Seniors and People with Disabilities Policy Transmittal Cathy Cooper Number: SPD-PT-08-015 Authorized Signature Issue Date: 7/30/2008 Topic: Long Term Care Transmitting (check the box that best applies): New Policy Policy Change Policy Clarification Executive Letter Administrative Rule Manual Update Other: Applies to (check all that apply): All DHS employees Area Agencies on Aging Children, Adults and Families County DD Program Managers County Mental Health Directors Health Services Seniors and People with Disabilities Other (please specify): SPD Central Office Policy/Rule Title: Changes in Special Needs to Support Nursing Facility Diversion Policy/Rule Number(s): 461-155-0500, 461-155-0526, 461-155-0600, 461-155-0610, 461-155- 0700 Release No: Effective Date: August 1, 2008 Expiration: none References: Web Address: Discussion/Interpretation: The Department is making some changes to special needs rules in order to support increased use of home- and community-based care setting placements in lieu of placements in nursing facilities. This transmittal explains the specific rule changes. OAR 461-155-0500. This is an overview rule that applies to all of the special needs rules, and it is being updated simply so that it matches the other rule changes. OAR 461-155-0526. This rule addresses the use of community transition services when a client is being discharged from a nursing facility. It is now more restrictive, DHS 0079 (02/04)
because now it can be used only to place clients (1) in their own home or apartment or (2) in an assisted living facility (ALF), and not other community-based care facilities. Other rule changes below will address the needs for the other facilities. When a payment is authorized for a client moving to an ALF, the payment cannot cover any item that the ALF is required to provide by rule or contract. The rule is also being changed to specify that payments can be issued to purchase climate control devices (such as window air conditioners), but payments cannot be issued to purchase lift chairs. Payment method: Continue to authorize payments for community transition services using Special Cash Pay reason code 49. OAR 461-155-0600. This is the home repairs rule. It is being made less restrictive, by now allowing more than one repair in a 24-month period. The payment limit for the rule is still $1000 in 24 months. However, it now allows the Department to pay $600 to fix the plumbing in one month, and then $400 to fix a leaky window in the same 24-month period. The total of all home repairs made in a 24-month period cannot exceed $1000. The intent of this change is to pay for home repairs more often than once in a 24- month period to allow more homeowners to continue receiving in-home care. When using the CMS N/R coding to track the incidence of these payments, continue to code the SHR N/R and the appropriate 24-month end date when the first payment is made. If the client requests a second payment for home repairs in that 24-month period, check the case record to determine how much of the total allowable $1000 has already been issued, and authorize up to the total in subsequent payments. Do not exceed $1000 for the 24-month period, however. Note a clarification that has been added to the home repairs rule. If the client is married, the client s spouse is considered a resource when authorizing a payment. When both spouses own the home, the client s share of any home repair is only half of the total cost. This is because the spouse is also half owner of the home and is responsible for paying his or her half. After the repair is completed, the spouse will realize an increase in the equity value of the home equal to his or her half ownership. Therefore, the spouse is expected to contribute his or her half of the cost of the home repair in order to realize that increased value. Payment method: Continue to authorize payments for home repairs using Special Cash Pay reason code 40. OAR 461-155-0610. This is the moving cost rule. It has a new higher limit for the cost of moving belongings; an increase from $300 to $500. In addition, two new situations when authorizing payment for moving costs have been added: When a service client s care needs increase or decrease, and To move a client out of state. DHS 0079 (02/04)
Payment method: Continue to authorize payments for moving costs using Special Cash Pay reason 42. OAR 461-155-0700. This is a new rule that allows payment of all or part of the personal incidentals and room and board related to community-based care settings, in specific situations when the client does not have enough income for those costs. Only clients leaving a permanent nursing facility placement or acute care hospital are eligible for this special need. There are four categories of clients eligible for this special need, as explained below. Clients determined eligible by the Presumptive Medicaid Disability Determination Team (PMDDT). If a PMDDT client has been placed in a nursing facility because they were unable to pay the room and board in a community setting, this special need will allow the client to move back to the community. If the client has zero income, the special need payment amount is the OSIPM standard (currently $638.70). If the client has other countable