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The processes below provide detailed information about steps to take when you are preparing to testify at an eligibility appeal. They include information about:
Preparing for the hearing;
How to present testimony at an hearing;
Standard questions you should be prepared to answer.
Review the legal authorities printed on the decision notice. The Administrative Law Judge (ALJ) may ask you questions about how the legal authorities apply to the decision.
NOTE If you have any questions, or if the legal authorities on the notice do not appear to apply to the decision, contact your Agency’s appeals office. The contact information for the appeals office will be provided with the request for your testimony.
Prepare a brief outline of all the information that was used to determine eligibility, Share of Cost (SOC), or KidsCare premium amount;
Review the case with your supervisor; and
Review “How to Present at Hearing” below for recommendations regarding etiquette and protocol.
You will be invited to a preparation meeting with your Agency’s appeals staff. The meeting will take place about a week before the hearing. If you have not been invited to a preparation meeting and there is less than a week to go before the hearing, notify your Agency’s appeals office.
For most hearings, Agency representatives and Agency witnesses will appear by phone. When appearing by phone, have the following pulled up on your computer and available for the hearing:
The hearing packet, either in HEAplus or DocuWare;
The customer’s case file in HEAplus;
The relevant Eligibility Policy Manual; and
A brief outline of all the information that was used to determine eligibility, Share of Cost (SOC), or premium amount.
Follow these guidelines when representing the Administration at hearings:
Be prepared and on time, whether attending in person or telephonically.
Dress professionally when attending in person.
Speak directly to the ALJ when testifying or answering questions.
Address the ALJ as "Your Honor" or “Sir” or “Madam”.
Be formal when addressing anyone else in the hearing. Do not use first names.
When the ALJ or attorney asks you a question, make your response as brief as possible. Answer with a simple yes or no when possible.
When you do not know the answer to a question, simply reply: "I do not know."
Do not make unnecessary comments or offer any information that you are not specifically asked to provide.
Testify only about information that you have first-hand knowledge of (i.e., something you witnessed or experienced).
Do not speculate, guess, or predict what may or may not happen in the future, in changed circumstances, or in hypothetical situations. If the ALJ directly asks you a hypothetical question, provide a professional answer in accordance with rules, procedures and policies. Introduce your answer by stating that the answer is in response to the hypothetical situation.
When you did not hear the question clearly, or do not understand it, ask that the question be repeated or rephrased. Do not guess at an answer to a question that you do not completely understand.
Answer one question at a time. When you are asked several questions in a row, make clear which answer applies to what question.
When the ALJ instructs you to take an action, do not agree or disagree with the ALJ. Simply take the action.
Avoid becoming frustrated and stay calm and courteous at all times, regardless of the situation.
When you are asked your opinion, respond that you do not have an opinion, or that your personal opinion is not relevant to the matter. However, when the ALJ instructs you to answer, give a professional opinion based upon policies.
If asked about policy, read passages from the policy manual rather than trying to recite from memory.
Be courteous to the complainant without being overly familiar.
A generic response to a variety of questions is: "A determination was made based upon information received during that time."
A brief recess or break may be requested when good cause exists.
When testifying, do not let attorneys or other parties confuse or sway you. Remember that your testimony and the original eligibility decision are in accordance with Medical Assistance rules, policies and procedures.
When the customer's eligibility status has changed since the adverse action, always suggest that the complainant may reapply.
The ALJ will generally begin your testimony with several standard questions. Be prepared to answer each of the questions listed below.
Where are you employed?
What are your duties?
How long have you worked in that capacity?
What is your education and professional background?
Approximately how many times have you determined an individual's eligibility?
How was the eligibility decision made?
Who was involved in the eligibility decision process?
When did the described events occur?
What actions did you take and what did you observe?
What records did you review and with whom did you speak?
When was the date of the customer’s application?
What was the date of the customer’s Notice of Action?
Was a Pre-Hearing Discussion held? If so, when? Who was present? What was the result?