Or. Admin. Code § 414-175-0055

Current through Register Vol. 63, No. 12, December 1, 2024

Section 414-175-0055 - Decision Notices

(1) A decision notice:

(a) Specifies the date the notice is mailed, which is the effective date for a basic decision notice.

(b) Except as provided in section (2) of this rule, specifies the action the Department intends to take and the effective date of the action.

(c) Specifies the reasons for the action.

(d) Informs the individual of the extent to which the individual has a right to a hearing before an impartial person.

(e) Specifies the method and deadline for requesting a hearing.

(f) Informs the individual of the right to representation, including legal counsel, and the right to have witnesses testify on his or her behalf.

(g) Provides information about the availability of free legal help.

(h) Cites the rules that support the action, or includes a notification of the rules that support the action.

(2) If benefits are reduced or closed to reflect cost-of-living adjustments in benefits or any other mass change under a program operated by a federal agency or to reflect a mass change to payments in a program operated by the Department:

(a) The requirements in subsection (1)(b) of this rule are optional. Instead of specifying the action the Department intends to take and the effective date of the action, the decision notice may state all of the following:

(A) The general nature of the change.

(B) Examples of how the change affects a individual's benefits.

(C) The month in which the change will take place.

(b) The decision notice must also state the individual's right to continue receiving benefits.

(3) The notice period is used to determine the effective date for taking action when a decision notice is sent to the filing group:

(a) For a basic decision notice, the notice period is the month in which the notice is mailed.

(b) For a continuing benefit decision notice, the notice period is the budget month from which information is used to initiate the decision notice.

(c) For a timely continuing benefit decision notice, the notice period is the month in which the mailing requirement ends.

(d) Except as provided under section (3)(e) of this rule, the timely continuing benefit decision notice mailing requirement is no later than the 15th day of the month.

(e) If the basis for a decision to reduce, suspend, or close ERDC benefits is a change to a benefit standard, the timely continuing benefit decision notice mailing requirement is:

(A) At least 30 calendar days before the effective date of the action, or

(B) If the Department has fewer than 60 days before the effective date to implement a change to a benefit standard, the mailing requirement is as provided under section (4) of this rule. For purposes of this section, the term "change to a benefit standard" means a change to the applicable inflation-adjusted contribution, income, or payment standard. It does not include the annual adjustment to a standard based on a federal or state inflation rate.

(4) Each household must receive a notice of expiration prior to the last month of the certification period containing:

(a) The date the certification period expires.

(b) A statement that to receive benefits, the individual must reapply and be found eligible for a new benefit amount.

(c) The household's right to request a contested case hearing if the reapplication is denied or if the household objects to the benefit amount.

(5) Notwithstanding any rule in Chapter 414, to the extent permitted by OAR 137-003-0530, the Department may take any of the following actions:

(a) Amend a decision notice with another decision notice or a contested case notice including to clarify the rules that support the decision.

(b) Amend a contested case notice.

(c) Delay a reduction or closure of benefits as a result of an individual's request for hearing.

(d) Extend the effective date on a decision notice or contested case notice.

(6) Except as provided in section (5) or when a delay results from the individual's request for a hearing, a notice to reduce or close benefits becomes void if the reduction or closure is not initiated on the date stated on the notice. If the notice is void, a new notice is sent to inform the financial group of a new date on which their benefits will be reduced or closed.

(7) No decision notice is required in each of the following situations:

(a) Benefits are ended because there is no living person in the benefit group.

(b) A notice was sent, the individual requested a hearing, and either the hearing request is dismissed or a final order is issued.

(c) The individual has signed a voluntary agreement that qualifies as a final order under ORS 183.417(3)(b) except as provided otherwise in this rule.

(d) No decision notice is required based on prior notice.

(8) When the Department amends a decision notice with another decision notice under subsection (4) of this section, the date of the amended notice restarts the individual's deadlines to request a hearing or continuing benefits, or both.

(9) When a contested case notice extends an effective date or delays a reduction or closure, the date of the amended notice restarts a individual's timeline to request continuing benefits.

(10) When an individual has a pending hearing request or is receiving continuing benefits, and the Department amends a notice under this section, the individual need not re-file the hearing request or renew the request for continuing benefits.

