358-3.3 Notice requirements.
(a) Public assistance, medical assistance and services: notice of
action.
(1) Action to discontinue, suspend, reduce,
restrict; changes in the manner of payment child care services; denial of an extension of
a waiver of public assistance program requirements or termination or modification of such
waiver. Except as set forth in subdivision (d) of this section, you have a right to timely
and adequate notice when a social services agency proposes to:
(i) take any action to
discontinue, suspend, or reduce your public assistance grant, medical assistance
authorization or services; or
(ii) change the manner
or method or form of payment of your public assistance grant; or
(iii) restrict your
medical assistance authorization; or
(iv) make changes
in the manner of payment for your child care services and such change results in the
discontinuance, suspension, reduction or termination of benefits, or forces you to make
changes in child care arrangements; or
(v) make changes in the
manner of payment for your supportive services povided to enable you as a recipient of
public asistance to participate in work activities pursuant to 12 NYCRR Part 1300 and such
changes result in the discontinuance, suspension, reduction or termination of benefits; or
(vi) deny an extension
of a waiver of public assistance program requirements under section 351.2(1) of this Title
or such waiver has been terminated or modified.
(2) Action to accept, deny, increase or make
change in calculation; denial of utilization threshold exemption or increase application;
employability determination; changes in the manner of payment for child care services;
denial of a waiver of public assistance program requirements. You have a right to adequate
notice when a social services agency:
(i) accepts or denies
your application for public assistance, medical assistance or services, or
(ii) increases your
public assistance grant, or
(iii) determines to
change the amount of one of the items used in the calculation of your public assistance
grant or medical assistance spenddown although there is no change in the amount of your
public assistance grant or medical assistance spenddown, or
(iv) denies an
application for an exemption from or an increase of a medical assistance utilization
threshold and you have reached the utilization threshold, or
(v) changes the manner
of payment for your child care services except as provided in subparagraph (1)(iv) of this
subdivision, or
(vi) determines that
you are not eligible for an exemption requested from work requirements as described in
Part 1300 of 12 NYCRR and you are an applicant for or recipient of public assistance or
medical assistance; or
(vii) denies a waiver
of public assistance program requirements under section 351.2(1) of this Title.
(3) Action based on a change in State or
federal law requiring automatic public assistance grant adjustments for classes of
recipients. When you are a member of a class of public assistance recipients for whom
changes in either State or federal law require automatic grant adjustments, you are
entitled to timely notice of such grant adjustment. This notice will be adequate if it
includes those items listed in section 358-2.2(b) of this Part.
(b) Food stamps.
(1) Action to discontinue, reduce or recoup:
adverse action notice. Except as set forth in subdivision (e) of this section, when a
social services agency proposes to take any action to discontinue or reduce your food
stamp benefits you have the right to timely and adequate notice.
(2) Action to accept, deny, increase, change in
calculation: action taken notice. When a social services agency accepts or denies your
application for food stamp benefits or increases your food stamp benefits, or changes the
amount of one of the items used in the calculation of your food stamp benefits although
there is no change in the amount of your food stamp benefits, you have the right to
adequate notice.
(3) Expiration notice.
(i) Before or at the
beginning of the last month of your household's current certification period for food
stamp benefits, you have a right to an expiration notice as defined in section 358-2.11 of
this Part; however, if your household was recertified for both public assistance and food
stamps prior to the last month of the food stamp certification period, an expiration
notice is not required.
(ii) For households
with certification periods longer than one or two months the notice of expiration must be
sent by the social services agency so that your household receives it no earlier than the
first day of the second to the last month of the certification period and no later than
one day before the last month of the certification period.
(iii) Households
certified for one month only, or initially certified for two months during the month
following the month of application, must be sent the expiration notice at the time of
certification.
(c) Home Energy Assistance Program (HEAP). When a social services
agency accepts or denies your application for HEAP benefits or determines that you are
eligible for HEAP benefits but federal funds are unavailable, you have a right to adequate
notice.
