HOUSE BILL 971344
BY REPRESENTATIVES Lawrence, Keller, Morrison, Paschall, Schwarz, and Snyder;
also SENATOR Wham.
CONCERNING THE APPEAL PROCESS FOR PUBLICLY FUNDED
PROGRAMS FOR NEEDY PERSONS.
Be it enacted by the General Assembly of the State
of Colorado:
SECTION 1. 262127,
Colorado Revised Statutes, 1989 Repl. Vol., is amended to read:
262127. Appeals.
(1) (a) (I) If an application for assistance
payments is not acted upon by the county department within a reasonable
time after filing of the same, or if an application is denied
in whole or in part, or if a grant of assistance payments is suspended,
terminated, or modified, the applicant or recipient, as the case
may be, may appeal to the state department in the manner and form
prescribed by the rules and regulations
of the state department. EVERY COUNTY DEPARTMENT OR SERVICE DELIVERY
AGENCY SHALL ADOPT PROCEDURES FOR THE RESOLUTION OF DISPUTES ARISING
BETWEEN THE COUNTY DEPARTMENT OR THE SERVICE DELIVERY AGENCY AND
ANY APPLICANT FOR OR RECIPIENT OF PUBLIC ASSISTANCE PRIOR TO APPEAL
TO THE STATE DEPARTMENT. SUCH PROCEDURES ARE REFERRED TO IN THIS
SECTION AS THE "DISPUTE RESOLUTION PROCESS". TWO OR
MORE COUNTIES MAY JOINTLY ESTABLISH THE DISPUTE RESOLUTION PROCESS.
THE DISPUTE RESOLUTION PROCESS SHALL BE CONSISTENT WITH RULES
PROMULGATED BY THE STATE BOARD PURSUANT TO ARTICLE 4 OF TITLE
24, C.R.S. THE DISPUTE RESOLUTION PROCESS SHALL INCLUDE AN OPPORTUNITY
FOR ALL CLIENTS TO HAVE A COUNTY CONFERENCE, UPON THE CLIENT'S
REQUEST, AND SUCH REQUIREMENT MAY BE MET THROUGH A TELEPHONIC
CONFERENCE UPON THE AGREEMENT OF THE CLIENT AND THE COUNTY DEPARTMENT.
THE DISPUTE RESOLUTION PROCESS NEED NOT CONFORM TO THE REQUIREMENTS
OF SECTION 244105, C.R.S., AS LONG AS THE RULES ADOPTED
BY THE STATE BOARD INCLUDE PROVISIONS SPECIFICALLY SETTING FORTH
EXPEDITIOUS TIME FRAMES, NOTICE, AND AN OPPORTUNITY TO BE HEARD
AND TO PRESENT INFORMATION. IF THE DISPUTE IS NOT RESOLVED, THE
APPLICANT OR RECIPIENT MAY APPEAL TO THE STATE DEPARTMENT IN THE
MANNER AND FORM PRESCRIBED BY THE RULES OF THE STATE DEPARTMENT.
WHETHER AT THE COUNTY LEVEL, STATE LEVEL, OR BOTH, DISPUTES RELATED
TO THE DELIVERY OF ASSISTANCE UNDER THE SUCCESSOR PROGRAM TO AID
TO FAMILIES WITH DEPENDENT CHILDREN SHALL BE DECIDED IN ACCORDANCE
WITH THE RULES PROMULGATED BY THE STATE BOARD PURSUANT TO THIS
SUBPARAGRAPH (I) AND WITH THE COUNTY'S OFFICIAL WRITTEN POLICIES
GOVERNING DELIVERY OF ASSISTANCE UNDER SUCH PROGRAM. THE STATE
BOARD SHALL ADOPT RULES SETTING FORTH WHAT OTHER ISSUES, IF ANY,
MAY BE APPEALED BY AN APPLICANT OR RECIPIENT TO THE STATE DEPARTMENT.
