921 KAR 2:055. Hearings and appeals.

921 KAR 2:055. Hearings and appeals.

RELATES TO: KRS Chapter 13B, 45.237, 205.211, 205.231, 205.237

STATUTORY AUTHORITY: KRS 13B.170, 194A.010(2), 194A.050(1), 205.231(5), 42 U.S.C. 601 -619

NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.010(2) requires the Cabinet for Health and Family Services to administer income-supplement programs that protect, develop, preserve, and maintain families and children in the Commonwealth. KRS 194A.050(1) requires the secretary to promulgate administrative regulations necessary to implement programs mandated by federal law or to qualify for the receipt of federal funds and necessary to cooperate with other state and federal agencies for the proper administration of the cabinet and its programs. 42 U.S.C. 601 to 619 requires states receiving Temporary Assistance for Needy Families (TANF) grants to provide a grievance procedure for TANF participants and outline this procedure in the TANF state plan. KRS Chapter 13B establishes the hearing process to be followed in the Commonwealth, and KRS 205.231(5) allows the cabinet to promulgate administrative regulations for the hearing process. This administrative regulation establishes the requirements to be followed in conducting a hearing related to the Kentucky Transitional Assistance Program (K-TAP), the Low-Income Home Energy Assistance Program (LIHEAP), or the State Supplementation Program.

Section 1. Hearing Information. A participant shall be informed of:

(1) The right to a hearing:

(a) Orally, at the time of application; and

(b) In writing:

1. At the time of application; and

2. When an action is taken which affects the benefits of the participant;

(2) The procedures for requesting a hearing, as defined in Section 3 of this administrative regulation; and

(3) Who may represent the participant in a hearing as defined in Section 2 of this administrative regulation.

Section 2. Request for a Hearing. (1) An individual shall request a hearing by:

(a) Completing and submitting a PAFS-78, "Request for Hearing, Appeal, or Withdrawal";

(b) Submitting a written request; or

(2) The hearing request may be:

(a) Submitted to the local department for community based services office; or

(b) Sent to the Cabinet for Health and Family Services, Division of Administrative Hearings, Families and Children Administrative Hearings Branch, 275 East Main, Frankfort, Kentucky 40621.

(3) The reason for the hearing shall be included in the hearing request.

Section 3. Timeframe for Hearing Request. (1) A written or oral request for a hearing shall be considered timely if received by the cabinet within:

(a) Forty (40) days of the date of the advance notice of adverse action;

(b) Thirty (30) days of the notice of:

1. Denial of an application; or

2. Decrease or discontinuance of an active case; or

(2) If a hearing officer determines an appellant meets good cause criteria in accordance with subsection 3 of this section, the appellant may be granted up to an additional thirty (30) days to submit a hearing request.

(3) An appellant may be granted good cause by the cabinet:

(a) For:

1. A delay in requesting a hearing;

2. A delay in requesting a continuation of benefits;

3. Failure to appear for a hearing; or

4. Postponement of a scheduled hearing; and

(b) If the appellant:

1. Was away from home during the entire filing period;

2. Is unable to read or to comprehend the right to request a hearing on an adverse action notice;

3. Moved, resulting in delay in receiving or failure to receive the adverse action notice;

4. Or a household member had a serious illness; or

5. Was not at fault for the delay of the request, as determined by the hearing officer.

Section 4. Continuation of Assistance Program Benefits. (1) When a hearing is requested, benefits shall remain inactive or reduced pending the issuance of a final order unless the appellant requests a continuation of benefits.

(2) Benefits shall be reinstated to the benefit level that was received prior to the adverse action being taken if the request for a continuation of benefits is received within:

(a) Ten (10) days of the date on the notice of adverse action; or

(b) Twenty (20) days of the date on the notice of adverse action or notice if the reason for delay meets the good cause criteria contained in Section 4(3) of this administrative regulation.

(3) If the program benefit has been reduced or discontinued as a result of a change in law, regulation, or policy of the cabinet, subsection (2) of this section shall not apply.

(4) If the action taken by the agency is upheld, continued, or reinstated benefits shall be:

(a) Considered overpayments as defined in KRS 205.211; and

(b) Collected in accordance with KRS 45.237.

Section 5. Hearing Notification. (1) The Division of Administrative Hearings, Families and Children Administrative Hearings Branch shall acknowledge a hearing request.

