HAR §17-1416-36. Request for additional services

(a) There shall be written documentation of a recipient’s request for services in addition to the services the recipient is already receiving. The documentation may be: (1) A written request completed. by the recipient; or (2) A recording of the request by departmental staff. (b) Disposition of requests for additional services shall be made in the same manner as an application and section 17-1416-13 shall apply. Disposition shall be made within thirty calendar days from the date the oral or written request is received by the department. [Eff 6/29/92; conp 10/28195) (Auth: HRS §346—14) (Imp: fIRS §346—14; 42 U.S.C. §1397c) §17—1416—37 Redetermination of eligibility for social services. (a) The department shall redetermine income and program eligibility for continued social services: (1) When informatiOn is obtained that there are anticipated changes in the individual’s or family’s situation; (2) Promptly, not to exceed thirty days, after information is received that changes have 1416—14 UNOFFICIAL §17-1416—39 occurred in the individual’s or family’s circumstances which may result in ineligibility for services; and, (3)’ At least once every year from the month eligibility for service was determined. (b) Redetermination of eligibility for a specific service shall be made in the same manner as the disposition of an application including signing and dating a form prescribed by the department. tEff’ 6/29/92; comp 10/28/95] (Auth: MRS §346—14) (Imp: MRS §346—14; 42 U.S.C §1397c) §17—1416—38 Confidentiality. The provisions of chapter 17—1401 shall be applicable to the specific services identified in chapters 17—1416 to 17—1421. fEff 6/29/92; comp 10/28/95; am 12/5/97] .(Auth: MRS §S346—1O, 346—14) (Imp: MRS §S346—10, 346—14) §17—1416—39 Reporting changes. (a) Social service recipients shall be responsible to report to the department within thirty days of occurrence any changes in: ‘ ‘ (1) Income maintenance status as specified in section 17—1416—20(2)(A); (2) Address, including: (A) Place of residence; and (B) Mailing address; (3) Family member size; ... (4) Marital status; (5) Providers of the service the recipient IE’’ receiving; arid. ‘ .- .‘ :. (6) Circumstances which may affect the recipient’s eligibility for continuing services, including, ‘ but not, limited to:.. (A) . Changes in. number of hours of service required; .‘‘ ... ‘.. . . . .‘ . (B) Changes in hours of employment; and (C) Anticipated changes in the individual’s situation which may affect the individual’s eligibility for continued services. . . •. . (b) Failure to report information, as specified in subsection (a), . which may affect ‘the recipient’s eligibility for services or amount of social services 1416—15 §17—1416—39 UNOFFICIAL payments shall be investigated by the department as a suspected fraud. (c) In situations where fraud is suspected, the provisions of chapter 17—1404 shall be applicable. [Eff 6/29/92; am 8/5/93; am and conp 10/28/95; am 12/5/97) .(Auth: HRS §346—14) (Imp: fiRS §346—14; 42 U.S.C. §1397c) §17—1416—40 Overpayments and recoupment. (a) An overpayment shall occur when a recipient receives social service cash payments or receives social services through a purchase of service provider to which the person is not entitled. (b) Overpayments shall be collected from the individual in the following manner: (1) As a refund from the currently available social service cash payment at a rate of ten, per cent of the monthly social service payment for individuals who continue to be eligible for social service costs; or (2) As a reduction in the current monthly service hours being authorized from the purcbaseof service provider at a rate of ten per cent for individuals who continue to be eligible for social services; or (3) Recovered for the department by the investigations office (INVO) for individuals who are no longer eligible for cash payments. (c) Overpayments resulting from the receipt of social services through a purchase of service provider shall not be collected from individuals who are no” longer eligible for the services. (d) Overpayments that meet.. the definition of fraud as defined in chapter 17—1404 shall bereferred to the investigations office (INVO) for investigation. [Eff 6/29/9*; am 8/5/93; am and comp 10/28/95; am 12/5/97] (Auth: fiRS §346—14) (Imp: fiRS §346—44) §17—1416—41 Claim against the estate of a deceased recipient. (a) If a recipient dies leaving an estate and does not-have a surviving spouse, child,. father, mother, grandfather, grandmother, grandchild, stepfather, stepmother, or designated heir, the department may tile a claim against the estate for the 1416—16 • UNOFFICIAL §17—1416—44 amount of social service benefits provided the deceased recipient. (b) If a recipient fraudulently received social service benefits because of the recipient’s withholding of information, the department may file a claim against the estate of the deceased recipient, notwithstanding subsection (a), for the amount of social service benefits overpaid. [Eff 12/5/97] (Auth: MRS §346—14, 346—44) (Imp: MRS SS346—37, 346—44) §17—1416—42 to 17—1416—43 (Reserved). SUBCHAPTER 6 TERMINATION, SUSPENSION, OR REDUCTION OF SERVICE §17—1416—44 Advance notice of action to terminate, suspend, or reduce social services. (a) The department shall give timely arid adequate notice prior to initiating action to terminate, suspend, or