FIRSTREGULARSESSION
HOUSEBILLNO.1223
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEPETERS.
2278H.01I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsections208.080and208.156,RSMo,andtoenactinlieuthereoftwonewsections
relatingtoadministrativeremediesinMOHealthNetcases.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections208.080and208.156,RSMo,arerepealedandtwonewsections
2enactedinlieuthereof,tobeknownassections208.080and208.156,toreadasfollows:
208.080.1.Anyapplicantfororrecipientofbenefitsorservicesprovidedbylawby
2thefamilysupportdivision,children'sdivision,[or]MOHealthNetdivision, orMissouri
3Medicaidauditandcomplianceunitmayappealtothedirectoroftherespectivedivisionor
4unitfromadecisioninanyofthefollowingcases:
5 (1)Ifhisorherrighttomakeapplicationforanysuchbenefitsorservicesisdenied;
6or
7 (2)Ifhisorherapplicationisdisallowedinwholeorinpart,orisnotactedupon
8withinareasonabletimeafteritisfiled;or
9 (3)Ifitisproposedtocancelormodifybenefitsorservices;or
10 (4)Ifheorsheisadverselyaffectedbyanydeterminationofthefamilysupport
11division,children'sdivision,[or]MOHealthNetdivision, orMissouriMedicaidauditand
12complianceunitintheadministrationoftheprogramsadministeredbysuchdivisionsor
13unit;or
14 (5)Ifadeterminationismadepursuanttosubsection2ofsection208.180that
15paymentofbenefitsonbehalfofadependentchildshallnotbemadetotherelativewith
16whomheorshelives.
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 2.Ifadivisionorunitproposestoterminateormodifythepaymentofbenefitsorthe
18providingofservicestotherecipientoradivisionorunithasterminatedormodifiedthe
19paymentofbenefitsorprovidingofservicestotherecipientandtherecipientappeals,the
20decisionofthedirectorastotheeligibilityoftherecipientatthetimesuchactionwas
21proposedortakenshallbebasedonthefactsshownbytheevidencepresentedatthehearing
22oftheappealtohaveexistedatthetimesuchactiontoterminateormodifywasproposedor
23wastaken.
24 3.Inthecaseofaproposedactionbythefamilysupportdivision,children'sdivision,
25[or]MOHealthNetdivision, orMissouriMedicaidauditandcomplianceunittoreduce,
26modify,ordiscontinuebenefitsorservicestoarecipient,therecipientofsuchbenefitsor
27servicesshallhavetendaysfromthedateofthemailingofnoticeoftheproposedactionto
28reduce,modify,ordiscontinuebenefitsorserviceswithinwhichtorequestanappealtothe
29directorofthedivisionorunit. Inthenoticetotherecipientofsuchproposedaction,the
30appropriatedivisionorunitshallnotifytherecipientofallhisorherrightsofappealunder
31thissection.Properblankformsforappealtothedirectorofthedivisionorunitshallbe
32furnishedbytheappropriatedivisionorunittoanyaggrievedrecipient.Everysuchappealto
33thedirectorofthedivisionorunitshallbetransmittedbytheappropriatedivisionorunit
34immediatelyuponthesamebeingfiledwiththeappropriatedivisionorunit. Ifanappealis
35requested,benefitsorservicesshallcontinueundiminishedorunchangeduntilsuchappealis
36heardandadecisionhasbeenrenderedthereon,exceptthatinanaidtofamilieswith
37dependentchildrencasetherecipientmayrequestthatbenefitsorservicesnotbecontinued
38undiminishedorunchangedduringtheappeal.
