BASIC (04-05)

A. Background

Based on the application input received, the subsidy determination process automatically generates a pre-decisional notice to the claimant whenever a potential denial (for any reason) is identified. The notice includes the basis for the proposed denial, lists any additional information we may need, and allows 10 days from the date of the notice for the proposed action to be rebutted or to receive additional information. Since this is only an advance notice of proposed action, it does not include formal appeal language.

B. Policy

1. Initial 20-Day Response Period

Although the pre-decisional notice indicates that the claimant has up to 10 days to respond, the determination process actually waits 20 days before taking any action.

2. Responding to Pre-Decisional Notice Inquiries

If an inquiry is received, the adjudicator must query MAPS to determine the basis for the pre-decisional notice and to explain to the inquirer what, if anything, is needed that may change the proposed action. See MSOM INTRANETMAPS 008.003 for information about querying MAPS. Absent evidence to the contrary, accept the claimant's allegation without requesting physical proofs. However, if further proof is deemed necessary, see HI 03035.005 and HI 03035.006 for Verification policies and procedures.

NOTE: If the claimant originally responded Yes to question 3. of the paper application (i.e., has resources of more than $11,500 if single or $23,000 if married) and consequently did not answer any or all of the remaining questions on the form, the WBDOC may have entered $1 in the remaining blank money amount fields to reflect that no amounts were given by the claimant, and that no action was taken to develop them. Otherwise, MAPS would erroneously create exceptions for what was then unnecessary data. This was done to bypass an ongoing system problem. Therefore, if the claimant is now indicating resources under the limit, any $1 money amount entries must be developed along with the rest of the application.”

3. Extending the 20-Day Response Period

If the claimant or his/her personal representative contacts us before the denial notice has been sent, adjudicators may extend the response period as many times as necessary, but not more than 50 days from the date of the pre-decisional notice.

4. Information Received Within the Response Period

If new information is received prior to expiration of the 20-day (or extended) time period, it is entered into MAPS and the determination is automatically recalculated. (See MSOM INTRANETMAPS 006.001 for instructions on how to enter information into MAPS.)

5. Change to Original Determination

If the additional information changes the original determination to a full or partial award, the determination process automatically deletes the indicator that would have issued the denial notice and initiates the appropriate award notice.

6. No Change to Original Determination

If the additional information does not change the original determination or no timely request for an extension/additional information is received, the denial notice is automatically initiated by the determination process. As in the pre-decisional notice, this notice will contain the basis for the denial and list any additional information we may need. However, it will also include formal appeal language.

7. New Information or Request for Extension Received After Denial Notice Issued

If new information or a request for an extension submitted by the claimant or his/her personal representative is received after the denial notice has been sent, treat it as an implied intent to appeal and enter the information into the Appeal process via MAPS. See HI 03040.200A.4.