All Medicaid Programs |
Obsolete Policy |
1. All hearings will be conducted informally and in a way to protect the rights of the parties. The hearing may be recorded.
2. The ALJ considers all issues relevant to the hearing and bases the decision on the relevant evidence and policies.
3. All parties may testify, present evidence, and comment on the issues.
4. All testimony of the parties and witnesses will be given under oath or affirmation.
5. The ALJ will direct the order of testimony and rule on the admissibility of evidence.
6. The ALJ may accept oral or written evidence of any nature, whether or not conforming to the legal rules of evidence, including hearsay, and determine its relevance to the issues.
7. Each party to a hearing receives an adequate opportunity to be heard and to present any pertinent evidence that helps prove the party's position. Each party can know about and rebut by cross-examination or otherwise any evidence submitted.
8. Official records of the eligibility agency, including reports submitted in connection with any program administered by the agency or other State agency may be included in the record.
9. The parties, with the consent of the ALJ, may stipulate to the facts involved. The ALJ may decide the issues on the basis of such facts or may set the matter for hearing and take such further evidence as deemed necessary to determine the issues.
10. The ALJ makes a decision based solely on the testimony and evidence presented at the hearing.
11. Unless the applicant or individual requests a continuance, the ALJ issues a decision within 60 days of the date on which the individual requests the hearing.
12. An individual may request an expedited fair hearing (a decision issued to the individual within 7 business days of request) if they can verify that waiting the standard time for a hearing (90 days) could jeopardize their life, or ability to reach, maintain or return their health to maximum function.
· These circumstances must be documented with a statement from a medical professional such as a doctor, nurse, or medical manager, and should be entered into the case record.
· If requested documentation is not received within 7 days, the request will be denied and treated as a standard fair hearing request (90-day decision).
· A decision of whether an expedited hearing will be granted will be made based on the evidence submitted. Additional information may be required to demonstrate the urgent need on a case-by-case basis.
· If the expedited hearing request is denied, the initial request will be treated as a standard fair hearing. The individual will be notified of the denial for an expedited fair hearing and allowed to request continued benefits during the appeal.
· If the Request is approved, the individual will be contacted to set up an expedited hearing.
· After the hearing, the department will issue a determination within 7 business days after receiving the initial request.
13. A decision of the ALJ which results in a reversal of the eligibility agency becomes final 30 days after the decision unless the Department of Health and Human Services chooses to conduct an Agency Review. (See 125-6)
A. The DWS hearing decision may be made final in less than 30 days upon agreement of all parties.
B. The Medicaid eligibility agency will take case action within 10 calendar days from the date the decision becomes final.
14. The ALJ may take evidence after the hearing. If more facts are found in the process, the ALJ may reopen the hearing.