(2) In accordance with KRS 13B.050, the notice of the hearing shall contain information regarding the:

(a) Hearing process, including the right to case record review prior to the hearing;

(b) Right to representation;

(d) Time and location of the hearing.

Section 6. Withdrawal or Abandonment of Request. (1) The appellant may withdraw a hearing request prior to the:

(a) Hearing; or

(b) Final order being issued if the hearing has already been conducted.

(2) The cabinet shall consider a hearing request abandoned if the appellant or authorized representative fails to:

(a) Appear for the scheduled hearing without notifying the cabinet prior to the hearing; and

(b) Establish good cause for failure to appear, in accordance with the criteria specified in Section 4(3) of this administrative regulation, within ten (10) days of the scheduled hearing date.

Section 7. Appellant’s Hearing Rights. (1) In addition to the rights described in Section 6(2) of this administrative regulation, the appellant shall have the right to submit additional information in support of the claim.

(2) The appellant shall have the right to a medical assessment at the expense of the cabinet by a person not associated with the original action if the hearing:

(a) Involves medical issues; and

(b) Officer considers it necessary.

(3) If a request for a medical assessment at cabinet expense is received and denied by the hearing officer, the denial shall;

(a) Be in writing; and

(b) Specify the reason for the denial.

Section 8. Postponement of a Hearing. (1) An appellant shall be entitled to a postponement of a hearing if the:

(a) Request for the postponement is made prior to the hearing; and

(b) Need for the delay is due to an essential reason beyond the control of the appellant in accordance with good cause criteria contained in Section 4(3) of this administrative regulation.

(2) The hearing officer shall decide if a hearing is postponed.

(3) The postponement of a hearing shall not exceed thirty (30) days from the date of the request for postponement.

Section 9. Conduct of a Hearing. (1) A hearing shall be:

(a) Scheduled by the hearing officer; and

(b) Conducted in accordance with KRS 13B.080 and 13B.090.

(2) A hearing officer shall make an effort to conduct a hearing at a location within the state that is convenient for the appellant and other parties involved.

(3) To secure all pertinent information on the issue, the hearing officer may:

(a) Examine each party or witness who appears; and

(b) If necessary, collect additional evidence from a party.

(4) Parties to a telephonic hearing shall:

(a) Submit all available documentary evidence to be used during the hearing to the hearing officer and the opposing party prior to the hearing being convened; and

(b) Within the timeframe specified by the hearing officer, mail the hearing officer and opposing party any documents or written materials that:

1. Are introduced as evidence into the hearing record; and

2. Have not been supplied to the opposing party prior to the hearing.

(5) If evidence addressed in subsection (4) of this section is not provided to the hearing officer and the opposing party, the evidence may be excluded from the hearing record.

Section 10. Recommended Order. (1) After the hearing has concluded, the hearing officer shall draft a recommended order which:

(a) Summarizes the facts of the case;

(b) Specifies the:

1. Reasons for the recommended order; and

2. Address to which a party in the hearing may send an exception to the recommended order; and

1. Findings of fact;

2. Conclusions of law;

3. Supporting evidence; and

4. Applicable state and federal regulations.

(2) A copy of the recommended order shall be sent to the:

(a) Appellant or representative; and

(b) Local Department for Community Based Services office.

Section 11. Written Exceptions and Rebuttals. (1) If a party to a hearing disagrees with the recommended order, the party may file a written exception with the Commissioner of the Department for Community Based Services or designee.

(2) A written exceptions or rebuttal shall:

(a) Be filed within fifteen (15) days of the date the recommended order was mailed;

(b) Be based on facts and evidence presented at the hearing;

(d) Be sent to each other party involved in the hearing.

Section 12. Final Order. Unless the issue is remanded to the hearing officer for further action, the commissioner or designee shall issue a final order within forty-five (45) days of receipt of the recommended order.

Section 13. Appeal of the Final Order. (1) A participant or authorized representative may appeal a final order by filing an appeal to an appeal board appointed in accordance with KRS 205.231(3).

(2) A request for appeal of a final order shall be submitted:

(a)1. Orally; or

2. In writing; and

(b) To the:

1. Local department for community based services office; or

2. Appeal board.

(3) The date a request is received by the cabinet is considered the date the request is filed.

