120-8  Fair Hearing Decisions

Effective:  April 1, 2006 - June 30, 2010

Previous Policy Reference

The Hearing Officer must issue a written recommendation to the Director of the Division of Health Care Financing.  The Director will review the recommendation and issue a final decision.

Although there is no time limit for issuing a Final Agency Action after the hearing officer issues a recommended decision, a Final Agency Action must be issued within 90 days of the initial hearing request.

A copy of the final decision is sent to the Bureau of Access Director and/or Director of the Bureau of Eligibility Services, the Regional Manager, the local office involved in the hearing, the enrollee, and the enrollee's authorized representative, as applicable.

1. What Must Be Included in the Decision

   1. A description of the evidence that was presented.

   2. Finding of Fact based on the evidence.  The decision must be based on more than just hearsay evidence.

   3. Laws and rules upon which the decision was based.

   4. Why such laws and rules apply to these facts and result in this decision.

2. What To Do When a hearing Decision is Received

1.  The local eligibility worker must comply within 10 days.  A hearing decision is binding on both the state and the local offices for the case in question.

2.  The Bureau Director, Regional Manager, or designee must review the case within thirty days to make sure the action has been taken.

3.  The State Bureau of Access and/or the Bureau of Eligibility Services will look at corrective action if a decision indicates a statewide problem.

4. What To Do if the Decision or Appeal Causes an Overpayment

When the hearing sustains the agency, report the ineligible case to the Office of Recovery Services using the process set up for your area. ORS will recover the assistance overpaid pending a hearing according to CHIP overpayment procedures.