Roles and Responsibilities

Roles of the Appeals Officer

Under state regulation, every state hearing request must be assigned to an Appeals Officer (AO) who assumes the responsibility of preparing and presenting the hearing case on behalf of the county. An AO is an impartial party reviewing the facts of an action(s) disputed by the claimant and should not have had immediate prior involvement with the appealed case.

Responsibilities of the Appeals Officer

An AO has the full authority to resolve hearing issue(s) in advance of a state hearing. The determination of how the hearing should proceed is the responsibility of the AO, and seeking prior approval is not required before agreeing on terms with a claimant and/or AR. The AO is authorized to make binding agreements and stipulations on behalf of the county.

When a person files a hearing request, the AO has the following responsibilities to:

Inform the claimant and/or AR of the administrative hearing process
Identify the issue(s) raised by the claimant and/or AR
Review the appropriateness of the disputed action(s) based on the existing evidence(s)
Review the applicable statues, regulations, and policies
Ensure Aid Paid Pending (APP) is provided to the claimant as appropriate
Determine the resolution of hearing issue(s) by pursuing corrective action(s)
Negotiate unconditional withdrawal(s) and conditional withdrawal(s)
Provide the claimant and/or AP with case records prior to a hearing
Provide reasonable accommodations
Determine if a request of postponement is needed
Request subpoenas and witnesses (EWs and other staff)
Prepare a county’s statement of position
Defend the county’s action(s).

Pre-Hearing Requirements of the Appeals Officer

Identifying Hearing Issue(s)

The AO should thoroughly review the case records to identify the issue(s) disputed by the claimant and/or AR.

If the request for a hearing does not present the basis for an appeal, the AO immediately contacts the claimant and/or Authorized Representative (AR) for clarification.

If the hearing issue(s) has been determined, the AO conducts a review of the applicable statutes, regulations, and policies for the appropriateness of the county’s action(s) and the need for a hearing.

If the issue(s) remains undetermined after full review of the case records, the AO prepares a limited “Statement of Position (SOP)” and documents all attempts to contact the claimant and/or AR.

Note: The limited SOP provides background information including household composition, aid being received, and a documented attempts to contact the claimant, AR, eligibility worker(s), and/or other counties' personnel to determine the issue(s) for hearing.

Review of County Actions and Hearing Issues

Once the issue(s) has been determined, AO must:

Review the applicable statues, regulations, and policies related to the evidence(s) contained in the case records
Determine the appropriateness of the county’s actions
Contact the claimant and/or AR and resolve any disagreements or misunderstandings to avoid an unnecessary hearing
Explain to the claimant and/or AR the right to a hearing if the claimant and/or AR has decided to pursue a hearing request
Provide the claimant and/or AR contact information of any free legal representation
Inform the claimant and/or AR of the right to review his/her case file before, during, and after the hearing
Assist the claimant and/or AR in preparing for the hearing by providing all relevant regulations and evidence
Explain the right to withdraw the request for a hearing if the claimant and/or AR no longer requests a hearing.

Reasonable Accommodations

When preparing for a hearing, the AO must be aware of the claimant’s needs for reasonable accommodations.

For a claimant with disabilities, the AO must:

Provide the necessary auxiliary aids and services
Take appropriate steps to ensure accessibility of all available resources.

Translation Services for Non-English Claimants

California Department of Social Services (CDSS) programs and Department of Health Care Services (DHCS) programs administered by counties have the responsibility to inform non-English speakers translation services are available when providing the Statement of Position (SOP). This requirement is met by attaching the GEN 1365, Notice of Language Services, to the front of the SOP.

For a claimant with limited English proficiency, the AO must also:

Notify the State Hearing Division that an interpreter is necessary at the hearing
Provide a bilingual service at no cost to the claimant during verbal communication
Use translated documents and forms into the claimant’s preferred language

Reminder: Refer to DEBS Business Process Chapter 33 Civil Rights for more information on translation services available for clients.

Access to Case Records Prior to Hearing

After the claimant and/or AR has filed a hearing request, the claimant and/or AR may request to review the case file before the hearing is held.

When a claimant and/or AR requests to review his/her case record, the AO:

Informs the claimant and/or AR of the right to review his/her files before, during, and after the hearing
Denies access to the claimant and/or AR certain documents, based on privilege or confidentiality
Provides copies of any non-privileged and non-confidential documents relating to the hearing from the case file at no charge
Charges the claimant a fee of 10 cents per page copied for all other materials, unless the other materials are related to the CalFresh Program, in which case they shall be made available at no charge.