(d) Public assistance and medical assistance programs: Exceptions to
timely notice requirements.
(1) As a recipient of either public assistance
or medical assistance you have the right to adequate notice sent no later than the
effective date of the proposed action when:
(i) the social services
agency has factual information confirming the death of a recipient or the payee of a
family assistance case, and there is reliable information that no relative is available to
serve as a new payee; or
(ii) the social
services agency has received a clear written statement signed by you which includes
information that requires the social services agency to discontinue or reduce your public
assistance or medical assistance and you have indicated in such statement that you
understand that such action will be taken as a result of supplying such information; or
(iii) the social
services agency has received a clear written statement from you indicating that you no
longer wish to receive public assistance or medical assistance; or
(iv) the agency has
reliable information that you have been admitted or committed to an institution or prison
which renders you ineligible for assistance or services under the Social Services Law; or
(v) your whereabouts
are unknown and mail addressed to you by the social services agency has been returned by
the post office with an indication that there is no known forwarding address. However,
public assistance or medical assistance will be given to you if the social services agency
is made aware of your whereabouts during the period covered by the returned public
assistance check or medical assistance authorization; or
(vi) you have been
accepted for public assistance or medical assistance in another local social services
district, State, territory or commonwealth, and that acceptance has been verified by the
social services district previously providing you with such assistance.
(2) As a recipient of public assistance, you
have the right to adequate notice sent no later than the date of the proposed action when
the following actions affect your public assistance grant:
(i) you have been
placed for long-term care in a skilled nursing facility, intermediate care facility or
hospital; or
(ii) a child has been
removed from your home as a result of a judicial determination, or voluntarily placed in
foster care by the child's legal guardian; or
(iii) a special
allowance granted for a specific period has been terminated and you had been informed in
writing at the time that you were first granted the special allowance that the allowance
would automatically terminate at the end of the specified period; or
(iv) the social
services agency has determined to accept your application for public assistance or has
determined to increase your assistance;
(v) the social services
agency action results from information you furnished in a quarterly report required by
section 351.24 of this Title;
(vi) you are a
recipient of public assistance and you have been determined eligible for supplemental
security income and the social services agency has made a determination that the amount of
supplemental security income makes you no longer eligible for public assistance.
(3) As a recipient of medical assistance, you
have the right to adequate notice if you are in a general hospital, not receiving chronic
care services and a utilization review committee has determined that your medical
assistance payment should be reduced or discontinued.
(e) Food Stamp Program: Exemption from notice requirements or timely
notice requirements.
(1) You are not entitled to an individual
adverse action notice when:
(i) a mass change is
initiated which affects all food stamp households or significant portions thereof; or
(ii) based on reliable
information, the social services agency determines that all members of your household have
died or that the household has moved from the social services district or will not be
residing in the social services district and will be unable therefore to obtain its next
food stamp allotment from such district; or
(iii) your
certification period has expired, you were previously informed of the expiration, and you
have not reapplied for benefits; or
(iv) your household has
been receiving an increased food stamp allotment to restore lost benefits, the restoration
is complete, and the household was previously notified in writing of the date when the
increased food stamp allotment would terminate; or
(v) your household's
allotment of food stamp benefits varies from month to month within the certification
period to take into account changes which were anticipated at the time of certification,
and the household was notified that the food stamp allotment would vary at the time of
certification; or
(vi) your household
applied jointly for public assistance and food stamp benefits and has been receiving food
stamp benefits pending the approval of the public assistance grant and was notified at the
time of food stamp certification that food stamp benefits would be reduced upon approval
of the public assistance grant; or
(vii) a household
member is disqualified from the Food Stamp Program for an intentional program violation in
accordance with Part 359 or Part 399 of this Title or the food stamp benefits of the
remaining household members are reduced or terminated to reflect the disqualification of
that household member; or
(viii) the social
services agency has elected to assign a longer certification period to your household
which was certified on an expedited basis and for which verification was postponed. The
household must have received written notice that in order to receive benefits past the
month of application the household must provide the verification which was initially
postponed and the social services agency may act on the verified information without
further notice; or
(ix) a social services
agency has converted your household from cash repayment of an intentional program
violation claim or an inadvertent household error to benefit reduction, as a result of the
household's failure to make an agreed upon cash repayment; or
(x) you are a resident
of a treatment center or group living arrangement which is determined to be ineligible for
food stamp benefits because the facility has either lost its certification from the
appropriate State agency/agencies or lost its status as an authorized representative due
to its disqualification by the federal Food and Nutrition Service as a retailer. However,
residents of group living arrangements applying on their own behalf may remain eligible to
participate in the Food Stamp Program; or
(xi) your household
voluntarily requests, in writing or in the presence of an agency employee, that its food
stamp benefits be terminated. If the household does not provide a written request, the
social services agency must send the household a letter confirming the voluntary
withdrawal.
