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 Administrative 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, and SNAP 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 an application will be denied or that benefits will be 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 decision notice may receive continuing 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.
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 isresponsible for some.
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. Most hearing requests must be submitted on an DHS 0443, (Administrative Hearing Request-see below), SNAP may be requested orally or in writing without the use of a form. Department staff are obligated 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 SNAP, clients may request hearings orally. In this case Department staff must initiate a written request.
Note: Submit a copy of the notice with the DHS 0443.
All requests for 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 APD Field Services.
Branch staff frequently provides 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 takes 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. In certain cases, branch staff will be asked to testify in administrative hearings.
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, who will forward it to the branch so that appropriate action can be taken.
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 that prompted the hearing request was sent or given to the claimant.
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. In SNAP, this is the date that the hearing request is considered complete and the date that the 60-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 SNAP, etc.). Use the specific program in which the hearing issue arose. If a request involves both public assistance and SNAP, 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 claimant'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 being 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 effective date of the notice of action they can have 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 SNAP, claimants 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. Please DO NOT date stamp the 'Date' field in the lower right corner of this section. This field is what hearing representative fills in when he/she refers the 443 to teh Office of Administrative Hearings (OHA).
Note: In SNAP, 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 APD Hearings Coordinator.
Please feel free to call the Hearings Coordinator if you have any questions about processing a hearing request.
DMAP: DMAP Hearings are sent directly to DMAP. Contact is Lisa Gutierrez, FAX number (503) 945-6035.
Adult Foster Home (AFH), Assisted Living Facility (ALF), and Residential Care Facility (RCF) hearings requests should be sent to the APD Hearings Coordinator, who will direct to the appropriate Program Coordinator in the Long-Term Care Quality Office.
Home Care Worker (HCW) appeals of Criminal History Checks: All aspects of these appeals are handled by the DHS Background Check Unit (formerly the Criminal Records Unit). HCW should use the DHS 0299 for an appeal to a criminal history check.
HCW Immediate Termination: The Homecare Worker may file an appeal of the decision in the following order:
DHS Central Office.
Office of Administrative Hearings.
HCW Termination Pending Appeal: The Homecare Worker may file an appeal of the decision in the following order:
The Program Manager (or designee) at the local office.
DHS Central Office.
Office of Administrative Hearings.
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 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 APD Central Office. If, following the review, APD Central Office concurs with the local office decision to terminate the Homecare Workers' provider enrollment, APD 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 APD hearing coordinator and an APD hearings rep will represent the Department. Please also contact the APD - In-Home Supports Section when Homecare Worker hearing requests are received. The APD 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 APD/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.