Title 16
5000 Fair Hearing Practice and Procedures
Advance Notice Period or Timely Notice Period - Is the ten (10) day period between the date a notice is mailed to the date a proposed action is to take effect.
Appellant - Is a recipient who has requested a hearing.
Benefits - Are any kind of assistance, payments or benefits made by TANF, GA, Medicaid, Child Care or Food Stamps.
Claimant - Is an applicant who has requested a hearing.
DHSS - Is the Department of Health and Social Services, including
1) the Division of Social Services (“DSS”), in connection with economic, medical, vocational or child care subsidy assistance;
2) the Division of Medicaid and Medical Assistance (“DMMA”) or a managed care organization (“MCO”) under contract with DHSS to manage an operation of the Medicaid Program, in connection with medical assistance;
3) the Division of State Service Centers (“DSSC”) in connection with the Emergency Assistance Program;
4) the Division of Developmental Disabilities Services (DDDS) in connection with Medicaid Program services;
5) the Division of Public Health in connection with Medicaid Program services;
6) the Division of Services for the Aging and Adults with Physical Disabilities (DSAAPD) in connection with Medicaid Program services.
DSS - Is the Division of Social Services (or "the Division.")
Fair Hearing - Is an administrative hearing held in accordance with the principles of due process which include:
1) Timely and adequate notice;
2) The right to confront and cross- examine adverse witnesses;
3) The opportunity to be heard orally;
4) The right to an impartial decision maker;
5) The opportunity to obtain counsel.
Hearing Decision - Is the decision in a case appealed to the State hearing officer. The decision includes the substance of what transpired at the hearing and a summary of the case facts, supporting evidence, and pertinent State or federal regulations and gives the reason for the decision. In Food Stamp disqualification cases, the hearing decision must also respond to reasoned arguments by the appellant.
EXAMPLE: At a Food Stamp Program Intentional Program Violation Hearing involving a failure to report a change promptly, an appellant may argue that a failure to report does not constitute "clear and convincing evidence" of intent to defraud. The hearing officer's decision must respond to this argument.
Hearing Officer - Is the individual responsible for conducting the hearing and issuing a final decision on issues of fact and questions of law.
Hearing Record - Is a verbatim transcript of all evidence and other material introduced at the hearing, the hearing decision, and all other correspondence and other documents which are admitted as evidence or otherwise included for the hearing record by the hearing officer.
Hearing Summary - Is a document prepared by an agency stating the reason(s) the action under appeal was taken and the information upon which the reasons are based. The summary may include documents to be used to decide the issue in question. Its purpose is to provide an appellant with information to prepare his case for the hearing.
MCO - Means a Managed Care Organization offering or providing medical services to recipients of medical assistance from DHSS and individual medical service providers of an MCO panel.
Party - A party to a hearing is a person or an administrative agency or other entity who has taken part in or is concerned with an action under appeal. A party may be composed of one or more individuals.
Request for a Fair Hearing - Any clear expression (oral or written) by the appellant or his authorized agent that the individual wants to appeal a decision to a higher authority. Such request may be oral in the case of actions taken under the Food Stamp Program.
State Presenter - Is the agency employee advocating the State's case in a hearing.
11 DE Reg. 1482 (05/01/08)