(2) Mass changes.
(i) When the federal
government initiates an adjustment to eligibility standards, allotments or deductions and
the State initiates adjustments to utility standards, you are not entitled to a notice of
adverse action.
(ii) When OTDA
initiates a mass change in food stamp eligibility or benefit levels simultaneously for the
entire caseload or that portion of the caseload that is affected, or by conducting
individual desk reviews in place of the mass change, no later than the date your household
is scheduled to receive the benefits which have been changed, you shall be informed of the
following:
(a) the general nature of the change;
(b) examples of the effect the changes will have on household allotments;
(c) the month in which the change will take effect;
(d) the right to a fair hearing;
(e) the right to continued benefits and under what circumstances benefits will be
continued, pending issuance of the fair hearing decision. You will be informed that at the
hearing, the hearing officer may determine to end your continuation of benefits if it is
determined that the issue being contested is not based on improper computation of benefits
or misapplication or misinterpretation of federal law or regulation;
(f) general information on whom to contact for additional information; and
(g) the liability the household will incur for any overissued benefits if the fair hearing
decision is adverse.
(3) As a recipient of food stamp benefits you
have the right to an adequate notice sent no later than the date of the proposed action
when the social services agency action results from information you furnished on a
periodic report. As a recipient of food stamp benefits, you have the right to an adequate
and timely notice because you failed to return a periodic report required by section
387.17(d) of this Title.
(f) Involuntary discharges from tier II facilities.
As a resident of a tier II facility you have a right to adequate notice when you have been
involuntarily discharged from a tier II facility as set forth in section 900.8 of this
Title and you have requested and participated in a hearing, held by the facility or by the
social services district in which the facility is located, to determine whether you should
be involuntarily discharged. Such notice must be on a form mandated by OTDA, which meets
the requirements for adequate notice as set forth in section 358-2.2 of this Part.
(g) Concurrent benefits. For the purposes of this subdivision, the term
"benefits" has the same meaning as that used in section 351.9 of this Title and
"concurrent benefits" has the same meaning as that used in section 351.9 of this
Title.
(1) Denial of benefits. You have the right to
an adequate notice when a social services official determines to deny you benefits on the
grounds that you are receiving or have been accepted to receive a concurrent benefit in
that social services district or in another social services district, state, territory or
commonwealth.
(2) Discontinuance of benefits - Timely and
adequate notice. You have the right to timely and adequate notice when:
(i) a social services
official determines to discontinue your benefits because you are receiving concurrent
benefits in that social services district and in another state, territory or commonwealth,
but you are not receiving concurrent benefits from social services districts solely within
the State; or
(ii) a social services
official determines to discontinue your benefits because you are receiving benefits in
that social services district and all concurrent benefits in that district and in any
other social services district in the state have been discontinued and no aid continuing
has been granted under section 358-3.6 of the Part for any such discontinuances.
(3) Discontinuance of benefits - Exception to
timely notice. Notwithstanding any other provision of this section, you have a right to
adequate notice sent no later than the effective date of the proposed action when a social
services official determines to discontinue your benefits because you are receiving
concurrent benefits in the same social services district or in another social services
district within the State.