PM 01-07-06

(BOC) Receives appeal request and conducts a pre-hearing review for AABD cases, when a decision to file a lien on real property owned by an AABD medical long term care client is appealed.

  1. (FCRC) For pre-hearing review, use information on the daily list of centrally issued client notices (see WAG 01-06-00) to verify:
    • that a notice was sent;
    • the dates of the notice and change; and
    • the specific information included on the notice.

      Make a copy of the list to submit as evidence at the hearing. 

  2. (FCRC) Notify the client in writing if the Department's action is reversed or modified.
    1. Send a timely corrected Notice of Change (Form 157) or an approval/denial notice, if the decision is to modify the original action.
    2. If the decision is to reverse the action on an active case, send the client a Notice of Benefit Restoration (Form 3363).
    3. Attach Request to Withdraw Appeal (Form 65) to the notice, and include a letter requesting that the client sign and return Form 65.
  3. (FCRC) Ensure that all necessary documentation or proofs required to proceed with the appeal are in hand if the client does not withdraw the appeal.
  4. (FCRC) Contact the appropriate bureau and attempt to get information if more documents or clarification is needed in order to proceed with the appeal.

    new textNote: For appeals related to overpayments ensure all necessary documents are included in the overpayment packet. Request any client notices from the Bureau of Collections (BOC).

  5. (FCRC) revised textContact the proper central office contact person if the issue involves complex collections, cross-match, special investigations' policies or practices, or genuineness of a signature.
  6. (Casework Supervisor) After the pre-hearing review, document the review results on Appeal Control Card and Pre-Hearing Review Quality Checklist (Form 1201), and sign the form.
    1. Use the back of the form during the pre-hearing review to document and determine if action taken was timely and appropriate.
    2. Use the front of the form to document action taken on the appeal.
  7. (Casework Supervisor) Forward the completed Form 1201 to the Appeal Coordinator.