39 4.Whenacasehasbeenclosedormodifiedandnoappealwasrequestedpriorto
40closingormodification,therecipientshallhaveninetydaysfromthedateofclosingor
41modificationtorequestanappealtothedirectorofthedivisionorunit. Eachrecipientwho
42hasnotrequestedanappealpriortotheclosingormodificationofhisorhercaseshallbe
43notifiedatthetimeofsuchclosingormodificationofhisorherrighttorequestanappeal
44duringthisninety-dayperiod.Properblankformsforrequestinganappealtothedirectorof
45thedivisionorunitshallbefurnishedbytheappropriatedivisionorunittoanyaggrieved
46applicant.Everysuchrequestmadeinanymannerforanappealtothedirectorofthedivision
47orunitshallbetransmittedbytheappropriatedivisionorunittothedirectorofthedivision
48orunitimmediatelyuponthesamebeingfiledwiththeappropriatedivisionorunit. Ifan
49appealisrequestedintheninety-dayperiodsubsequenttotheclosingormodification,
50benefitsorservicesshallnotbecontinuedattheirpriorlevelduringthependencyofthe
51appeal.
52 5.Inthecaseofarejectionofanapplicationforbenefitsorservices,theaggrieved
53applicantshallhaveninetydaysfromthedateofthenoticeoftheactioninwhichtorequest
HB1223 2 54anappealtothedirectorofthedivisionorunit. Intherejectionnoticetheapplicantfor
55benefitsorservicesshallbenotifiedofallofhisorherrightsofappealunderthissection.
56Properblankformsforrequestinganappealtothedirectorofthedivisionorunitshallbe
57furnishedbytheappropriatedivisionorunittoanyaggrievedapplicant.Anysuchrequest
58madeinanymannerforanappealshallbetransmittedbytheappropriatedivisionorunitto
59thedirectorofthedivisionorunit, immediatelyuponthesamebeingfiledwiththe
60appropriatedivisionorunit.
61 6.Ifthedivisionorunithasrejectedanapplicationforbenefitsorservicesandthe
62applicantappeals,thedecisionofthedirectorastotheeligibilityoftheapplicantatthetime
63suchrejectionwasmadeshallbebaseduponthefactsshownbytheevidencepresentedatthe
64hearingoftheappealtohaveexistedatthetimetherejectionwasmade.
65 7.Thedirectorofthedivisionorunitshallgivetheapplicantforbenefitsorservices
66ortherecipientofbenefitsorservicesreasonablenoticeof,andanopportunityfor,afair
67hearinginthecountyofhisorherresidenceatthetimetheadverseactionwastaken.The
68hearingshallbeconductedbythedirectorofthedivisionorunitorsuchdirector'sdesignee.
69Everyapplicantorrecipient,onappealtothedirectorofthedivisionorunit,shallbeentitled
70tobepresentatthehearing,inpersonandbyattorneyorrepresentative,andshallbeentitled
71tointroduceintotherecordofsuchhearinganyandallevidence,bywitnessesorotherwise,
72pertinenttosuchapplicant'sorrecipient'seligibilitybetweenthetimeheorsheappliedfor
73benefitsorservicesandthetimetheapplicationwasdeniedorthebenefitsorserviceswere
74terminatedormodified,andallsuchevidenceshallbetakendown,preserved,andshall
75becomeapartoftheapplicant'sorrecipient'sappealrecord.Upontherecordsomade,the
76directorofthedivisionorunitshalldetermineallquestionspresentedbytheappeal,andshall
77makesuchdecisionastothegrantingofbenefitsorservicesasinhisorheropinionis
78justifiedandisinconformitywiththeprovisionsofthelaw.Thedirectorshallclearlystate
79thereasonsforhisorherdecisionandshallincludeastatementoffindingsoffactand
80conclusionsoflawpertinenttothequestionsinissue.
81 8.Allappealrequestsmayinitiallybemadeorallyorinanywrittenform,butallsuch
82requestsshallbetranscribedonformsfurnishedbythedivisionorunitandsignedbythe
83aggrievedapplicantorrecipientorhisorherrepresentativepriortothecommencementofthe
84hearing.
208.156.1.ThefamilysupportdivisionortheMOHealthNetdivisionshallprovide
2forgrantinganopportunityforafairhearingundersection208.080toanyapplicantor
3recipientwhoseclaimformedicalassistanceisdeniedorisnotacteduponwithreasonable
4promptness.
5 2.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit
6paymentsareauthorizedundersection208.152whoseclaimforreimbursementforsuch
HB1223 3 7servicesisdeniedorisnotacteduponwithreasonablepromptnessshallbeentitledtoa
8hearingbeforetheadministrativehearingcommissionpursuanttotheprovisionsofchapter
9621.
