Tenn. Comp. R. & Regs. 1240-01-20-.09 - RESTORATION OF LOST BENEFITS

(1) Entitlements. The county office shall restore to the household benefits which were lost whenever the loss was caused by an administrative error, or whenever an administrative disqualification decision for intentional program violation is subsequently reversed, or whenever federal regulations specifically state that a household is entitled to restoration of lost benefits. Benefits shall be restored for not more than twelve months prior to whichever of the following occurred first:

(a) The date the state agency receives a request for restoration from a household; or

(b) The date the state agency is notified or otherwise discovers that a lost to a household has occurred.

(2) The county office shall restore to households benefits which were found by any judicial action to have been wrongfully withheld.

(3) If the judicial action is the first action the recipient has taken to obtain restoration of lost benefits, then benefits shall be restored for a period of not more than twelve months from the date the court action was initiated.

(4) When the judicial action is a review of a county office action, the benefits shall be restored for a period of not more than twelve months from the first of the following dates:

(a) The date the state agency receives a request for restoration; or

(b) If no request for restoration is received, the date the fair hearing action was initiated; but

(c) Never more than one year from when the state agency is notified of or discovers the loss.

(5) Errors Discovered By The County Office. If the county office determines that a loss of benefits has occurred, and the household is entitled to restoration of those benefits, the county office shall automatically take action to restore any benefits that were lost. No action by the household is necessary. However, benefits shall not be restored:

(a) If the benefits were lost more than 12 months prior to the month the loss was discovered by the county office in the normal course of business; or

(b) If the benefits were lost more than 12 months prior to the month the county office was notified in writing or orally of a possible loss to a specific household.

(6) Notification And Method Of Restoration.

(a) Notification to the Household.

1. When it is determined by the county office that a loss of benefits has occurred, the household shall be notified, in writing, of the following:

(i) Entitlement to restored benefits;

(ii) The amount of benefits to be restored;

(iii) Any offsetting that was done;

(iv) The method of restoration; and

(v) The right to appeal through the fair hearing process if the household disagrees with any aspect of the proposed lost benefit restoration.

2. Reserved for Future Use.

3. Reserved for Future Use.

(b) Method of Restoration.

1. Regardless of whether a household is currently eligible or ineligible, the county office shall restore lost benefits to a household by issuing an allotment equal to the amount of benefits that were lost. The amount restored shall be issued in addition to the allotment currently eligible households are entitled to receive.

2. Deviations. The county office shall honor reasonable requests by households to restore lost benefits in monthly installments if, for example, the household fears that excess coupons may be lost or stolen, or that the amount to be restored is more than it can use in a reasonable period of time.

(c) Household Composition Changes. Whenever lost benefits are due a household and the household's membership has changed. the county office shall restore the lost benefits to the household containing a majority of the individuals who were household members at the time the loss occurred. If the county office cannot locate or determine the household which contains a majority of the household members, the county office shall restore the lost benefits to the household containing the individual who was head of the household at the time the loss occurred.

(d) Reserved for Future Use.

(e) Reserved for Future Use.

(7) Computing The Amount To Be Restored. After correcting the loss for future months and excluding those months for which benefits may have been lost prior to the twelve (12) month time limits described in Section 1240-1-21-.01, the county shall calculate the amount to be restored as follows:

(a) Incorrect Allotment. If the household was eligible but received an incorrect allotment, the loss of benefits shall be calculated only for those months the household participated.

(b) Delay, Denial, or Termination. If the loss was caused by an incorrect delay, denial, or termination of benefits, the months affected by the loss shall be calculated as follows:

1. If an eligible household's application was erroneously denied, the month the loss initially occurred shall be the month of application or for an eligible household filing a timely reapplication, the month following the expiration of its certification period.

2. If an eligible household's application was delayed, the months for which benefits are lost shall be calculated in accordance with procedures in Section 1240-1-17 of the Family Assistance Manual for determining the delay was caused by the household or by the county office.

3. If a household's benefits were erroneously terminated, the month the loss initially occurred shall be the first month benefits were not received as a result of the erroneous action.

4. After computing the date the loss initially occurred, the loss shall be calculated for each month subsequent to that date until either the first month the error is corrected or the first month the household is found ineligible.

(c) Determination of Eligibility. For each month affected by the loss, the county office shall determine if the household was actually eligible. In cases where there is not information in the household's case file to document that the household was actually eligible, the county office shall advise the household of what information must be provided to demonstrate eligibility for these months. For each month the household can't provide the necessary information to demonstrate its eligibility, the household shall be ineligible.

(d) Calculation of Benefits. For the months the household was eligible, the county office shall calculate the allotment the household should have received. If the household received a smaller allotment than it was eligible to receive, the difference between the actual and correct allotment equals the amount to be restored.

(e) Offsetting Claims. If a claim against a household is unpaid or held in suspense as provided in Section 1240-1-20 of the Family Assistance Manual, the amount to be restored shall be offset against the amount due on the claim before the balance, if any, is restored to the household. At that point in time when the household is certified and received an initial allotment, the initial allotment shall not be reduced to offset claims, even if the initial allotment is paid retroactively.

(8) Disputed Benefits.

(a) Household Disagrees With State Agency.

1. If the county office determines that a household is entitled to restoration of lost benefits, but the household does not agree with the amount to be restored as calculated by the county office or any other action taken by the county to restore lost benefits, the household may request a fair hearing within 90 days of the date the household is notified of its entitlement to restoration of lost benefits.

2. If a fair hearing is requested prior to or during the time lost benefits are being restored, the household shall receive the lost benefits as determined by the county office, pending the results of the fair hearing.

3. If the fair hearing decision is favorable to the household, the county shall restore lost benefits in accordance with that decision.

(b) State Agency Disagrees With Household.

1. If a household believes it is entitled to restoration of lost benefits but the county office, after reviewing the case file, does not agree, the household has 90 days from the date of the county office's determination to request a fair hearing. The county office shall restore lost benefits to the household only if the fair hearing decision is favorable to the household.

2. Benefits lost more than 12 months prior to the date the county office was initially informed of the household's possible entitlement to lost benefits shall not be restored.

(9) Entitlement To Lost Benefits For Individuals Who Were Disqualified For Intentional Program Violation.

(a) Individuals disqualified for intentional program violation are entitled to restoration of any benefits lost during the months they were disqualified only if the disqualification decision is subsequently reversed. The months covered in the restoration must not exceed 12 months prior to the date the county received notification.

(b) For each month the individual was disqualified, the amount to be restored, if any, shall be determined by comparing the allotment the household received with the allotment the household would have received had the disqualified member been allowed to participate.

(c) If the household received a smaller allotment than it should have received, the difference equals the amount that should have been restored.

(d) Participation in an administrative disqualification hearing in which the household contests the State Agency assertion of intentional program violation shall be considered notification that the household is requesting restored benefits.

Notes

Tenn. Comp. R. & Regs. 1240-01-20-.09

Original rule filed August 15, 1980; effective September 29, 1980. Repeal and new rule filed June 28, 1983; effective July 28, 1983. Amendment filed October 14, 1983; effective November 14, 1983.

Authority: T.C.A. §§ 14-27-104, 14-27-106, 14-27-109, 14-27-110; 7 CFR 273.17.