(1)A claimant (see OAR 461-025-0305 (Definitions)) has the right to a contested case hearing in the following situations upon the timely completion of a request for hearing:
(a)Except as provided in subsection (o) of this section, the Department has not approved or denied a request or application for public assistance or medical assistance within 45 days of the application.
(b)The Department has not acted timely on an application as follows:
(A)An application for SNAP program benefits, within 30 days of the filing date.
(B)An application for a JOBS support service payment, within the time frames established in OAR 461-115-0190 (Application Processing Time Frames; Not Pre-TANF or SNAP)(3).
(c)The Department acts to deny, reduce, close, or suspend SNAP program benefits, a grant of public assistance, a grant of aid, a support service payment authorized in the JOBS program by OAR 461-190-0211 (Case Plan Activities and Standards for Support Service Payments; JOBS, Pre-TANF, REF, REP, SFPSS, TANF), medical assistance, or child care benefits authorized under Division 160 or 165 of this chapter of rules in the ERDC or TANF child care programs. When used in this subsection, grant of public assistance and grant of aid mean the grant of cash assistance calculated according to the client’s need.
(d)The Department has sent a decision notice (see OAR 461-001-0000 (Definitions for Chapter 461)) that the claimant is liable for an overpayment (see OAR 461-195-0501 (Definitions and Categories of Overpayments)).
(e)The Department modifies a grant of public assistance or a grant of aid; or the claimant claims that the Department previously underissued public assistance, medical assistance, or SNAP program benefits and the Department denies, or denies in part, that claim.
(f)The household disputes its current level of SNAP program benefits.
(g)The filing group (see OAR 461-110-0370 (Filing Group; SNAP)) is aggrieved by any action of the Department that affects the participation of the filing group in the SNAP program.
(h)The claimant asks for a hearing to determine if the waiver of an Intentional Program Violation hearing was signed under duress.
(i)The Department establishes or changes the client’s premium for the Oregon Health Plan.
(j)In the Pre-TANF program, the Department denies payment for a basic living expense (see OAR 461-135-0475 (Specific Requirements; Pre-TANF Program)) or other support service payment in the JOBS program (see subsection (c) of this section).
(k)In the TA-DVS program, when OAR 461-135-1235 (TA-DVS; Right to Hearing) provides a right to a hearing.
(l)A service re-assessment of a client conducted in accordance with OAR Division 411-015 has resulted in a reduction or termination of nursing facility services or home and community-based care (see OAR 461-001-0030 (Definitions; OSIP, OSIPM Long-Term Care or Home and Community-Based Care)).
(m)The claimant’s benefits are changed to vendor, protective, or two-party payments.
(n)Department has issued a notice seeking repayment under ORS 411.892 (Employer eligibility) to an employer participating in the JOBS program.
(o)In the OSIP and OSIPM programs, when the Department has not approved or denied an application within the time frames established in OAR 461-115-0190 (Application Processing Time Frames; Not Pre-TANF or SNAP).
(p)The right to a hearing is otherwise provided by statute or rule.
(q)To resolve a grievance under 45 CFR 261.70 against an employer. A hearing request under this subsection must be in writing with the claimant’s name, address, and daytime phone number (if available). The hearing request must be received by the Department within 45 days of the alleged violation or within 30 days after completion of an employer grievance process.
(2)A client is not entitled to a hearing on the question of the contents of a case plan (defined in OAR 461-190-0151 (Case Planning; JOBS, Pre-TANF, REP, SFPSS, TA-DVS)) unless the right to hearing is specifically authorized by the Department’s rules. For a dispute about an activity in the JOBS program, the client is entitled to use the Department’s re-engagement process (see OAR 461-190-0231 (Re-engagement; JOBS, Pre-TANF, REP, SFPSS, TA-DVS)). In the TA-DVS program, a dispute about the contents of a TA-DVS case plan is resolved through re-engagement if there is no right to a hearing under OAR 461-135-1235 (TA-DVS; Right to Hearing).
(3)A request for hearing is complete:
(a)In public assistance and SNAP programs, when the Department’s Administrative Hearing Request form (form DHS 443) is:
(B)Signed by the claimant, the claimant’s attorney, or the claimant’s authorized representative (see OAR 461-115-0090 (Authorized Representatives; General)); and
(C)Received by the Department. OAR 137-003-0528 (Late Hearing Requests)(1)(a) (which allows hearing requests to be treated as timely based on the date of the postmark) does not apply to hearing requests contesting a decision notice (see OAR 461-001-0000 (Definitions for Chapter 461)). The Department has adopted the exception to the Attorney General’s model rules set out in this paragraph due to operational conflicts.
(b)In the SNAP program, when the Department receives an oral or written statement from the claimant, the claimant’s attorney, or the claimant’s authorized representative that the claimant wishes to appeal a decision affecting the claimant’s SNAP program benefits to a higher authority.
(c)In the case of a provider of child care, when a written request for hearing from the provider is received by the Department.
(d)For medical assistance, when a hearing request is made in a manner permitted under OAR 410-200-0145 (Contested Case Hearing) or this section.
(4)In the event a request for hearing is not timely, the Department may issue an order of dismissal if there is no factual dispute about whether sections (7) and (10) of this rule provide a right to a hearing. The Department may refer an untimely request to the Office of Administrative Hearings for a hearing on the question of timeliness.