10 3.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit
11paymentsareauthorizedundersection208.152whoisdeniedparticipationinanyprogramor
12programsestablishedundertheprovisionsofchapter208shallbeentitledtoahearingbefore
13theadministrativehearingcommissionpursuanttotheprovisionsofchapter621.
14 4.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit
15paymentsareauthorizedundersection208.152whoisaggrievedbyanyruleorregulation
16promulgatedbythedepartmentofsocialservicesoranydivisionorunitthereinshallbe
17entitledtoahearingbeforetheadministrativehearingcommissionpursuanttotheprovisions
18ofchapter621.
19 5.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit
20paymentsareauthorizedundersection208.152whoisaggrievedbyanyruleorregulation,
21contractualagreement,ordecision,asprovidedforinsection208.166,bythedepartmentof
22socialservicesoranydivisionorunitthereinshallbeentitledtoahearingbeforethe
23administrativehearingcommissionpursuanttotheprovisionsofchapter621.
24 6.Noproviderofservicemayfileapetitionforahearingbeforetheadministrative
25hearingcommissionunlesstheamountforwhichheorsheseeksreimbursementexceedsfive
26hundreddollars.
27 7.Oneormoreprovidersofserviceaswillfairlyinsureadequaterepresentationof
28othershavingsimilarclaimsagainstthedepartmentofsocialservicesoranydivisionorunit
29thereinmayinstitutethehearingonbehalfofallintheclassifthereisacommonquestionof
30laworfactaffectingtheseveralrightsandacommonreliefissought.
31 8.Anypersonauthorizedundersection208.153toprovideservicesforwhichbenefit
32paymentsareauthorizedundersection208.152andwhoisentitledtoahearingasprovided
33forintheprecedingsectionsshallhavethirtydaysfromthedateofmailingordeliveryofa
34decisionofthedepartmentofsocialservicesoritsdesignateddivisionorunitinwhichtofile
35hisorherpetitionforreviewwiththeadministrativehearingcommissionexceptthatclaims
36oflessthanfivehundreddollarsmaybeaccumulateduntiltheytotalthatsumandatwhich
37timetheprovidershallhaveninetydaystofilehisorherpetition.
38 9.Whenapersonentitledtoahearingasprovidedforinthissectionappliestothe
39administrativehearingcommissionforastayorderstayingtheactionsofthedepartmentof
40socialservicesoritsdivisionsorunits, theadministrativehearingcommissionshallnotgrant
41suchstayorderuntilafterafullhearingonsuchapplication.Theapplicationshallbe
42advancedonthedocketforimmediatehearinganddetermination.Thepersonapplyingfor
43suchstayordershallnotbegrantedsuchstayorderunlessthatpersonshallshowthat
HB1223 4 44immediateandirreparableinjury,loss,ordamagewillresultifsuchstayorderisdenied,or
45thatsuchpersonhasareasonablelikelihoodofsuccessuponthemeritsofhisorherclaim;
46andprovidedfurtherthatnostayordershallbeissuedwithoutthepersonseekingsuchorder
47postingabondinsuchsumastheadministrativehearingcommissionfindssufficientto
48protectandpreservetheinterestofthedepartmentofsocialservicesoritsdivisionsorunits.
49[Innoeventmaytheadministrativehearingcommissiongrantsuchstayorderwherethe
50claimarisesunderaprogramorprogramsfundedbyfederalfundsorbyanycombinationof
51stateandfederalfunds,unlessitisspecifiedinwritingbythefinancialsectionofthe
52appropriatefederalagencythatfederalfinancialparticipationwillbecontinuedunderthestay
53order.]
54 10.Theotherprovisionsofthissectionnotwithstanding,apersonreceivingor
55providingbenefitsshallhavetherighttobringanactioninappealingfromtheadministrative
56hearingcommissioninthecircuitcourtofColeCounty,Missouri,orthecountyofhisorher
57residencepursuanttosection536.050.
âś”
HB1223 5