P1703 Pre-Hearing Discussion Procedures

MA1703

If the customer states that they disagree with the decision, process the case. Advise the customer that they have the right to have their decision reviewed by a fair hearing liaison.

Does the customer want the decision to be reviewed?

• If YES, select the “End Task” button in HEAplus and switch the customer to the Fair Hearing track. Continue to step 3.

• If NO, advise the customer they still have the right to a Fair Hearing. Skip to step 6.

The Fair Hearing liaison will review all the following:

• Documents and notes in HEAplus for current and prior application;

• Recent documents in OnBase and notes in the “Case Documentation” (CADO) screen of AZTECS;

• All eligibility factors, especially any factors that resulted in a negative outcome; and

• Policy and procedure sections for the relevant topics.

After reviewing all the information available, review any batteries associated with the negative outcome. Is the information in the batteries correct?

• If YES, continue to step 5.

• If NO, correct the batteries and process the case. Continue to step 5.

Explain why the Agency took the action and allow the customer to ask questions. Inform the customer of the legal authorities for the decision. Does the customer still wish to continue with the appeal?

• If YES, continue to step 6.

• If NO, STOP. Complete the pre-hearing process. Document in case notes all actions taken and the result of the pre-hearing discussion.

Review “Case Summary” in HEAplus. Is the “Request an Appeal” link available?

• If YES, click the “Request an Appeal” link. Continue to Step 7.

• If NO, STOP:

  • Complete the FAA-0098A form with the customer.

  • Inform customer that they will receive a letter in the mail with the date of the appeal and the next steps in the appeals process.

  • Fax this form to the Appeals Department at (602)257-7058.

  • Upload a copy to OnBase and mail a copy to the customer.

  • Document in HEAplus the actions taken and the result of the pre-hearing discussion.

Complete the following actions:

• Review the “Appeal Notice” with the customer.

• Complete the Appeal Request Form.

• Enter the appeal date and type.

• Enter the correct address for the customer.

• Select the decision that the customer is appealing.

• Enter the customer’s explanation of why an appeal is being requested.

• Select whether the customer requests an expedited appeal.

• If the customer requests a disability accommodation or an interpreter, select the appropriate checkbox.

• Review form for accuracy and submit.

• Inform customer that they will receive a letter in the mail with the date of the appeal and the next steps in the appeals process.

• Document actions taken and result of pre-hearing discussion in HEAplus and AZTECS case notes.

Was the request received in-person or by telephone?

• If YES, have the Pre-Hearing Discussion immediately when possible. When the Pre-Hearing Discussion cannot be held at that time, schedule the discussion within 10 days. Continue to step 2.

• If NO, contact the customer by phone as soon as possible. Schedule the Pre-Hearing Discussion within 10 days. When unable to contact the customer, send a Pre-Hearing Discussion Appointment Notice (DE-170) form. Continue to step 2.

Prepare a brief outline of the eligibility decision factors along with a timeline of the customer’s coverage.

Complete as much of the Pre-Hearing Discussion/Summary (DE-147) form as possible before the Pre-Hearing Discussion. Include all relevant policies and legal authorities.

When possible, have a supervisor review the information you have prepared.

Explain why the Agency took the action and allow the customer to ask questions.

Allow the customer to explain why the action should not have been taken. Include the explanation on the DE-147.

NOTE     If additional information or proof is needed, explain how the customer can provide the information.

Was the complaint the result of an administrative error?

• If YES, make the necessary corrections. Explain how the correction affects the customer’s eligibility. Continue to step 8.

• If NO, continue to step 8.

Does the customer wish to withdraw the appeal?

• If YES, STOP. Note the customer’s decision on the DE-147. Place a copy of the DE-147 in the hearing packet in DocuWare. Notify the OEA Eligibility Hearing Coordinator that the customer has withdrawn the appeal.

• If NO, continue to step 9.

Explain the customer’s rights and responsibilities using the Hearing Rights Information (DE-154) form. 

Obtain the customer’s signature on the DE-154.

NOTE     If the discussion is not in person, enter your name and date on the form.

Explain that the customer will receive a letter in the mail with the date of the hearing.

Place a copy of the signed DE-154 and the completed DE-147 in the hearing packet in HEAplus or DocuWare as appropriate.