reduce social services unless the provisions of subsection (d) apply. Under this requirement: (1) “Timely” means that: (A) The department shall mail a written notice at least ten days prior to the effective date of action.. The date of action shall be the date on which services shall be terminated, reduced, or. suspended; and (B) When the department obtains facts indicating need for the action because of probable fraud, the department shall mail a written notice at least five days before social service is actually terminated 1 suspended, or reduced. Where possible, these facts shall have been verified through collateral • sources; and (2) “Adequate” means a written notice that includes statements of: (A) What action the department intends to take; (B) Reasons for the intended action; 1416—17 §17-1416-44 UNOFFICIAL (C) The departmental rules supporting the intended action; (D) The individual’s right to request an informal review,, a fair hearing, or• both; and (E) The circumstances under which social services, shall be continued if a fair hearing is requested. (b) Unless specified otherwise, timely notice shall not be required under the following circumstances but adequate notice shall be sent no later than the date of action when one of the following conditions is met: (1) The department receives a clear written statement signed by a recipient that: (A) The recipient no longer wishes social services; or (B) Provides information which necessitates termination or reduction of social services and indicates that the recipient understands the consequences of supplying the information shall be reduction or termination of social service; .; (2) The recipient is admitted or committed to’ a public institutiàn; (3) The recipient is placed in a nursing facility or is hospitalized on a long—ten basis; (4) The recipient’s whereabouts are unknown and mail sent -the recipient is returned by the post office indicating no known forwarding address. When mail is returned, both timely and adequate notice shall be issued only when the recipient has provided the department with a new address. The returned social service assistance check, however, shall be released to the recipient if the recipient’s whereabouts become known during the payment period covered by the, returned check; (5) The recipient is accöpted for social services in another state and this fact is established by the department; or (6) A special allowance granted for a specific period is terminated and the recipient is informed in writing ‘at the time the allowance is made that the allowance would 1416—18 UNOFFICIAL §17—1416-45 automatically terminate at the end of the specified period. (C) Timely and adequate notice shall be given when automatic grant adjustments are made due to changes in state or federal law. The notice shall be adequate if it includes a statement of: (1) The intended action; (2) Reasons for the intended action; (3) The specific change in law requiring the action; and (4) The circumstances under which a fair hearing may be obtained and assistance may be continued. (d) Neither timely nor adequate notice shall be required nor shall aid be paid pending a fair hearing when changes in state or federal law or funding result in changes such as deletions or reductions in current social services, reduction or elimination of eligible groups, or changes in eligibility requirements for social services provided that: (1) At the beginning of a program year, the department issues a public report specifying the social services to be provided and the individuals eligible for the social services during that year; (2) Changes which are made during a program year are identified for the public by a press release prior to the effective date of change; and (3) Recipients to be affected by the changes in the program are informed in writing at least ten days prior to the effective date of change The determination that the change meets the criteria of this subsection and that no aid shall be paid pending a fair hearing shall be made by the department. (Eff 6/29/92; am and comp 10/28/95) (Auth: fiRS §346—14) (Imp: fiRS §346—12) §17—1416—45 Basis for reduction or termination of services. (a) Services shall be reduced or terminated when one or more of the following occurs: (1) when it is determined that the individual is ineligible for continued services; 1416—19 517-1416-45 UNOFFICIAL (2) The recipient moves and leaves no forwarding address or the recipient’s whereabouts are unknown; (3) The service is no longer included in the department’s scope of service; (4) The recipient is unwilling or unable to make constructive use of the service; (5) The department social worker has determined that the recipient’s need for the service has decreased; (6) The purchase of service provider no longer has a valid contract with the department to provide the service; (7) The recipient requests termination of services; (8) The recipient leaves the State; (9) The recipient dies; or (10) The department lacks available funds to provide services. (b) Services shall be reduced or terminated upon mutual agreement between the recipient and the department or after written notice, specified in section 17—1416—44, of the intent to reduce or terminate services has been given the recipient tEff 6/29/92; am 7/25/94; comp 10/28/95] (Auth: MRS §346—14) (Imp: MRS §346—14; 42 U.S.C. §1397c) §517—1416—46 to 17—1416—48 (Reserved). 1416—20