income, the payment amount is reduced by that income. For example, if the client receives $250 per month from a deceased relative s trust, the payment amount would be $638.70 (OSIPM standard) - $250 trust benefits = $388.70 special need per month. Clients whose benefits have been reduced to $30 or $90 despite the fact that they are leaving a nursing facility and being placed in community-based care. This happens erroneously in some situations where the client receives SSI or Veterans benefits. Special needs payments can be made until the client s benefits are restored to the correct amount. If the client has $30 income, the special need payment amount is $638.70 - $30 = $608.70, for example. Clients who lost their SSI payment because of their non-citizen status. If a noncitizen client has been placed in a nursing facility because they lost their SSI and were unable to pay the room and board in a community setting, this special need will allow the client to move back to the community. The payment amount is calculated the same as for PMDDT clients above. Clients who are placed in a nursing facility because that results in a larger community spouse income allowance (CSIA) to meet the spouse s monthly maintenance needs. In cases where the community spouse has chosen a nursing facility placement for the client because the spouse will get a larger CSIA, this special need will allow the client to move back to a community-based care setting. The payment amount is the difference between the calculated CSIA and the amount of income available to divert from the client, up to a maximum of the OSIPM standard ($638.70). For example: A client has $800 SSD income. The spouse has $1600 countable income and pays shelter costs of $500 rent and $319 full utility standard. $500 + $319 = $819 shelter - $525 = $294 excess shelter. The spouse s calculated DHS 0079 (02/04)
monthly need, then, is $1750 (basic need) + $294 (excess shelter) = $2044. This amount ($2044) minus the spouse s income of $1600 = $444 CSIA. While the client is in a nursing facility, the spouse receives the full CSIA. However, should the client move to the community, the amount of income available to divert would be $800 SSD - $638.70 = $161.30. The special need payment for this case would be $444 (calculated CSIA) - $161.30 income available to divert = $282.70. Using this special need, the spouse receives the full CSIA ($1600 income + $161.30 LDS + $282.70 special need = $2044), which allows the client to move back to the community. Please see the attached new OSIP Worker Guide 12 for more calculation examples. This Worker Guide will be posted in the OSIP Manual. As explained in the Worker Guide, also please use the new Notice of Payment Responsibility (DHS 547) instead of the 512 for the client and provider in these situations. Payment method: Use Special Cash Pay reason 13 to issue all payments under this special needs rule. Issue the payment to the client who is then responsible for paying the room and board to the provider or diverting the income to the community spouse for the LDS. Implementation/Transition Instructions: None. Training/Communication Plan: Issuance of this Policy Transmittal and a training session with Diversion and Transition Coordinators is scheduled for August 20, 2008. Local/Branch Action Required: Effective August 1, 2008, staff can begin making special needs payments consistent with these rule changes to support home- and community-based care placements in lieu of nursing facility placements. Central Office Action Required: Provide technical assistance as questions from field staff arise. Field/Stakeholder review: Yes No If yes, reviewed by: Filing Instructions: DHS 0079 (02/04)
If you have any questions about this policy, contact: Contact(s): Joanne Schiedler Phone: (503) 947-5201 Fax: (503) 947-5357 E-mail: joanne.r.schiedler@state.or.us DHS 0079 (02/04)
461-155-0500 Special Needs; Overview (1) In the GA, GAM, MAA, MAF, OSIP, OSIPM, REF, REFM, and TANF programs, special needs are needs not included in the basic standard. They may be one-time needs or ongoing needs. (2) Ongoing special needs are needs that last several months at a consistent cost. Examples are special diets and shelter exceptions accommodation allowances. OAR 461-155-0010 is used to determine how special needs are considered for each program. (3) Some special need items replace the standard allowances and do not change the standard payment. No additional payments are made for these items, for instance room and board or adult foster care. (4) To be eligible for a special need item, clients must have no other available resources in the community or in their natural support system to meet the need, excluding resources used in determining eligibility. (5 4) To be eligible for a special need item, clients must not be eligible for the item through Medicare, Medicaid, or any other medical coverage. (5) Clients may be eligible for an ongoing special need item if providing the ongoing special need item is authorized in lieu of additional provider service hours pursuant to OAR 411-030-0002 through 411-030-0090 and is more cost-effective. (6) The Department will authorize payment for one-time and ongoing special needs for the following, in accordance with the rules that follow OAR 461-155-0510 through 461-155-0680: (a) One-time needs for the following: (A) Home adaptations to accommodate a client's physical condition (see OAR 461-155-0551) (B) Home repairs (see OAR 461-155-0600) (C) Moving costs (see OAR 461-155-0610) (D) Property taxes (see OAR 461-155-0620) (E) Transportation costs (F) Community transition services (see OAR 461-155-0526) (F) Community based facility room and board (see OAR 461-155-0630)