(4) An appeal request shall be considered timely if the request is received within:

(a) Twenty (20) days of the date the final order was mailed; or

(b) Thirty (30) days of the date the final order was mailed if good cause, in accordance Section 4(3) of this administrative regulation, is met.

Section 14. Appellant’s Rights Prior to Appeal Board Consideration. (1) An appeal to the appeal board shall be acknowledged in writing to the appellant and authorized representative.

(2) The acknowledgment shall:

(a) Advise the appellant that:

1. A brief may be filed; or

2. Upon the appeal board approval, new or additional evidence may be submitted; and

(b) State the tentative date on which the board shall consider the appeal.

Section 15. Appeal Board Review. (1) The appeal board shall consider:

(a) The records of the hearing; and

(b) New evidence or exhibits introduced before the appeal board in accordance with subsection (2), (3), or (4) of this section.

(2) If an appeal is being considered on the record, the parties may:

(a) Present written arguments; and

(b) At the board's discretion, be allowed to present oral arguments.

(3) If needed, the appeal board may request additional evidence to resolve the appeal.

(4) Additional evidence shall be accepted by the board after a party to the hearing has been given seven (7) days notice of the opportunity to:

(a) Object to the introduction of additional evidence; or

(b) Rebut or refute any additional evidence.

Section 16. The Appeal Board Decision. (1) The decision of the appeal board shall be in accordance with KRS 205.231.

(2) The appeal board shall be allowed to reverse the decision in subsection (1) of this section if the following criteria are met:

(a) The correct determination of eligibility based on incapacity or disability is the only issue being considered in the appeal board decision; and

(b) Within twenty (20) days of the appeal board decision, the appellant, or household member whose incapacity or disability is the issue of the hearing, receives and provides to the appeal board an award letter for benefits based on disability including:

1. Supplemental security income;

2. Retirement, survivors, and disability insurance;

3. Federal black lung benefits;

4. Railroad retirement benefits; or

5. Veterans Administration benefits based on 100% disability.

Section 17. Payments of Assistance. (1) Payments of assistance shall be made within ten (10) days of the receipt of a final order or a decision of the appeal board and shall include:

(a) The month of application; or

(b) If it is established that the appellant was eligible during the entire period in which assistance was withheld, a month in which incorrect action of the cabinet adversely affected the appellant.

(2) For reversals involving reduction of benefits, action shall be taken to restore benefits within ten (10) days of the receipt of a final order or a decision of the appeal board.

Section 18. Limitation of Fees. (1) The cabinet shall not be responsible for payment of attorney fees.

(2) Pursuant to KRS 205.237, an attorney representing an appellant shall not charge more than the following amounts for his services:

(a) Seventy-five (75) dollars for preparation and appearance at a hearing before a hearing officer;

(b) Seventy-five (75) dollars for preparation and presentation, including any briefs, of appeals to the appeal board;

(c) $175 for preparation and presentation, including pleadings and appearance in court, of appeals to the circuit court; or

(d) $300 for preparatory work, briefs, and other materials related to an appeal to the Court of Appeals.

(3) The cabinet shall approve the amount of a fee, if the:

(a) Appellant and legal counsel agree to the fee; and

(b) Fee is within the maximums specified in subsection (2) of this section.

(4) Collection of an attorney fee shall:

(a) Be the responsibility of the counsel or agent; and

(b) Not be deducted from the benefits provided to an appellant.

Section 19. Incorporated by Reference. (1) The form, "PAFS-78, Request for Hearing, Appeal, or Withdrawal, edition 6/06", is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Community Based Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (2 Ky.R. 239; Am. 3 Ky.R. 218; eff. 8-4-76; 6 Ky.R. 152; eff. 10-3-79; 8 Ky.R. 1193; eff. 6-25-82; 9 Ky.R. 1249; eff. 6-1-83; 11 Ky.R. 296; eff. 9-11-84; 15 Ky.R. 2314; 16 Ky.R. 35; eff. 8-5-89; 1039; eff. 1-12-90; 22 Ky.R. 2153; eff. 7-5-96; 24 Ky.R. 985; 1533; 1684; eff. 2-17-98; Recodified from 904 KAR 2:055, 10-30-98; 33 Ky.R. 138; 421; eff. 9-1-06.)