SECTION 340:2-5-61. Client hearings conducted by the Appeals Unit

(a)   Children's Special Health Care Needs Program. Circumstances that constitute a basis for a hearing are:

(1)   a denial of an individual's application for services;

(2)   a decision regarding eligibility has not been reached within 45 days from the application date;

(3)   the client disagrees with the date on which assistance begins; or

(4)   the client is dissatisfied with an action affecting eligibility for receipt of medical services or with the relevant policy as applied to his or her situation.

(b)   Child Care Subsidy Program. A hearing may be granted if:

(1)   there is a delay in reaching a decision on an application for assistance of more than two working days of receiving all necessary verification to certify or deny the application;

(2)   the client disagrees with the date on which assistance begins;

(3)   the client disagrees with the amount of the family share co-payment; or

(4)   the client, family, or guardian is aggrieved because of Oklahoma Department of Human Services (DHS) actions to deny, terminate, or reduce services.

(c)   Services for persons with developmental disabilities.

(1)   A hearing may be granted if:

(A)   the application for services is denied;

(B)   the DHS action regarding the application for state-funded services has not occurred within 180 days from the date DHS received the application and the client has exhausted the remedies afforded by the Office of Client Advocacy (OCA);

(C)   when resources are sufficient for initiation of Home and Community Based Waivered Services and action is not taken within 45 days; or

(D)   the client, family, or guardian is aggrieved because of the DHS action to suspend, terminate, or reduce services.

(2)   All other complaints or grievances are made to OCA and are addressed per OCA policies and procedures.

(3)   Nothing contained in this subsection is construed as a limitation of the rights of class members regarding the review and appeal procedures set forth in the Consent Decree in Homeward Bound vs. The Hissom Memorial Center.

(d)   Supplemental Nutrition Assistance Program (SNAP). A hearing may be granted if:

(1)   the household's application is denied;

(2)   a decision regarding eligibility has not been reached within 30 days from the date of application;

(3)   a requested change in the amount of benefits has not been made within 10 days from the request;

(4)   a decision regarding loss of benefits occurred in the previous 90 days; or

(5)   the household is aggrieved by:

(A)   reason of DHS interpretation and application of SNAP policy as applied to the household's situation during the certification period; or

(B)   any other DHS action in its administration of the program that affects the household's participation.

(e)   Individual and Family Disaster Grant Program. A hearing may be granted if:

(1)   the applicant's application is denied;

(2)   the applicant is dissatisfied with the amount of the grant award; or

(3)   there is an unreasonable delay relating to the application.

(f)   Low Income Home Energy Assistance Program and Energy Crisis Assistance Program. A hearing may be granted if:

(1)   the applicant's application is denied;

(2)   there is a delay in reaching a decision regarding eligibility on an application for assistance of more than 10 calendar days;

(3)   the client disagrees with the date on which assistance begins; or

(4)   the applicant is dissatisfied with the amount of the payment.

(g)   Medical Assistance Program under Title XIX of the Social Security Act.

(1)   The Oklahoma Health Care Authority (OHCA) is the state agency authorized to operate Oklahoma's Medical Assistance Program pursuant to Title XIX of the Social Security Act. Through an interagency agreement with OHCA, DHS:

(A)   determines financial and non-financial eligibility for certain categories of eligibility for the Medical Assistance Program;

(B)   conducts hearings regarding:

(i)   financial and non-financial eligibility for certain categories of eligibility for the Medical Assistance Program; and

(ii)   the scope of services provided through the DHS Developmental Disabilities Services; and

(C)   does not conduct hearings when the action being appealed is based on an OHCA decision, or the action relates to the Advantage Waiver Program.

(2)   Circumstances that constitute a basis for a hearing are:

(A)   the individual's application for medical services is denied;

(B)   a decision regarding eligibility has not been reached within the specified time limit from the date of the application:

(i)   30 days for:

(I)   Refugee Medical Assistance; and

(II)   categorically related to Aid to the Aged;

(ii)   45 days for:

(I)   Medical Assistance only, categorically related to Aid to the Disabled;

(II)   a request for long-term care on an active State Supplement Payment (SSP) or Medical Assistance case; and

(III)   Medical Assistance for optional tuberculosis (TB) coverage group;

(iii)   60 days for categorically related to Aid to the Blind or Disabled when disability must be established; and

(C)   the client disagrees with the date on which assistance begins; or

(D)   the client is dissatisfied with any other action affecting eligibility for Medical Assistance.

(3)   Administrative hearings are not granted when either state or federal law requires automatic adjustments for classes of recipients unless the reason for an individual appeal is incorrect eligibility determination.

(h)   Social services under Title XX of the Social Security Act. A hearing may be granted if:

(1)   the client is aggrieved because of:

(A)   denial of a request for, or exclusion from, a service program;

(B)   failure to consider the individual's choice of service in assignment of program; or

(C)   a decision requiring participation in a service program; or

(2)   the recipient is aggrieved about the operation of the service program.

(i)   SSP for the Aged, Blind, and Disabled and TANF, including TANF Emergency Assistance.

(1)   A hearing is not granted in these programs when either state or federal law or regulation requires automatic grant adjustments for classes of recipients unless the reason for an individual appeal is incorrect grant computation.

(2)   A hearing may be granted when:

(A)   there is a delay in reaching a decision on an application for assistance of more than:

(i)   five business days for TANF Emergency Assistance;

(ii)   30 days for:

(I)   SSP for the Aged;

(II)   TANF; or

(III)   Refugee Cash Assistance;

(iii)   45 days for SSP for the Blind; or

(iv)   60 days for SSP for the Disabled;

(B)   there is a delay of more than 10 days in implementing a requested change regarding an assistance payment;

(C)   the client disagrees with the date on which assistance begins;

(D)   the assistance payment was discontinued or suspended;

(E)   the client is aggrieved regarding protective payments because:

(i)   payment is made in the form of a protective payment; or

(ii)   of any action with regard to the protective payment, such as the protective payee selected; or

(F)   the client is aggrieved about conditions of payment, including the requirements for work, medical treatment, or training, but only when the requirement complained of, if true, would constitute a violation of DHS policy.

(j)   Assistance. In any other program which constitutes assistance within the definition of Section 164 of Title 56 of the Oklahoma Statutes, a hearing may be requested if the client disagrees with:

(1)   denial or termination of assistance;

(2)   amount of assistance; or

(3)   the conditions on receipt of benefits.

(k)   Overpayments. If a client is notified of an overpayment in any of the programs listed in this Section, the client may request a hearing regarding:

(1)   the existence of the overpayment;

(2)   the amount of the overpayment;

(3)   when appropriate, whether the overpayment was caused due to DHS error, inadvertent client error, or willful misrepresentation by the client; and

(4)   when appropriate, the client's liability to repay the overpayment.

(l)   Any action, not specified in subsections (a) through (k) of this Section, for which DHS is required to provide an administrative hearing by state or federal constitution, statute or regulation.

[Source: Added at 19 Ok Reg 2199, eff 6-27-02; Amended at 31 Ok Reg 1820, eff 9-15-14]