(b) Ongoing needs for the following: (A) Adult foster care (AFC) (B) Food for guide dogs and special assistance animals (see OAR 461-155- 0530) (C B) Laundry allowances (see OAR 461-155-0580) (D C) Residential care facility (RCF) or assisted living facility (ALF) (E D) Restaurant meals (see OAR 461-155-0640) (F) Room and board (G E) Shelter exceptions Accommodation allowances (see OAR 461-155- 0660) (H F) Special diet allowances (see OAR 461-155-0670) (I G) Telephone allowances (see OAR 461-155-0680) (7) In the GA, GAM, OSIP, and OSIPM programs, payment for a one-time special need will be authorized if providing for the need will sustain the client's independence and stability. This includes payments to prevent foreclosure resulting from nonpayment of property taxes and payments for adaptations to the home for reasonable accommodation of physical needs. Ongoing special needs are to be provided to enhance the client's ability to meet an unmet maintenance need such as a telephone allowance in lieu of additional service hours or due to a rural setting. Ongoing special needs are to be considered if the client cannot meet these needs through family support or other service organizations that provide funding for persons who are elderly or disabled. Stat. Auth.: ORS 411.060 Stats. Implemented: ORS 411.070
461-155-0526 Special Need; Community Transition Services; OSIP and OSIPM (1) In the OSIP and OSIPM programs, the Department will authorize one-time payments for allowable expenses necessary for clients to set up housing in Oregon in their own homes or apartment, not including an adult foster home or an assisted living facility as long as the facility is not required to provide the item covered by the payment by contract or by the administrative rule governing assisted living facilities (OAR 411-054-0000 through 411-054-0300). Payments are allowed only for the following clients who are returning to the community if they meet the criteria for one of the service priority levels served by the Department according to OAR 411-015-0015(1)-- (a) (b) Clients leaving a nursing facility. Clients who have been admitted as an inpatient and are leaving an acute care hospital. (2) Examples of allowable expenses are expenses for moving belongings; housing security deposits; essential furnishings; eating utensils; food preparation items; deposits for utility hook-ups for heat, electricity and telephone; climate control; and health and safety measures such as pest eradication or allergen control. Allowable expenses do not include rent for housing or temporary housing, ongoing utility costs, medical supplies such as lift chairs, reachers, grabbers, wheelchairs, and transfer trays, or recreational items such as a television or cable television access. (3) Payment will be authorized only for the minimum amount necessary to establish the client's basic living arrangement. Stat. Auth.: ORS 411.060 Stats. Implemented: ORS 411.060
461-155-0600 Special Need; Home Repairs, GA, OSIP and OSIPM In the GA, OSIP and OSIPM programs, the Department will authorize a special need payment for home repairs for homeowners or buyers as a one-time special need within the following limits: (1) The repairs must be needed to remove a physical hazard to the health and safety of the client. (2) Payment for repairs authorized by this rule--- (a) May be authorized for not more than one repair in any 24-month period; (b a) Is limited to the least expensive means possible; and (c b) Cannot exceed $1,000 in any 24-month period. (c) When the home is jointly owned, is limited to a percentage of the cost of the repairs equal to the percentage of client ownership. (3) Payments necessary for a one-time home repair may be made over a period not to exceed 30 consecutive days. (4) A filing group that has received a home repair payment under this rule is not eligible for a home repair payment again until the first day of the 24th month following the first payment that was made for the most recent home repair. (5 3) The repairs must cost less than moving to another home. (6 4) Payment is limited to the lowest possible cost that will provide adequate facilities. The client must provide three competitive bids for the repairs, unless there are not three providers of the service in the local area. (7 5) Before approving payment for repairs or new installations, the Department will consider the use value and will determine whether it is consistent with the care service plan for the client to remain in the house. Providers of the repairs or new installations must ensure that the work being completed meets current building codes. (6) Providers of the repairs or new installations must ensure that the work being completed meets current building codes. (8 7) Repairs or replacements include, but are not limited to: (a) Electrical wiring that does not constitute conversion to electrical space heating but that is needed:
(A) (B) To avoid condemnation; or To remove a definite fire or shock hazard as documented by appropriate public officials. (b) Plumbing--but not including the costs of plumbing items with which the house is not already equipped except that a toilet may be paid for when newly required by the creation or extension of a sewer district. Examples of what plumbing-related items may be covered include: (A) (B) (C) Toilets and sinks. Cleaning or replacing septic tanks or cesspools. Installing sewer connections from house to street--but not sewer installation--if required by the creation of a new sewer district or the extension of an existing district. (c) (d) (e) (f) Repair or replacement of existing electric pumps for wells needed to continue the water supply. This does not include drilling a new well. Heating equipment--repair of heating stoves, furnaces and water heaters and, if repair is not possible, replacement with the least expensive adequate equipment. Repair of roofs. Repair or replacement of steps and repair of floors. (9 8) Clients with life estates are not eligible for this special need allowance. The person who will benefit from the life estate, following the death of the client, is considered responsible for the home repairs. Stat. Auth.: ORS 411.060 Stats. Implemented: ORS 411.060
461-155-0610 Special Need; Moving Costs (1) In the GA, OSIP and OSIPM programs, the Department will authorize payment for the cost of moving a client s household effects as a one-time special need if-- (a) (b) (c) (d) (e) Moving is essential to provide nonhazardous housing. "Hazardous" housing means a building so deteriorated and unsafe that it is uninhabitable or subject to condemnation. If no official certification to that effect can be obtained, the condition of the dwelling must have been seen by a Department employee and documented in the case record. The client has been evicted for reasons other than his or her own neglect or failure to make rent or house payments. The move is a result of domestic violence or protective services. For a client in a nonstandard living arrangement (see OAR 461-001-0000), the client must move because the level of needed services increases or decreases. The client s needs would be better met out of state. (2) The Department will not authorize payment of expenses to return the client to a state of former residence. (3) Payment for moving costs authorized by this rule-- (a) (b) (c) May be authorized for not more than one move in any 12-month period; Is limited to the least expensive means possible; and Cannot exceed $300 $500 in any 12-month period. (4) Payments necessary for a one-time move may be made over a period not to exceed 30 consecutive days. (5) A filing group that has received a payment for moving costs under this rule is not eligible for a moving cost payment again until the first day of the 12th month following the first payment that was made for the most recent month. Stat. Auth.: ORS 411.060 Stats. Implemented: ORS 411.070
461-155-0700 Special Need; Personal Incidentals and Room and Board Allowance; OSIP and OSIPM THIS IS A NEW RULE (1) Personal incidental and room and board allowances are allowed for the following OSIP and OSIPM clients leaving a nursing facility or an acute care hospital to reside in a community based care facility (see OAR 461-155-0630). (a) An individual who is determined eligible based on a disability determination made by the Department (see OAR 461-125-0370). (A) (B) To receive this payment, a client must pursue SSI by making application with the Social Security Administration (SSA) and appealing denials until SSA makes a final administrative decision. If SSI is denied at the final administrative level, the client is no longer eligible for this payment. The payment is the difference between the client's countable income and the OSIPM adjusted income standard (see OAR 461-155-0250). (b) (c) An individual who is leaving a nursing facility and limited to a maximum SSI payment of $30 or to a maximum Veterans benefit payment of $90. The payment is the difference between the client's countable income and the OSIPM adjusted income standard (see OAR 461-155-0250). An individual who has lost eligibility for SSI due to the individual s qualified non-citizen status and has not met the requirements to become a naturalized citizen. (A) (B) The individual must pursue naturalization. The payment is the difference between the client's countable income and the OSIPM adjusted income standard (see OAR 461-155-0250). (d) An individual who does not have sufficient income to cover the needs of the individual s community spouse income allowance as outlined in OAR 461-160- 0620(3)(d). The allowance is the lesser of the following: (A) (B) The OSIPM adjusted income standard (see OAR 461-155-0250); or The difference between the calculated community spouse income allowance (see OAR 461-160-0620(3)(d)) and the amount of income that the client has available to divert to the community spouse. (2) The payment amount is prorated in the first month for clients who move to a community based care facility on any day other than the first day of the month.