Note: The information from an active welfare fraud investigation relating to the application, receipt, or misuse of public assistance by a recipient, adult, or head of household, in or out of the home, is confidential.

Authority of the AO to Settle a Case

After determining the issue(s), the AO resolves any disagreement(s) or misunderstanding(s) with the claimant and/or AR at the lowest possible administrative level to avoid an unnecessary hearing. An AO is granted the authority to settle the case, and determines whether:

The case should proceed to a hearing
The case should be settled with the claimant and/or AR
Corrective action(s) are required for an Eligibility Worker/Social Worker/Employment Counselor to resolve the hearing issue(s).

If the county action was correct, the AO contacts the claimant and/or AR to:

Attempt to resolve the issue(s) without hearing
Inquire if the claimant plans to attend the hearing
Explain the claimant’s right to withdraw the request for the hearing
Determine any other issue(s) the claimant may raise at the hearing
Inform the claimant and/or AR of the right to review his/her case file
Provide all information to assist the claimant and/or AR in preparing for the hearing.

If the county action was incorrect, the AO:

Attempts to resolve the issue(s) without the hearing
Contacts EW/SW/EC to take corrective action(s)
Offers the claimant and/or AR an agreement by signing the “Conditional Withdrawal of Request for Hearing” (DPA 315) form.

A sufficiently detailed DPA 315 states:

The specific program(s) and issue(s) are to be reevaluated
The claimant’s agreement to provide any information needed to complete the reevaluation or cancellation of the county action(s)
The effective or eligibility date based on reevaluation, reassessment, or cancellation of the county’s action(s)
The claim numbers, benefits, and time frames to be reevaluated or canceled for overpayment and/or overissuance case(s).

Overissuance and Overpayment Revision

When the issue being appealed involves overissuance or overpayment activity the AO must determine who is responsible to mail a notice of action, suspend, revise, terminate or refund the claimant. The chart below details responsibilities involving overpayment and overissuance:

Action	Responsible Department
Suspending a claim due to Fair Hearing	Open and active cases involving claim activity will be directed to the assigned EW, if case is not assigned the task will be directed to the Appeals Liaison. When the program is closed and not active the DTAC will suspend the claim.
Revisions, Notice of Action	Any claims involving current or past IEVS department Eligibility Examiners are handled exclusively by the IEVS Unit. All requests must be emailed to the EE who created the claim, IEVS Program Control Supervisor, IEVS lead, and Appeals Supervisor. Open and closed cases assigned or unassigned are emailed to the Appeals Liason where the case is currently housed, or the program discontinued.
Refunds	All refunds are directed to DTAC.
Termination with no previous repayment activity	Open and active cases are emailed to the Appeals Liason where the case is located. Closed and inactive cases are directed to DTAC.
Termination with previous repayment activity	DTAC must process refund or offset balance prior to termination. Open and active cases are emailed to the Appeals Liason where the case is located. Closed and inactive cases are directed to DTAC.
Any activity involving IEVS staff must be directed to the IEVS unit

Expunged Cash Aid Benefits

When cash aid benefits are expunged, those benefits can be reissued. The client has a right to claim these cash benefits at any time in the future. When a client requests to be paid expunged cash benefits they must be reissued via Electronic Funds Transfer (EFT).

Important: When cash aid benefits are expunged, the amount expunged must not be used to offset an existing overpayment unless the client signs a repayment agreement.

Withdrawals

Unconditional Withdrawal

An unconditional withdrawal is generally referred to as a “straight withdrawal” or simply as a withdrawal, and is a decision by the client to withdraw from the appeals process without an action on the part of the county. When the withdrawal is unconditional, the hearing request shall be immediately dismissed.

An unconditional withdrawal may result when:

The request for hearing does not present the basis for appeal
The matter has already been resolved
The claimant has accepted the county’s explanation
The client has admitted the correctness of the county’s position.

Conditional Withdrawal

If the AO concludes that the county’s action as inappropriate, that the evidence does not support the county’s action, or that the claimant has additional information which would change the outcome, a conditional withdrawal agreement may be offered to the claimant and/or AR prior to or during a hearing.