COUNTY NOTICES TO APPLICANTS OR RECIPIENTS SHALL INFORM THEM OF
THE BASIS FOR THE COUNTY'S DECISION OR ACTION AND SHALL INFORM
THEM OF THEIR RIGHTS TO A COUNTY CONFERENCE UNDER THE DISPUTE
RESOLUTION PROCESS AND OF THEIR RIGHTS TO STATE LEVEL APPEAL AND
THE PROCESS OF MAKING SUCH APPEAL. A hearing need not be granted
when either state or federal law requires or results in an automatic
grant adjustment for classes of recipients, unless the reason
for an individual appeal is incorrect grant computation.
(II) Upon receipt of an appeal, the state
department shall give the appellant reasonable notice and an opportunity
for a fair hearing in accordance with rules and
regulations of the state department.
Any such fair hearing shall comply with section 244105,
C.R.S., and the state department's administrative law judge shall
preside.
(III) The appellant shall have an opportunity
to examine all applications and pertinent records concerning said
appellant which
THAT constitute a basis for the denial, suspension, termination,
or modification of assistance payments.
(IV) The appellant may represent himself
OR HERSELF or he OR SHE may be represented by legal counsel, or
by a relative, friend, or other spokesman, and such representation
by nonlawyers shall not be considered to be the practice of law.
(b) The state department, by its rules,
and regulations,
may provide for fair hearings and appeals for applicants for and
recipients of social services.
(c) Upon its
own motion, the state department may review any decision of a
county department and may consider any application upon which
a decision has not been made by the county department within a
reasonable time. The state department may make such additional
investigation as it deems necessary and shall make such decision
as to the granting of assistance payments and the amount thereof
as in its opinion is justifiable pursuant to the provisions of
this article and the rules and regulations of the state department.
Applicants or recipients affected by such decisions of the state
department, upon request, shall be given reasonable notice and
opportunity for a fair hearing by the state department.
(2) All decisions of the state department
shall be binding upon the county department involved and shall
be complied with by such county department.
(3) THE STATE DEPARTMENT, THE DEPARTMENT
OF HEALTH CARE POLICY AND FINANCING, AND THE DIVISION OF ADMINISTRATIVE
HEARINGS IN THE DEPARTMENT OF PERSONNEL SHALL WORK TOGETHER TO
STREAMLINE THE PROCESS FOR THE APPEAL OF DISPUTES THAT ARE NOT
RESOLVED AT THE COUNTY LEVEL AND SHALL CONSIDER PROPOSED LEGISLATIVE
CHANGES OR FEDERAL WAIVERS FOR THE SUCCESSOR PROGRAM TO AID TO
FAMILIES WITH DEPENDENT CHILDREN IN ORDER TO ADDRESS CHANGES IN
THE APPEALS PROCESS TO AVOID OR MITIGATE EXPENSES TO COUNTIES
OF MAINTAINING BENEFITS DURING THE PENDENCY OF STATELEVEL
APPEALS.
(4) THE STATE DEPARTMENT IS AUTHORIZED
TO APPLY TO THE UNITED STATES DEPARTMENT OF AGRICULTURE AND THE
HEALTH CARE FINANCING ADMINISTRATION FOR WAIVERS TO DEVELOP A
PROCESS FOR APPEALS THAT ENSURES THAT ISSUES MAY BE CONSOLIDATED
AT THE LOCAL AND STATE LEVELS. IN APPLYING FOR THE WAIVER, THE
STATE DEPARTMENT SHALL DEMONSTRATE THAT DUE PROCESS CONSIDERATIONS
ARE ADDRESSED THROUGH OTHER APPEAL MECHANISMS.
SECTION 2. 264402,
Colorado Revised Statutes, 1989 Repl. Vol., as amended, is amended
to read:
264402. Appeals.
(1) (a) (I) If an application for medical
benefits is not acted upon by the county department within a reasonable
time after filing of the same, or if an application is denied
in whole or in part, or if medical benefits are suspended, terminated,
or modified, the applicant or recipient, as the case may be, may
appeal to the state department in the manner and form prescribed
by the rules and regulations
of the state department. EVERY COUNTY DEPARTMENT OR SERVICE DELIVERY
AGENCY SHALL ADOPT PROCEDURES FOR THE RESOLUTION OF DISPUTES ARISING
BETWEEN THE COUNTY DEPARTMENT OR THE SERVICE DELIVERY AGENCY AND
ANY APPLICANT FOR OR RECIPIENT OF MEDICAL ASSISTANCE PRIOR TO
APPEAL TO THE STATE DEPARTMENT. SUCH PROCEDURES ARE REFERRED TO
IN THIS SECTION AS THE "DISPUTE RESOLUTION PROCESS".