Stat. Auth.: ORS 411.060 Stats. Implemented: ORS 411.070
Worker Guide: Issuing Special Needs Payments for Personal Incidentals and Room and Board This worker guide is not policy. It contains guidance and examples for help in understanding the purpose of and correct application of Oregon Administrative Rule 461-155-0700. For OSIPM clients who need long term care services, it is the Department s goal to place the client in the least restrictive care setting that is appropriate for the client s level of care and care setting preference. Therefore, under OAR 461-155-0700 the Department can make special needs payments for personal incidentals/room and board in 4 situations where the client: Is leaving a nursing facility or acute care hospital to reside in a communitybased care facility, and Does not have enough income to pay for personal incidentals and room and board in a community-based care facility, or May have enough income for the personal incidentals/room and board, but then does not have enough remaining to pay the community spouse s full income allowance. Payments cannot be made under this rule for clients receiving services in their own homes. Special needs payments under this rule are issued by Authorization of Cash Payment (DHS 437) using pay reason 13. Issue the payment to the client who is then responsible for paying the total room and board cost to the service provider or diverting income to the community spouse. In addition, CMS will not be programmed to make these payments at this time. Because the payments are made by Special Cash Pay, figures on the 512 will not reflect accurate information. Please send a Notice of Payment Responsibility (DHS 547) to the provider and the client instead of the 512, when the first payment is issued and each time the payment amount changes. If you are making a partial month payment because the client moves mid-month, use the chart in SPD Worker Guide F-7 to calculate the prorated amount. For example, if the payment amount is $400 and the client moves on August 13, the calculation is $400 X 61.29% (from the chart) = $245.16 prorated payment. Use the first column on the DHS 547 to notify the client and the provider of the prorated payment amount, and use the second column on the form to notify each of them of the first full-month payment amount. Fill out the form only once, using the client s (or client s representative) name as the mailing address. Copy the
notice that is sent to the client and highlight the cc: Service Provider name at the bottom. Put it into an envelope addressed to the provider. This notice is designed to work the same as the 512; each person gets a copy of the same notice but it is sent in envelopes addressed to different people. Note that in the liability calculation (see OAR 461-160-0620), the client s personal needs and room and board are the first and second deductions. The next deduction is for the community spouse s needs. Therefore, due to the order of the deductions required by this rule, no other deductions (e.g., medical costs) are considered when issuing this special needs payment. Also, clients who receive these payments while they are awaiting receipt of SSI, will most likely receive a lump sum SSI payment at some point in the future. When that SSI lump sum payment is received, it is excluded for 9 months (see OAR 461-145-0510). Following are examples of how to calculate special needs payments under this rule: 1. Presumptive Medicaid Disability Determination Team (PMDDT) clients. Many PMDDT clients have little or no income because they have applied for SSI but have not been approved yet. These clients who move out of a nursing facility or are discharged from an acute care hospital to a community-based care setting are eligible for a payment of up to the OSIPM standard (currently $638.70). The payment amount is reduced by the client s countable income. Example 1: Horace is residing in nursing facility and is a PMDDT client with zero income. Horace wants to move to an adult foster home (AFH). Issue Horace a special need payment of $638.70 per month to cover his personal needs and room and board in the AFH until his SSI is approved. Example 2: Greta is residing in a nursing facility and is a PMDDT client. She receives $400/month income from a trust that her deceased grandmother funded for her. Greta wants to move to a residential care facility (RCF). Calculate Greta s payment as follows: $638.70 - $400 trust income = $238.70. Issue Greta a special needs payment of $238.70 per month. NOTE: The client is only eligible for these ongoing payments if he or she continues to pursue the SSI application by appealing denials. If the Social