A conditional withdrawal represents the claimant's decision to withdraw the appeal based on certain promises of future action(s) taken by the county. An AO shall contact line staff such as an EW, SW, and/or EC to have the action(s) corrected and follow up to inquire whether all appropriate actions have been completed in a timely matter.

The completed “Conditional Withdrawal of Request For Hearing” (DPA 315) form with the proposed terms and conditions and the signatures of the AO and claimant and/or AR is required for a conditional withdrawal and the corrective actions must be completed without delay, no longer than 30 days from the date of the agreement.

Withdrawal Requests

The claimant and/or AR may withdraw his or her hearing request any time before a decision of the Director is signed. Such a withdrawal shall be submitted in writing; however, a verbal request for withdrawal is acceptable, and the process as follows.

Verbal Request of an Unconditional Withdrawal

If the claimant has verbally withdrawn the hearing request prior to the hearing, the county must send the claimant a letter confirming the withdrawal of the request. The letter will serve as the written withdrawal. The request for a hearing shall be considered withdrawn unless, within 15 days of the mailing of such a letter, the county receives notice, either submitted in writing or orally, that the claimant has not withdrawn the request for a hearing.

Verbal Request of a Conditional Withdrawal

An oral request of a conditional withdrawal must be accompanied by an agreement signed by an AO and the claimant and/or AR upon DPA 315 form. The request for a hearing must be considered withdrawn unless the county receives notification from the claimant that he or she has not withdrawn it.

Important: Line staff are not authorized to sign DPA 315.

Reminder: Oral requests for withdrawals must be documented in CalWIN Maintain Case Comments window.

Postponement Request

In cases where the issue(s) is/are identified on the day of the hearing and the AO and the claimant and/or AR cannot come to an agreement to resolve the issue(s), the AO may request a postponement. In such cases, the AO must provide testimony or evidence of the attempt to contact the claimant and/or AR, the pre-hearing review of the case records, and the attempted contact with the claimant’s county worker(s).

Statement of Position

The AO summarizes the facts of the case and regulatory justifications for the county’s action(s) on the Statement of Position (SOP). A copy of the SOP must be available to the claimant and/or AR at least two (2) working days before the date of the scheduled hearing.

The SOP must provide:

A statement about the county’s action(s) or inaction(s)
A statement of the issue(s) being presented as identified by the parties
A listing of the relevant facts and any evidence(s) leading to the issuance of the NOA or the hearing request that supports the county’s position
The authorities that the county relied upon when taking the contested action(s): Program Regulations, statutes, and/or state/county policies as well as ACL, ACIN, state Policy Interpretations, etc.
The amount of aid, grant adjustment, final budget computation, and/or demand for payment for the period at issue
Copies of documentary evidence and a list of witnesses
The reason for the withholding of specific documents due to privileged information (i.e. ATTACHMENT A)
Attachments summarizing the county’s review of the hearing and its conclusion
A document on the last page of the SOP itemizing its contents.

Safety and Hearing Room Requirements

Where the Department conducts in-person administrative hearings in county offices, the counties have been and will continue to be expected. to adhere to the following requirements:

Requirement

The hearing room must be large enough to allow reasonable entry and exit, including ADA required access for wheelchairs. The room should accommodate seating for a minimum of one Administrative Law Judge (ALJ) and four other people. If the size of the hearing room is at the minimum standard, the county must have an alternative larger room available for occasional hearings which involve six or more people.
The room should be arranged so that the ALJ is at the head of a T-shaped table or desk arrangement, unless this arrangement prohibits the ALJ’s access to the silent alarm and/or the entrance/exit.
The room must have adequate ventilation that complies with the current Cal/OSHA standards.
The room must be sufficiently soundproof to prevent interference with the proper electronic recording of the hearing and to preserve the confidential nature of the proceedings.
The room must have a telephone and at least two working electrical outlets and/or a power strip to facilitate the use of electronic equipment, including a laptop computer, recording, and other peripheral devices/equipment.
The room should have an appearance appropriate to quasi-judicial proceedings and should be maintained in that fashion. Accordingly, it should not have the appearance of a dual-purpose room.
The county must provide a level of security at the hearing room site which ensures the safety of all agency personnel and which is equivalent to the security which is provided to other county employees who are in similar public contact situations.
The hearing room must be configured so that the ALJ is closest to the entrance/exit. In hearing rooms with two entrances/exits, the judge should enter and exit from the entrance closest to where the judge is seated, and the participants should enter from the other entrance/exit.
Each hearing room must be equipped with a silent alarm or other device to notify county security, county personnel and/or law enforcement should an incident or threat of violence occur during the hearing. The device must be located within an arm’s reach of the judge during the hearing, preferably under the judge’s desk. the county must have a coordinated response plan in place should the device be utilized.
In the event a particular claimant presents an increased security risk, the county and Presiding Judge (PJ) for the relevant regional office will work together to ensure that appropriate security is in place at the county hearings site. The PJ may arrange for security provided by the California Highway Patrol as necessary. SHD reserves the right to change the hearing modality, postpone, or immediately stop a hearing in progress to ensure the safety of all participants.

