Timely and adequate notice - Assistance pending hearing

1. A notice is adequate if it includes: a. An explanation of the type of proposed action; b. An explanation of the reason for the proposed action and the regulation or law upon which the action is based; and c. An explanation of the person's right to request corrective action from the human service zone and the department, the person's right to request a fair hearing, and the circumstances under which assistance will be continued if a fair hearing is requested. 2. Except as provided in subsection 6, a notice is timely if mailed at least five days prior to the date of action based on subsection 3, and at least ten days prior to the date of any other action. 3. Except in supplemental nutrition assistance program cases, if facts indicate that assistance should be discontinued, suspended, terminated, or reduced because of suspected fraud by the recipient, and, where possible, such facts have been verified through collateral sources, notice of a benefit adjustment is timely if mailed at least five days prior to the effective date of the proposed action. 4. If human service zone or department action results in a denial of Medicaid, children's health insurance program, economic assistance programs, autism voucher, intellectual disabilities - developmental disabilities program management services, or Medicaid eligibility, an adequate written notice must be sent to the person affected. 5. Except as provided in subsection 6, if human service zone or department action results in a discontinuance, termination, suspension, withholding, or reduction of Medicaid, children's health insurance program, economic assistance programs, autism voucher, intellectual disabilities - developmental disabilities program management services, or Medicaid eligibility benefits, a timely and adequate written notice must be sent to the person affected. 6. If human service zone or department action results in a discontinuance, termination, suspension, withholding, or reduction of Medicaid, children's health insurance program, economic assistance programs, autism voucher, intellectual disabilities - developmental disabilities program management services, or Medicaid eligibility benefits, an adequate written notice must be sent to the person affected no later than the date of action if: a. The human service zone or department has factual information confirming the death of the person affected or for temporary assistance for needy families factual information exists confirming the death of the payee when there is no other relative to serve as a new payee; b. The human service zone or department receives a clear written statement signed by the person affected that the person no longer wishes assistance; or that gives information which requires discontinuance or reduction of assistance and the person has indicated, in writing, that the person understands that this must be the consequence of supplying such information; c. The person affected has been admitted or committed to an institution, and further payments to that individual do not qualify for federal financial participation under the state plan; d. The person affected has been placed in a nursing facility or is receiving long-term hospitalization. A ten-day notice is required for supplemental nutrition assistance program when the individual moves to a long-term care facility, basic care, or institution within the human service zone; e. The whereabouts of the person affected are unknown and mail directed to the person has been returned by the post office indicating no known forwarding address; f. A temporary assistance for needy families child is removed from the home as a result of a judicial determination, or voluntarily placed in foster care by the child's parent or legal guardian; g. The person affected has been accepted for assistance in new jurisdiction and that fact has been established by the human service zone previously providing assistance or the department; h. A change in level of medical care is prescribed by the recipient patient's physician or other practitioner of the healing arts; i. A special allowance granted for a specific period is terminated and the recipient has been informed in writing at the time of initiation that the allowance shall automatically terminate at the end of the specified period; j. The state or federal government initiates a mass change which uniformly and similarly affects all similarly situated applicants, recipients, and households; k. A determination has been made, based on reliable information, that all members of a household have died; l. A determination has been made, based on reliable information, that the household has moved from the project area; m. The household has been receiving an increased allotment to restore lost benefits, the restoration is complete, and the household was previously notified in writing of when the increased allotment would terminate; n. The household's allotment varies from month to month within the certification period to take into account changes anticipated at the time of certification, and the household was so notified at the time of certification; o. The household jointly applied for public assistance and supplemental nutrition assistance program benefits and has been receiving supplemental nutrition assistance program benefits pending the approval of the public assistance grant and was notified at the time of certification that supplemental nutrition assistance program benefits would be reduced upon approval of the public assistance grant; p. A household member is disqualified for an intentional program violation, or the benefits of the remaining household members are reduced or terminated, to reflect the disqualification of that household member; q. The household contains a member subject to a lockout or strike or signs a waiver of its right to notice of adverse action for purposes of receiving a longer certification period than is otherwise allowed for such households; r. The human service zone or department has elected to assign a longer certification period to a household certified on an expedited basis and for whom verification was postponed, provided the household has received written notice that the receipt of benefits beyond the month of application is contingent on its providing the verification which was initially postponed and that the human service zone or department may act on the verified information without further notice; s. The action is based upon information the recipient furnished in a monthly report; t. The action is taken because the recipient has failed to submit a complete or timely monthly report without good cause; u. A special item or need or job opportunities and basic skills program supportive service is terminated at the end of a specified period; v. Benefits are reduced or terminated following the imposition of a child support or job opportunities and basic skills program sanction; w. Upon receipt of factual information confirming the household is no longer a resident of the state; x. If household is entitled to a supplemental nutrition assistance program underpayment and has chosen monthly installments instead of a lump sum and the household was previously notified in writing when the monthly installments would terminate; y. Joint temporary assistance for needy families and supplemental nutrition assistance program application results in the receipt of supplemental nutrition assistance program pending temporary assistance for needy families grant approval and household is notified at the time of certification that supplemental nutrition assistance program benefits would be reduced upon receipt of a grant; or z. For supplemental nutrition assistance program, changing a household from cash repayment to allotment reductions as a result of failure to make the agreed payments. 7. In any case where assistance has been discontinued, suspended, withheld, or reduced without timely notice, if the person affected requests a fair hearing within ten days of the mailing of the notice of action, assistance must be reinstated retroactively and the provisions of subsection 9 shall apply. 8. If, within the timely notice period, the person affected indicates a wish for a conference, that person or that person's authorized representative will be given an opportunity by the human service zone or department to discuss the problems, and will be given an explanation of the reasons for the proposed action, and will be permitted to show that proposed action is incorrect. a. During this conference, the person affected will be permitted to represent himself or herself or be represented by legal counsel or by a friend or other spokesman. b. The conference does not diminish the person's right to a fair hearing. 9. Where the person affected is a recipient and has filed a request for a fair hearing within the timely notice period, the assistance will be continued without implementation of the proposed action, until the fair hearing decision is rendered, unless: a. Prior thereto the claimant unconditionally withdraws or abandons the fair hearing request; b. Prior thereto the department reverses the proposed action without a hearing; c. The department determines, based upon the record of the claimant's fair hearing, that the issue involved in such hearing is one of state or federal law or change in state or federal law and not one of incorrect benefit computation; d. A change affecting the recipient's benefits occurs before the decision on the request for fair hearing and the recipient fails to file a timely request for a fair hearing after notice of such change; or e. A supplemental nutrition assistance program household's certification period expires. 10. Any assistance continued under subsection 9 is subject to recovery if the claimant does not prevail in the claimant's appeal. 11. Any notice that is the subject of a request for fair hearing may be supplemented at any time before the conclusion of the hearing. The information in any supplemental notice must be considered in determining the adequacy of the notice unless the claimant shows that the claimant is prejudiced by that consideration.