature and date: Either the claimant, the claimant's attorney, or claimant's representative can sign the DHS 443.
The local office does not complete this section. It will be completed by the Department Hearing Representative after it has been referred to the SPD Hearing Coordinator
Note: In the SNAP program, a hearing request can be verbal or in writing. If it is verbal, or written on something other than the DHS 443, the worker will complete the hearing request on behalf of the client and forward it to the SPD Hearings Coordinator.
Please feel free to call the Hearings Coordinator if you have any questions about processing a hearing request.
The DHS 0443H "Administrative Hearing Request for Termination of Homecare Worker Provider Enrollment" is the hearing request form for Homecare Workers. Homecare Workers should not use the standard DHS 0443 used for DHS clients because it contains fields and benefits that do not apply to Homecare Worker hearings.
Homecare Workers have the right to request an administrative hearing on the termination of their provider enrollment, following the Administrative Review process as described in 411-031-0050. The Administrative Review process can include appeal through the local office Program Manager and through SPD Central Office. If, following the review, SPD Central Office concurs with the local office decision to terminate the Homecare Workers' provider enrollment, SPD Central Office will notify the Homecare Worker of their right to a hearing.
The DHS 9003H "How to Prepare for your Homecare Worker Hearing" is a two-sided brochure which provides Homecare Workers with information about how DHS hearings are conducted and what kind of evidence can be presented.
Local offices should be prepared to provide these forms when they are requested. Individual copies of these forms can be printed from the DHS Forms Server or a supply can be ordered through FBOS.
When a local office receives the 443H, they should submit it to the SPD hearing coordinator and an SPD hearings rep will represent the Department. Please also contact the SPD - In-Home Supports Section when Homecare Worker hearing requests are received. The SPD In-Home Supports Section can provide technical assistance to local offices about the right to a hearing and on providing an adequate contested case notice.
Homecare Workers have hearing rights on the termination of the provider enrollment and on criminal history clearance fitness determinations. Homecare Workers do not have the right to an administrative hearing on decisions related to a reduction in authorized hours, their rate of pay or removal from a local SPD/AAA office referral list.
Grievances on issues covered in the Homecare Workers' collective bargaining agreement are handled through the Home Care Commission and are not referred through the Office of Administrative Hearings.