Security Administration (SSA) makes a final administrative decision that the client is not eligible for SSI, send timely notice to end the payments. 2. Clients whose social security or veterans benefit income is erroneously reduced in a community-based care setting. Sometimes when a client moves from a nursing facility or acute care hospital to a community-based care setting the benefit amount erroneously remains at the nursing facility rate for a period of time. These clients are eligible for a payment of up to the OSIPM standard (currently $638.70). The payment amount is reduced by the client s countable income. Example 3: Ivamae is residing in a nursing facility and receives $30 SSI income. After her condition improves, she moves to an assisted living facility (ALF); however, her SSI remains at $30. Issue Ivamae a special need payment of $638.70 - $30 income = $608.70 per month to cover her personal needs and room and board in the ALF until her SSI is increased to the full benefit amount. Example 4: Kermit is residing in a nursing facility and receives $90 Veterans benefits. After his condition improves, he moves to an AFH; however, his benefits remain at $90. Issue Kermit a special need payment of $638.70 - $90 income = $548.70 until his Veterans benefit is increased to the full benefit amount. 3. Clients who lose their SSI because they have exceeded the time allowed to become a naturalized citizen. Qualified non-citizens receive SSI for 7 years to allow them to have time to become a naturalized citizen. If the non-citizen fails to become a citizen within that time, the SSI ends. These clients who move out of a nursing facility or are discharged from an acute care hospital to a community-based care setting are eligible for a payment of up to the OSIPM standard (currently $638.70). The payment amount is reduced by the client s countable income. The calculation is the same as for PMDDT clients above. NOTE: The client is only eligible for these ongoing payments if he or she continues to pursue becoming a citizen. Send a timely notice to end the benefits if the client fails, without good cause, to take necessary steps to become a citizen. A client who is not competent, for example, would have good cause for failing to pursue naturalization.
4. Clients who are placed in a nursing facility because in a community-based care setting the community spouse would not receive the full calculated income allowance. Sometimes a client is placed in a nursing facility because it allows more of the client s income to be diverted to the community spouse. The spouse would experience a financial hardship if the client moved to a community-based care setting. These clients who move out of the nursing facility to a communitybased care setting are eligible for a special needs payment so that there is enough money available for the full community spouse income allowance (CSIA) (See OAR 461-160-0620(3)(d)). Issue the payment to the client who is then responsible for diverting the appropriate LDS amount to the community spouse. Example 5: Mr. X resides in a nursing facility and has $800 SSB income. Mrs. X resides in a rental that costs $500 + utilities, and has $1600 countable income. The total shelter costs are $500 rent + $319 utilities = $819. Subtracting the standard $525 results in $294 excess shelter. The minimum monthly need $1750 + $294 excess shelter = $2044 (Mrs. X s total needs). Mrs. X has $1600 income, so she is lacking $2044 monthly needs - $1600 income = $444 CSIA to meet her needs. While Mr. X is in the nursing facility, he is able to pay the full $444. When Mr. X moves to a residential care facility, calculate the special needs payment as follows: Mr. X has $800 SSB - $638.70 = $161.30 LDS. $2044 (Mrs. X s total needs) - ($1600 income + $161.30 LDS) = $282.70 special need payment. This payment to the client allows Mrs. X to have the full calculated CSIA ($161.30 LDS + $282.70 special need = $444 CSIA). Example 6: Mr. W resides in a nursing facility and has $950 SSB income. Mrs. W resides in a home that is paid off, has taxes and insurance costs of $115 + utilities, and has $1150 countable income. The total shelter costs are $115 + $319 utilities = $434, so there is no excess over $525. The minimum monthly need $1750 applies. Mrs. W has $1150 income, so she is lacking $1750 monthly needs - $1150 income = $600 CSIA to meet her needs. While Mr. W is in the nursing facility, he is able to pay the full $600. When Mr. W moves to assisted living facility, calculate the special needs payment as follows: Mr. W has $950 SSB - $638.70 = $311.30 LDS. $1750 (Mrs. X s total needs) - ($1150 income + $311.30 LDS) = $288.70 special need payment. This payment to the
client allows Mrs. W to have the full calculated CSIA ($311.30 LDS + $288.70 special need = $600 CSIA).