TWO OR MORE COUNTIES MAY JOINTLY ESTABLISH THE DISPUTE RESOLUTION
PROCESS. THE DISPUTE RESOLUTION PROCESS SHALL BE CONSISTENT WITH
RULES PROMULGATED BY THE STATE BOARD PURSUANT TO ARTICLE 4 OF
TITLE 24, C.R.S. THE DISPUTE RESOLUTION PROCESS SHALL INCLUDE
AN OPPORTUNITY FOR ALL CLIENTS TO HAVE A COUNTY CONFERENCE, UPON
THE CLIENT'S REQUEST, AND SUCH REQUIREMENT MAY BE MET THROUGH
A TELEPHONIC CONFERENCE UPON THE AGREEMENT OF THE CLIENT AND THE
COUNTY DEPARTMENT. THE DISPUTE RESOLUTION PROCESS NEED NOT CONFORM
TO THE REQUIREMENTS OF SECTION 244105, C.R.S., AS
LONG AS THE RULES ADOPTED BY THE STATE BOARD INCLUDE PROVISIONS
SPECIFICALLY SETTING FORTH EXPEDITIOUS TIME FRAMES, NOTICE, AND
AN OPPORTUNITY TO BE HEARD AND TO PRESENT INFORMATION. IF THE
DISPUTE IS NOT RESOLVED, THE APPLICANT OR RECIPIENT MAY APPEAL
TO THE STATE DEPARTMENT IN THE MANNER AND FORM PRESCRIBED BY THE
RULES OF THE STATE DEPARTMENT. COUNTY NOTICES TO APPLICANTS OR
RECIPIENTS SHALL INFORM THEM OF THE BASIS FOR THE COUNTY'S DECISION
OR ACTION AND SHALL INFORM THEM OF THEIR RIGHTS TO A COUNTY CONFERENCE
UNDER THE DISPUTE RESOLUTION PROCESS AND OF THEIR RIGHTS TO STATE
LEVEL APPEAL AND THE PROCESS OF MAKING SUCH APPEAL. THE STATE
BOARD SHALL ADOPT RULES SETTING FORTH WHAT OTHER ISSUES, IF ANY,
MAY BE APPEALED BY AN APPLICANT OR RECIPIENT TO THE STATE DEPARTMENT.
A hearing need not be granted when either state or federal law
requires or results in a reduction or deletion of a medical benefit
UNLESS THE APPLICANT OR RECIPIENT IS ARGUING THAT HIS OR HER CASE
DOES NOT FIT WITHIN THE PARAMETERS SET FORTH BY THE CHANGE IN
THE LAW. IN NOTIFYING THE APPLICANT OR RECIPIENT THAT AN APPEAL
IS BEING DENIED BECAUSE OF A CHANGE IN STATE OR FEDERAL LAW, THE
STATE'S NOTICE SHALL INFORM THE APPLICANT OR RECIPIENT THAT FURTHER
APPEAL SHOULD BE DIRECTED TO THE APPROPRIATE STATE OR FEDERAL
COURT.
(II) Upon receipt of an appeal, the state
department shall give the appellant at least ten days' notice
and an opportunity for a fair hearing in accordance with the rules
and regulations
of the state department. Any such fair hearing shall comply with
section 244105, C.R.S., and the state department's
administrative law judge shall preside.
(III) The appellant shall have an opportunity
to examine all applications and pertinent records concerning said
appellant which
THAT constitute a basis for the denial, suspension, termination,
or modification of medical benefits.
