Mont. Admin. R. 37.5.316 - CONTINUATION OF PUBLIC ASSISTANCE BENEFITS
(1)
This rule regarding continuation of benefits applies only to benefits under the
following programs:
(a) TANF cash
assistance;
(b) food stamps;
and
(c) Medicaid, subject to
(2).
(2) For purposes of
this rule, benefits include services being received under the Medicaid home and
community-based services program for persons who are elderly or who have a
disability, or developmental disability services funded under the Medicaid
program. Applicants for such services who are aggrieved by a department
determination are not entitled to Medicaid Home and Community Based Services
under this rule.
(3) If a claimant
requests a hearing within the period between the date of the notice and the
date of the adverse action and the claimant is receiving benefits at that time,
at the request of the claimant benefits shall be continued until the earlier of
the expiration of the current eligibility or authorization period or issuance
of a hearing decision except as provided in (7) and (8) of this rule.
(4) If the claimant establishes that his
failure to request a hearing within the notice period was for good cause the
department shall at the request of the claimant, reinstate the benefits to
their prior level until the earlier of the expiration of the current
eligibility or authorization period or issuance of a hearing decision, except
as provided in (6) and (7) of this rule.
(5) If an action is taken without timely
notice and the claimant requests a hearing within ten days of the mailing of
the notice of the action, at the request of the claimant benefits shall be
reinstated and continued until the earlier of the expiration of the current
eligibility or authorization period or issuance of a hearing decision if the
case is one in which the applicant is entitled to a hearing and the hearing is
not subject to dismissal under ARM
37.5.313.
(6) A claimant is not entitled to continued
benefits if, after a hearing, the hearing officer makes a determination in
writing that the sole issue is one of state or federal law or policy and no
valid issue of improper benefit calculation, or misapplication or
misinterpretation of state or federal law or policy exists.
(7) Except as provided in (6), once continued
or reinstated, benefits may not be reduced or terminated prior to a hearing
decision unless:
(a) the eligibility, or
authorization period expires, although the claimant may reapply and may be
determined eligible for benefits;
(b) a subsequent change affecting claimant's
benefits occurs while the hearing is pending and a subsequent hearing is not
requested after notice of adverse action resulting from the subsequent change;
or
(c) a mass change affecting
claimant's eligibility or benefit level occurs while the hearing decision is
pending.
(8) If a
claimant requests a hearing on an adverse action concerning food stamp benefits
and does not positively indicate whether continued benefits are requested, the
department shall assume that continuation of benefits is desired and the
benefits shall be issued on the same basis as authorized immediately prior to
the notice of adverse action. If a recipient specifically waives continuation
of food stamp benefits, the department shall terminate benefits pending a
hearing decision in the contested case. This subsection applies only to food
stamp benefits, and not to benefits of any other kind.
(9) Regardless of any other provision of this
rule, a claimant is not entitled to continuation of benefits unless the
decision at issue is a rescission by the department of a specific eligibility
or authorization period previously granted by the department, such as
eligibility for a specified time period or authorization for a particular
service or quantity of services. A claimant is not entitled to a continuation
of benefits where the department granted the benefit for a particular period of
time or in a particular quantity and the contested action is the department's
denial of an additional grant of benefits for an additional period of time or
quantity of services.
(10) A
claimant is not entitled to continuation of benefits when the issue is the lack
of a negotiated FIA as specified at ARM
37.78.216(2).
(11) A claimant is not entitled to
continuation of benefits for any month that TANF cash assistance benefits have
been issued for a required filing unit member in another case or
state.
(12) A claimant is not
entitled to continuation of benefits if the department demonstrates at the
hearing that continuation of benefits would pose a risk of harm to the claimant
or another person.
(13) Benefits
paid to a claimant pending a hearing decision are subject to recovery by the
department if the adverse action is sustained.
(14) This rule shall not be construed to
provide continuation of benefits with respect to an action taken by a provider
rather than the department.
(15)
This rule shall not be construed to prevent or delay a department action
against a provider. If an adverse action is taken against a provider, payments
may be withheld pending the final hearing decision.
Notes
52-2-111, 53-2-201, 53-2-606, 53-2-803, 53-3-102, 53-4-111, 53-4-212, 53-6-111, 53-6-113, 53-7-102, MCA; IMP, 52-2-112, 53-2-201, 53-2-306, 53-2-606, 53-2-801, 53-3-107, 53-4-112, 53-6-111, MCA;
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