HAR §17-1703.1-15. Hearing decision

(a) All matters relating to the hearing shall be heard and disposed of as follows: (1) Within ninety (90) calendar days from the date of request for a hearing that is submitted in accordance with section 17- 1703.1-4; (2) Within forty-five (45) calendar days from the date of an appeal decision by the Health Insurance Exchange involving an earlier determination of Medicaid eligibility; or (3) As expeditiously as the individual’s health conditions requires, but no later than three (3) working days after the department receives the request for an expedited hearing. (b) Exception to the provision described in subsection (a), shall be when the hearing is continued or the record is held open as specified in section 17- 1703.1-12(g). The time limit shall be extended only for the period of the continuance. (c) Unless the record is held open for additional documentary evidence, after closing the hearing, the hearing officer shall prepare the decision in writing. The decision shall contain a statement concerning the individual’s right to judicial review, the reasons for the decision, the evidence, and the rules supporting the decision. A copy of the written decision shall be provided the individual and the department. (d) The transcript, recording, or an official record containing the substance of the hearing UNOFFICIAL 1703.1-14 proceedings, together with all papers filed in the proceeding and the hearing officer's decision shall constitute the exclusive record and shall be made available to the individual during normal business hours through the hearing office. (e) The department shall comply with the hearing decision immediately upon receipt of the decision. (1) When the hearing decision is favorable to the individual, the department shall promptly make necessary corrections, retroactive to the date the incorrect action was taken, and shall notify the hearing office, in writing, of the action and the date the action was taken. (2) If the hearing decision is in favor of the individual on the issue involved, but for technical reasons such as computer problems, immediate corrections are not made, the department shall submit a notice to the hearing officer and include a statement of why the department could not immediately comply with the decision. (3) The hearing officer shall review the notice to assure that the department has correctly complied with the decision. (f) All hearing decisions shall be accessible to the public, subject to provision of safeguarding public assistance information stated in section 346- 10, HRS, and the department's confidentiality provisions specified in chapter 17-1702. [Eff 09/30/13] (Auth: HRS §346-14(9); 42 C.F.R. §431.244) (Imp: HRS §346-12; 42 C.F.R. §431.244) §17-1703.1-16 Decisions pending over ninety days. (a) When a final decision has not been made and implemented within ninety (90) days of the request, the department shall reduce the premium-share amount or spenddown amount to what existed prior to the hearing request or restore or grant any service which was reduced or denied, if the individual is not already receiving aid paid pending. When the hearing decision is pending over ninety (90) days, aid paid shall be determined in accordance with subsections (d) and (e). (b) The hearing officer shall notify the Med- QUEST Division orally on the ninety-first(91st) day when a final decision is not reached within ninety UNOFFICIAL 1703.1-15 (90) days. If the ninety-first (91st) day falls on a weekend or holiday, the ninety-first (91st) day shall then be the first working day following the weekend or holiday. A written confirmation shall be sent within three (3) working days. (c) In situations where an individual has requested or is otherwise responsible for a delay in the hearing process, the time period shall be tolled only for the period of the delay. (d) When a final decision is not made and implemented within ninety (90) days: (1) The specific medical care denied the individual which is the issue on appeal shall be authorized from the ninety-first (91st) day until the hearing decision is made and implemented; or (2) The individual applying for medical assistance shall be made presumptively eligible to secure assistance from the ninety-first (91st) day until the hearing decision is made and implemented. (e) The department shall review current need and eligibility factors exclusive to the issue on appeal. If the individual is found to be currently eligible, the department shall reduce the premium-share amount or spenddown amount to what existed prior to the hearing request effective the ninety-first(91st) day. The required action shall be taken within five (5) working days after the oral notice is received from the hearing officer. The amount of premium-share or spenddown amount shall be restored to the previous level until a final decision is made, provided the individual remains eligible and no other changes become necessary. (f) If, for reasons exclusive to the issue pending hearing, the department determines that the individual is ineligible to receive assistance, the department shall terminate or deny the assistance on or after the ninety-first (91st) day of the hearing request. The department shall send a notice indicating the reasons for not restoring assistance pending the final hearing decision. [Eff 09/30/13] (Auth: HRS §346-14(9); 42 C.F.R. §431.244) (Imp: HRS §346-12; 42 C.F.R. §431.244)