(b) Upon its
own motion, the state department may review any decision of a
county department and may consider any application upon which
a decision has not been made by the county department within a
reasonable time. The state department may make such additional
investigation as it deems necessary and shall make such decision
as to the granting of medical benefits and the amount thereof
as in its opinion is justifiable pursuant to the provisions of
this article and the rules and regulations of the state department.
Applicants or recipients affected by such decisions of the state
department, upon request, shall be given reasonable notice and
opportunity for a fair hearing by the state department.
(2) All decisions of the state department
shall be binding upon the county department involved and shall
be complied with by such county department.
SECTION 3. 262104
(1), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
amended to read:
262104. Public assistance
programs electronic benefits transfer service rules.
(1) (a) The state department is hereby designated
as the single state agency to administer or supervise the administration
of public assistance programs in this state in cooperation with
the federal government pursuant to the social security act and
this article. The state department shall establish public assistance
programs consisting of assistance payments and social services
to be made available to eligible individuals, including but not
limited to old age pensions, aid to families with dependent children,
aid to the needy disabled, and aid to the blind.
(b) THE STATE DEPARTMENT MAY REVIEW ANY
DECISION OF A COUNTY DEPARTMENT AND MAY CONSIDER ANY APPLICATION
UPON WHICH A DECISION HAS NOT BEEN MADE BY THE COUNTY DEPARTMENT
WITHIN A REASONABLE TIME TO DETERMINE THE PROPRIETY OF THE ACTION
OR FAILURE TO TAKE TIMELY ACTION ON AN APPLICATION FOR PUBLIC
ASSISTANCE. THE STATE DEPARTMENT SHALL MAKE SUCH ADDITIONAL INVESTIGATION
AS IT DEEMS NECESSARY AND SHALL, AFTER GIVING THE COUNTY DEPARTMENT
AN OPPORTUNITY TO REBUT ANY FINDINGS OR CONCLUSIONS OF THE STATE
DEPARTMENT THAT THE ACTION OR DELAY IN TAKING ACTION WAS A VIOLATION
OF OR CONTRARY TO STATE DEPARTMENT RULES, MAKE SUCH DECISION AS
TO THE GRANTING OF ASSISTANCE PAYMENTS AND THE AMOUNT THEREOF
AS IN ITS OPINION IS JUSTIFIABLE PURSUANT TO THE PROVISIONS OF
THIS ARTICLE AND THE RULES OF THE STATE DEPARTMENT. APPLICANTS
OR RECIPIENTS AFFECTED BY SUCH DECISIONS OF THE STATE DEPARTMENT,
UPON REQUEST, SHALL BE GIVEN REASONABLE NOTICE AND OPPORTUNITY
FOR A FAIR HEARING BY THE STATE DEPARTMENT.
SECTION 4. 262126,
Colorado Revised Statutes, 1989 Repl. Vol., is repealed as follows:
262126. Evidentiary conference.
The county department, prior to making
any decision to deny, terminate, suspend, or modify assistance
payments to a recipient, shall provide said recipient opportunity
for an evidentiary conference in the county department in accordance
with the rules and regulations of the state department.
SECTION 5. 262303,
Colorado Revised Statutes, 1989 Repl. Vol., is repealed as follows:
262303. Evidentiary conference.
Prior to making any decision to deny,
terminate, suspend, or modify food stamp benefits of a recipient,
the county department, or the state department in food stamp districts
administered by the state department, shall provide said recipient
opportunity for an evidentiary conference in the county in accordance
with the rules and regulations of the state department.