(11) To end benefits if an individual receives them for less than 30 days, a basic decision notice is sent.

(12) The Department sends a continuing benefit decision notice when:

(a) Benefits are calculated in accordance with OAR 414-175-0075.

(b) To remove an individual from the need group.

(13) To end benefits for an individual who has moved out of Oregon and no longer meets residency requirements under OAR 414-175-0020, the Department sends the following decision notice:

(a) The Department sends a timely continuing benefit decision notice to the individual who has moved out of Oregon.

(b) The Department sends a basic decision notice if the individual becomes eligible for benefits in another state.

(14) The Department does not send a notice of termination to an individual disqualified for an IPV after a court order, a final order from an administrative hearing, or a signed waiver (see section (7)(c) and OAR 461-195-0621(2)) that imposes the disqualification.

(15) If benefits are reduced or closed to reflect cost-of-living adjustments in benefits or other mass change under a program operated by a federal agency or to reflect a mass change to payments in a program operated by the Department, the type of decision notice used is the same as otherwise applies to the reduction or closure of benefits under the rules of this division. Section 2 of this rule modifies the content requirements for a decision notice sent because of a cost-of-living adjustment or mass change that apply to other decision notices under Section 1.

(16) When the Department takes action on information reported on the Periodic Report form, the Department sends a continuing benefit decision notice. The notice includes the amount of income used to determine the benefits or ineligibility.

(a) For all changes not reported on the Periodic Report form, which result in a closure or reduction in benefits, the Department sends a timely continuing benefit decision notice.

(b) When the Department changes the reporting system from one reporting system to another reporting system, the Department provides a continuing benefit decision notice if the change occurs at a time other than at the start of a certification period.

(17) The Department sends a continuing benefit decision notice to close benefits when the benefit group fails to return the reapplication form. The case is closed on the last day of the last month of the certification period.

(18) When benefits are reduced for recovery of an overpayment (see OAR 414-175-0097 and 461-195-0551) a timely continuing benefit decision notice is sent for the first month of the reduction.

(19) Except as provided in section (22) of this rule, when benefits will end or be reduced after a specific period of time, the Department may issue a decision notice informing the benefit group of the date benefits will end or be reduced, and no further decision notice is required.

(20) Except as provided in section (22) of this rule, if the benefit group was informed in writing when the benefits began that the benefit group would receive benefits only for a specific period of time a basic decision notice may be used to-

(a) Deny an application to start or continue benefits after the completion of a certification period or to approve benefits at a level lower than the prior certification period.

(b) Indicate that benefits have been ended or reduced when no timely application is submitted.

(21) A basic decision notice is used when a special need allowance granted for a specific period of time is removed at the end of the specified period and the benefit group was informed of this in writing when the allowance began. A timely continuing benefit decision notice is required if stopping the special need allowance results in benefit closure.

(22) Relating to sections (19), (20), and (21) of this rule, no additional decision notice is required when:

(a) Notwithstanding OAR 414-175-0005, when a benefit group submits an application for a program from which they currently are receiving benefits.

(b) When a filing group is receiving priority processing but does not return postponed verification to the Department by the last day of the month in which the application period ends.

(c) A decision notice that included the eligibility begin and end dates was given for the reduced ERDC copay described in OAR 414-175-0050 and the three-month eligibility period ends.

(23) If the caregiver, another adult member of the need group, or the authorized representative:

(a) Makes an oral request to end or reduce benefits, a timely continuing benefit decision notice is sent.

(b) Makes a signed, written request to withdraw, end, or reduce benefits, a basic decision notice is sent.

(c) Makes an oral request to withdraw an application for benefits, a basic decision notice is sent. The Department may reduce or terminate benefits to an individual when the individual completes a voluntary agreement on a Department form used for this purpose.

Or. Admin. Code § 414-175-0055

ELD 11-2023, adopt filed 06/28/2023, effective 7/1/2023; DELC 16-2024, minor correction filed 03/04/2024, effective 3/4/2024

Statutory/Other Authority: ORS 329A.500

Statutes/Other Implemented: ORS 329A.500