(5)In the event the claimant has no right to a contested case hearing on an issue, the Department may enter an order accordingly. The Department may refer a hearing request to the Office of Administrative Hearings for a hearing on the question of whether the claimant has the right to a contested case hearing.
(6)For medical assistance, to be timely, a hearing request must be received by the Department or the OHP Customer Service in the time frame set out in OAR 410-200-0015 (General Definitions) and 410-200-0145 (Contested Case Hearing). In other programs, to be timely, a completed hearing request must be received by the Department not later than:
(a)Except as provided in subsection (b) of this section, the 45th day following the date of the decision notice (see OAR 461-001-0000 (Definitions for Chapter 461)) in public assistance programs.
(b)The 90th day following the effective date of the reduction or termination of benefits in a public assistance program if the reduction or termination of aid is a result of a JOBS disqualification (see OAR 461-130-0330 (Disqualifications; Pre-TANF, REF, SNAP, TANF)) or a penalty for failure to seek treatment for substance abuse or mental health (see OAR 461-135-0085 (Requirement to Attend an Assessment or Evaluation, or Seek Medically Appropriate Treatment for Substance Abuse and Mental Health; Disqualification and Penalties; Pre-TANF, REF, TANF)).
(c)The 90th day following the date of the decision notice in the SNAP program, except:
(A)A filing group may submit a hearing request at any time within a certification period (see OAR 461-001-0000 (Definitions for Chapter 461)) to dispute its current level of benefits.
(B)A filing group may submit a hearing request within 90 days of the denial of a request for restoration of benefits if not more than twelve months has expired since the loss of benefits.
(d)The 30th day following the date of notice from the Oregon Department of Revenue in cases covered by ORS 293.250 (Collections Unit).
(e)In a case described in subsection (1)(h) of this rule, the request must be made within 90 days of the date the waiver was signed.
(7)When the Department receives a completed hearing request that is not filed within the timeframe required by section (6) of this rule but is filed no later than 120 days after a decision notice became a final order:
(a)The Department refers the hearing request to the Office of Administrative Hearings for a contested case hearing on the merits of the Department’s action described in the notice:
(A)If the Department finds that the claimant and claimant’s representative did not receive the decision notice and did not have actual knowledge of the notice; or
(B)If the Department finds that the claimant did not meet the timeframe required by section (6) of this rule due to excusable mistake, surprise, excusable neglect (which may include neglect due to significant cognitive or health issues), good cause (see OAR 461-025-0305 (Definitions)), reasonable reliance on the statement of a Department employee relating to procedural requirements, or due to fraud, misrepresentation, or other misconduct of the Department.
(b)The Department refers the request for a hearing to the Office of Administrative Hearings for a contested case proceeding to determine whether the claimant is entitled to a hearing on the merits if there is a dispute between the claimant and the Department about either of the following paragraphs.
(A)The claimant or claimant’s representative received the decision notice or had actual knowledge of the decision notice. At the hearing, the Department must show that the claimant or claimant’s representative had actual knowledge of the notice or that the Department mailed or electronically mailed the notice to the correct address of the claimant or claimant’s representative, as provided to the Department.
(B)The claimant qualifies for a contested case hearing on the merits under paragraph (a)(B) of this section.
(c)The Department may only dismiss such a request for hearing as untimely without a referral to the Office of Administrative Hearings if the following requirements are met:
(A)The undisputed facts show that the claimant does not qualify for a hearing under this section; and
(B)The decision notice was served personally or by registered or certified mail.
(8)In computing the time periods provided by this rule, see OAR 461-025-0300 (Contested Case Hearings)(1).
(9)In the REF and REFM programs, a client is not eligible for a contested case hearing when assistance is terminated because the eligibility time period imposed by OAR 461-135-0900 (Specific Requirements; REF, REFM) has been reached. If the issue is the date of entry into the United States the Department provides for prompt resolution of the issue by inspection of the individual’s documentation issued by the US Citizenship and Immigration Services (USCIS) or by information obtained from USCIS, rather than by contested case hearing.
(10)If the Department receives a hearing request more than 120 days after an overpayment notice became a final order by default:
(a)The Department verifies whether its records indicate that the liable adult requesting the hearing was sent the overpayment notice.
(b)If no overpayment notice was sent to that liable adult, the overpayment hearing request is timely. The Department will send the claimant a decision notice or a contested case notice.
(c)If the Department determines that an overpayment notice was sent to the liable adult, there is no hearing right based on the issue of whether or not the overpayment notice was received.
(d)Any hearing request is treated as timely when required under the Servicemembers Civil Relief Act.
(e)The Department may dismiss a request for hearing as untimely if the claimant does not qualify for a hearing under this section.
(11)If the Department receives a hearing request more than 120 days after a decision notice (other than an overpayment notice) became a final order by default:
(a)Any hearing request is treated as timely when required under the Servicemembers Civil Relief Act.
(b)The Department may dismiss a request for hearing as untimely if the claimant does not qualify for a hearing under subsection (a) of this section.
(12)Notwithstanding sections (7), (10), and (11) of this rule, for medical assistance, the time frame is the same as the one in OAR 410-200-0146 (Final Orders, Dismissals and Withdrawals) instead of 120 days.
Rule 461-025-0310 — Hearing Requests,