SECTION 6. 262133
(2), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
amended to read:
262133. State income tax
refund offset. (2) As a condition
of certifying an overpayment to the department of revenue as provided
in subsection (1) of this section, the state department shall
ensure that the obligated person has been afforded the opportunity
for an evidentiary
A conference at the county department level pursuant to section
262126 or 262303
SECTION 262127 OR 264402 and the opportunity
for an appeal to the state department pursuant to section 262127
or 262304. In addition, the state department, prior
to final certification of the information specified in subsection
(1) of this section to the department of revenue, shall notify
the obligated person, in writing, at his last known address, that
the state intends to refer the person's name to the department
of revenue in an attempt to offset the obligation against the
person's state income tax refund. Such notification shall inform
the obligated person of the opportunity for an
evidentiary A conference with the
county department pursuant to section
262126 or 262303
SECTION 262127 OR 264402 and of the opportunity
for an appeal to the state department pursuant to section 262127
or 262304. In addition, the notice shall specify issues
that may be raised at an evidentiary conference or on appeal,
as provided by this subsection (2), by the obligated person in
objecting to the offset and shall specify that the obligated person
may not object to the fact that an overpayment occurred. A person
who has received a notice pursuant to this subsection (2) shall
request, within thirty days from the date such notice was mailed,
an administrative review or evidentiary conference, as provided
in this subsection (2).
SECTION 7. 264104
(1), Colorado Revised Statutes, 1989 Repl. Vol., as amended, is
amended to read:
264104. Program of medical
assistance single state agency.
(1) (a) The state department, by rules and regulations,
shall establish a program of medical assistance to provide necessary
medical care for the categorically needy. The state department
is hereby designated as the single state agency to administer
such program in accordance with Title XIX and this article. Such
program shall not be required to furnish recipients under sixtyfive
years of age the benefits that are provided to recipients sixtyfive
years of age and over under Title XVIII of the social security
act; but said program shall otherwise be uniform to the extent
required by Title XIX of the social security act.
(b) THE STATE DEPARTMENT MAY REVIEW ANY
DECISION OF A COUNTY DEPARTMENT AND MAY CONSIDER ANY APPLICATION
UPON WHICH A DECISION HAS NOT BEEN MADE BY THE COUNTY DEPARTMENT
WITHIN A REASONABLE TIME TO DETERMINE THE PROPRIETY OF THE ACTION
OR FAILURE TO TAKE TIMELY ACTION ON AN APPLICATION FOR MEDICAL
ASSISTANCE. THE STATE DEPARTMENT SHALL MAKE SUCH ADDITIONAL INVESTIGATION
AS IT DEEMS NECESSARY AND SHALL, AFTER GIVING THE COUNTY DEPARTMENT
AN OPPORTUNITY TO REBUT ANY FINDINGS OR CONCLUSIONS OF THE STATE
DEPARTMENT THAT THE ACTION OR DELAY IN TAKING ACTION WAS A VIOLATION
OF OR CONTRARY TO STATE DEPARTMENT RULES, MAKE SUCH DECISION AS
TO THE GRANTING OF MEDICAL BENEFITS AND THE AMOUNT THEREOF AS
IN ITS OPINION IS JUSTIFIABLE PURSUANT TO THE PROVISIONS OF THIS
ARTICLE AND THE RULES OF THE STATE DEPARTMENT. APPLICANTS OR RECIPIENTS
AFFECTED BY SUCH DECISIONS OF THE STATE DEPARTMENT, UPON REQUEST,
SHALL BE GIVEN REASONABLE NOTICE AND OPPORTUNITY FOR A FAIR HEARING
BY THE STATE DEPARTMENT.
SECTION 8. 264401,
Colorado Revised Statutes, 1989 Repl. Vol., as amended, is repealed
as follows:
264401. Evidentiary conference.
The county department, prior to making
any decision to deny, terminate, suspend, or modify medical benefits
to a recipient, shall provide said recipient opportunity for an
evidentiary conference in the county department in accordance
with the rules and regulations of the state department.
SECTION 9. Effective date.
This act shall take effect July 1, 1997.
SECTION 10. Safety
clause. The general assembly hereby finds, determines, and
declares that this act is necessary for the immediate preservation
of the public peace, health, and safety.
____________________________ ____________________________
Charles E. Berry Tom Norton
SPEAKER OF THE HOUSE PRESIDENT OF
OF REPRESENTATIVES THE SENATE
____________________________ ____________________________
Judith M. Rodrigue Joan M. Albi
CHIEF CLERK OF THE HOUSE SECRETARY OF
OF REPRESENTATIVES THE SENATE
APPROVED________________________________________
_________________________________________
Roy Romer
GOVERNOR OF THE STATE OF COLORADO