Prior to changing hearing locations the county must notify SHD to ensure the new location meets the criteria and that all notices are properly updated with the correct hearing location.

Hearing Presentation

At the hearing, the AO assumes full responsibility for the presentation of the county's case by:

Having the county case record available at the hearing
Summarizing the written position statement
Examining the county witnesses
Cross-examining the claimant and the claimant's witnesses
Making any appropriate objections or motions during the hearing
Responding to any questions from the claimant or Administrative Law Judge concerning the case.

Only the AO has the authority to make agreements or to stipulate on behalf of the county during the course of the hearing.

Post Hearing Instructions

After the hearing is concluded, the Appeals Officer will inform the Eligibility Worker of additional information/action required and as to the continuation of Aid Paid Pending.

Role of the EW Supervisor

Upon notification of the filing of an appeal by the SCD 2595 and/or e-mail, the EW supervisor must:

Ensure implementation of Aid Paid Pending as required.
Ensure compliance for request is correct and timely.
Ensure that the Appeals unit is notified timely of the completion of the forms SCD 2597.
Be available and present at the hearing as witness when the EW is not available.

Role of the EW

Ensure that all current documents are scanned into IDM, for the AO to be able to review the case.
Enter clear case comments in CalWIN Maintain Case Comments window.
Ensure that the Appeals unit is notified timely on the completion of the forms SCD 2597.
Be available and present at the hearing as witness.

Department or District Office Contacted

For the purposes of this section, the Eligibility Worker (EW), Social Worker (SW), or Employment Counselor (EC) to be contacted for corrections will be the EW/SW/EC or Unit to whom the case is currently assigned at the time of the hearing request. This may or may not be the EW/SW/EC or unit who took the action under dispute.

Exceptions to the above condition:

Hearing decision pertains to an intake denial. The corrective action will be returned to the EW/SW/EC or unit where the denial originated.
Case is currently assigned to an office or unit who no longer processes the program in dispute. (e.g., CF Appeals currently assigned to BSC). The corrective action will be assigned to an office where the program is administered.

When a hearing decision is assigned to a EW/Counselor/Unit, the expectation is that the hearing decision will be processed timely. Any disputes regarding the assignment must be brought up to the attention of the SSPM for immediate resolution.

Reminder: When assistance from the worker, counselor or unit is required to clarify any questions, such assistance must be sought without delay.

Witness

Attendance of Eligibility Workers or EW Supervisors at hearings as witnesses is at the discretion of the Appeals Officer assigned to the case. Because of EW workload, such requests will be made only when, in the best judgment of Appeals staff, the presence/testimony of the EW is essential to the County's case. Thus, it is imperative that EWs honor such requests. The County's case and significant program costs may be adversely affected by the failure of witnesses to appear.

Any unexcused failure to appear will be brought to the attention of the appropriate office manager by the supervisor of the Appeals unit.

Representation

Agency policy specifically prohibits staff (EWs and social workers) from representing a client in a State hearing. This is considered a conflict of interest, since the staff member is an employee of the agency against which the appeal is brought.

This refers specifically to representation or advocacy in the hearing itself.

This policy in no way limits the right/obligation of staff to assist clients in knowing and exercising their appeal rights.

Agreement Cannot Be Reached

If agreement cannot be reached between the Appeals Officer and the line Eligibility Worker, resolution will be as follows:

Appeals Officer - EW supervisor
Appeals Supervisor - SSPM

Compliance

Conditional withdrawals must be acted upon and appropriate notice issued within 30 days of the date of the signing of the conditional withdrawal. Agreement as outlined above is a commitment to take the action required. Dishonored agreements will result in a reopening of the hearing and in damage to the credibility of the Agency. If situations arise where compliance is impossible, immediate contact with the Appeals supervisor is required.