Notice of Payment Responsibility Date: Name: Address: City, State Zip: Dear [Name]: This notice is regarding how facility costs will be paid in this case. The Department is making a special payment to the client by mail to help with the room and board costs. The payment has not been programmed into our main computer system, so we are sending this special notice to let you know what part of the costs the client will pay and what part Medicaid will pay. Effective [Date], the amounts will be paid as listed below. We will let you know if these amounts change at a later date. Sincerely, 1 st Month Prorated Room and board payment from client $ $ Service payment from Medicaid +$ +$ Full Month Total Due $0.00 $0.00 SENIORS AND PEOPLE WITH DISABILITIES SDS 0547 Client Date sent Case number Prime number Date of birth Program Branch code Worker [Worker Name] cc: [Service Provider] Worker phone # Notice of Payment Responsibility SDS 0547 (07/08)
What You Can Do When You Do Not Agree with This Decision Please contact your local office if you need this form in another language or alternate format You have the right to challenge this decision by requesting a hearing. Hearings are held by the Office of Administrative Hearings, which is independent from the Department of Human Services (DHS). If you want a hearing, you must request it on time. For more information, see Part 1 below. You can also talk with a manager. Ask for a meeting by contacting your local office. Call 1-800-442-5238 if you do not know who to call. Your deadline to request a hearing (Part 1 below) does not change even if you are in contact with a manager or trying to reach one. Part 1 Ask for a Hearing What must I do to get a hearing? For all benefits except Food Stamps, you must fill out a Hearing Request Form (DHS 0443) and return it to a DHS office. You can get this form at a DHS office or on the web at http://dhsforms.hr.state.or.us/forms/served/de0443.pdf. For Food Stamps, you can ask for a hearing on DHS Form 0443, by phone, in writing, or by asking a DHS employee in person. Your local office can help you. In most cases, DHS must receive your request within 45 days from the date identified as the sending date on the decision notice. You have 90 days for Food Stamps and for TANF reductions for not cooperating with your case plan. You may request a hearing at any time if you disagree with the current amount of your Food Stamps. Who can help with my hearing? In the Food Stamp and medical programs, any adult may represent you. In all other programs, you must represent yourself or have a lawyer or a legal assistant (supervised by a Legal Aid attorney) represent you. You may call the Public Benefits Hotline (a program of Legal Aid Services of Oregon and the Oregon Law Center) at 1-800-520-5292 for advice and possible representation. What are my other hearing rights? At the hearing, you can tell why you do not agree with the decision. You can have people testify for you. The laws about your hearing rights and the hearing process are at OAR 137-003-0501 to 0700, 410-120-1860, 410-141-0264, 461-025-0300 to 0375, ORS 183.411 to 183.470, and ORS 411.095. What happens if there is no hearing? If you do not ask for a hearing on time, or if you withdraw the hearing request or miss your hearing, you may lose your right to a hearing. This notice will be the final DHS decision (called a final order by default ). You will not get a separate final order by default. The case file, along with any materials you submitted in this matter, is the record. The record is used to support the DHS decision upon default. You may appeal the final order by default by filing a petition in the Oregon Court of Appeals. (ORS 183.482) If you do not ask for a hearing, this appeal must be filed within 60 days of the date this notice becomes a final order by default. If you withdraw a hearing request or miss your hearing, the appeal deadline is set out in the dismissal order. Part 2 How can I keep getting benefits until my hearing? You can ask for your benefits to stay the same until the hearing decision ( continuing benefits ). In all programs other than Food Stamps, you must ask on the Hearing Request Form (DHS 0443). For Food Stamp benefits, use DHS Form 0443, phone, write, or ask a DHS employee in person. You must ask your branch for continuing benefits by either the effective date on the notice or 10 days after the date identified as the sending date of the notice. To keep getting benefits, you must ask by whichever date is later. If you keep getting benefits but lose the hearing, you must pay back the benefits you should not have received. If you don t keep getting benefits and win the hearing, DHS will give you the benefits you should have received. Part 3 Can I have my hearing within five working days? You may have the right to an expedited hearing for any of the following types of benefits or events: Expedited or Emergency Food Stamps JOBS and Pre-TANF payments Temporary Assistance for Domestic Violence Survivors (TA-DVS) eligibility and payments While receiving medical benefits, you are denied a medical service for an immediate, serious threat to your life or health DHS denied your request to keep getting benefits until your hearing DHS will not discriminate against anyone. This means DHS will help all who qualify. DHS will not deny help to anyone based on age, race, color, national origin, sex, sexual orientation, religion, political beliefs, or disability. You can file a complaint if you think DHS discriminated against you because of any of these reasons. DHS 0447 (7/08), Can use prior version Notice of Payment Responsibility SDS 0547 (07/08)