OAR 410-200-0145
Contested Case Hearing

(1) For the purposes of this rule, timely means within 90 days of the date the notice of adverse action is received.
(2) This rule applies to contested case hearings for programs described in OAR chapter 410 division 200, except for individuals receiving HSD Medical Program benefits during a period of Hospital Presumptive Eligibility (OAR 410-200-0105 (Hospital Presumptive Eligibility)). Contested case hearings are conducted in accordance with the Attorney General’s model rules OAR 137-003-0501 (Rules for Office of Administrative Hearings) and following ORS Ch. 183 except to the extent that Authority rules provide for different procedures.
(3) The Authority’s contested case hearings governed by this rule are not open to the public and are closed to nonparticipants, except nonparticipants may attend subject to the parties’ consent and applicable confidentiality laws.
(4) A claimant may request a contested case hearing upon the timely completion of a hearing request in medical assistance programs in the following situations:
(a) The Authority has not approved or denied an application within 45 days of the date of request for benefits or the extended time the Authority has allowed for processing;
(b) The Authority acts to deny, reduce, close, or suspend medical assistance, including the denial of continued benefits pending the outcome of a contested case hearing;
(c) The Authority claims that an earlier medical assistance payment was an overpayment;
(d) A claimant claims that the Authority previously under issued medical assistance;
(e) A claimant disputes the current level of benefits.
(5) An officer or employee of the Authority or the Department of Human Services may appear on behalf of the Authority in medical assistance hearings described in this rule. The Authority’s lay representative may not make legal argument on behalf of the Authority.
(6) The Authority representative is subject to the Code of Conduct for Non-Attorney Representatives at Administrative Hearings, which is maintained by the Oregon Department of Justice and available on its website at http://www.doj.state.or.us. An Authority representative appearing under this rule shall read and be familiar with it.
(7) When an Authority representative is used, requests for admission and written interrogatories are not permitted.
(8) The Authority representative and the claimant may have an informal conference in order to:
(a) Provide an opportunity to settle the matter;
(b) Review the basis for the eligibility determination, including reviewing the rules and facts that serve as the basis for the decision;
(c) Exchange additional information that may correct any misunderstandings of the facts relevant to the eligibility determination; or
(d) Consider any other matters that may expedite the orderly disposition of the hearing.
(9) A claimant who is receiving medical assistance benefits and who is entitled to a continuing benefit decision notice may, at the option of the claimant, receive continuing benefits in the same manner and amount until a final order resolves the contested case. In order to receive continuing benefits, a claimant must request a hearing not later than:
(a) The tenth day following the date the notice is received; and
(b) The effective date of the action proposed in the notice.
(10) The continuing benefits are subject to modification based on additional changes affecting the claimant’s eligibility or level of benefits.
(11) The claimant shall receive an expedited hearing in the following situations:
(a) When the claimant contests the denial of continuing benefits; or
(b) When following the final order timelines in OAR 410-200-0146 (Final Orders, Dismissals and Withdrawals) could jeopardize the individual’s life, health, or ability to attain, maintain, or regain maximum function.
(12) In computing timeliness under sections (1) and (9) of this rule:
(a) The agency follows criteria outlined in 461-125-0310 (Basis of Need; OSIPM)(7); and
(b) The notice is considered to be received on the fifth day after the notice is sent unless the claimant shows the notice was received later or was not received.

Source: Rule 410-200-0145 — Contested Case Hearing, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-200-0145.

410‑200‑0010
Overview 410‑200‑0015
General Definitions 410‑200‑0100
Coordinated Eligibility and Enrollment Process with the Department of Human Services and the Federally Facilitated Marketplace 410‑200‑0105
Hospital Presumptive Eligibility 410‑200‑0110
Application and Renewal Processing and Timeliness Standards 410‑200‑0111
Authorized Representatives 410‑200‑0115
HSD Medical Programs—Effective Dates 410‑200‑0120
Notices 410‑200‑0125
Acting on Reported Changes 410‑200‑0130
Retroactive Medical 410‑200‑0135
Assumed, Continuous, and Protected Eligibility for Children and Pregnant Individuals 410‑200‑0140
Eligibility for Inmates 410‑200‑0145
Contested Case Hearing 410‑200‑0146
Final Orders, Dismissals and Withdrawals 410‑200‑0200
Residency Requirements 410‑200‑0205
Concurrent and Duplicate Program Benefits 410‑200‑0210
Requirement to Provide Social Security Number 410‑200‑0215
Citizenship and Non-Citizen Status Requirements 410‑200‑0220
Requirement to Pursue Assets 410‑200‑0225
Assignment of Rights 410‑200‑0230
Verification 410‑200‑0235
Changes That Must Be Reported 410‑200‑0240
Eligibility for Individuals Who Do Not Meet the Citizen and Non-Citizen Status Requirements 410‑200‑0305
Eligibility Determination Group — MAGI Medicaid/CHIP 410‑200‑0310
Eligibility and Budgeting 410‑200‑0315
Standards and Determining Income Eligibility 410‑200‑0400
Specific Requirements 410‑200‑0405
Specific Requirements 410‑200‑0407
Specific Requirements—Former Foster Care Youth Medical Program 410‑200‑0410
Specific Requirements 410‑200‑0415
Specific Requirements 410‑200‑0420
Specific Requirements 410‑200‑0425
Specific Requirements 410‑200‑0435
Specific Requirements 410‑200‑0440
Specific Requirements 410‑200‑0520
COVID-19 Emergency Policies
Last Updated

Jun. 8, 2021

Rule 410-200-0145’s source at or​.us