Library: Policy

340:2-5-103. Hearing decision

Issued 06-27-02

(a) The Appeals Committee.

(1) The Appeals Committee makes the hearing decision.
(2) Unless otherwise designated by the Director of the Department of Human Services (DHS), the Appeals Committee consists of the:

(A) administrative hearing officer (AHO) who presided over the hearing;
(B) director of the DHS division which administers the program which was the subject of the hearing. The division director may delegate this responsibility to someone in the division at the level of programs administrator; and
(C) Appeals Unit supervisor.

(3) No member of the Appeals Committee may obtain information about the case from outside the hearing record.
(4) Any member of the Appeals Committee who was involved in making the decision which is the subject of appeal disqualifies himself or herself from participation.

(A) The division director or programs administrator appoints an appropriate substitute from within the division or, if an appropriate substitute is not available within the division, a substitute is appointed by the Appeals Unit supervisor.
(B) The Appeals Unit supervisor appoints a substitute for himself or herself from the Legal Division.

(b) Legal and factual basis of the decision.

(1) The factual basis of the decision is the information that was available to DHS on the date of the decision and, if DHS failed to follow its own rules regarding the gathering of information, the information that would have been available to DHS at the time of the decision had the rules been followed. This information is obtained through:

(A) hearing testimony;
(B) exhibits introduced at the hearing; and
(C) facts or law of which the AHO has taken judicial notice.

(2) The law applied to the case is described in (A) - (C) of this paragraph.

(A) The relevant sections of the Oklahoma Administrative Code (OAC) are applied.
(B) Where the OAC is ambiguous or silent on a point critical to the decision, reference to other sources, including state and federal statues, federal regulations, sub-regulatory material, and case law is appropriate. • 1
(C) No section of the OAC shall be declared invalid. However, if the validity of any section of the OAC is raised as an issue, the AHO permits arguments concerning that issue so that the issue is preserved for subsequent review.

(1) Following the hearing, the AHO reviews the evidence and applicable law.
(2) If the AHO concludes that DHS acted correctly, the AHO issues a hearing decision letter on behalf of the Appeals Committee.
(3) If the AHO concludes that DHS acted incorrectly, the AHO refers the case to the Appeals Committee.

(A) The AHO prepares a:

(i) summary of the hearing, which includes the AHO's findings of fact. The findings of fact are binding on each member of the Appeals Committee; and
(ii) vote sheet, which contains the AHO’s vote and the reasoning supporting the vote.

(B) The AHO sends the summary, vote sheet, and Appeals Unit file to the member of the Appeals Committee from the division, who reviews the summary and Appeals Unit file prior to voting.
(C) If the vote from the division member is:

(i) favorable to the client, the file is returned to the AHO to issue a decision; or
(ii) unfavorable to the client, the file is sent to the Appeals Unit supervisor to review and vote.

(D) Following the vote by the Appeals Unit supervisor, the file is returned to the AHO to issue a decision in accord with the majority vote of the Appeals Committee.

(d) The Appeals Committee may make a decision:

(1) completely favorable to the client;
(2) partially favorable to the client;
(3) completely unfavorable to the client;
(4) dismissing the hearing request because of client withdrawal or abandonment; or
(5) dismissing the hearing request because the hearing request does not relate to an appealable issue.

(e) The Appeals Committee decision must contain:

(1) a sufficient explanation of the issues, evidence, findings of fact, and law which are sufficient to inform the parties of the basis for the decision; • 2 and
(2) appeal rights, the action required to appeal, and the time within which such action must be taken.

(f) The Appeals Committee decision is sent to:

(1) the client;
(2) the authorized representative, if any;
(3) the local office;
(4) the DHS State Office programs manager of the program most affected by the decision;
(5) any other component of DHS which is necessary for implementation of the decision; and
(6) any other component of DHS which the AHO chooses to notify.

INSTRUCTIONS TO STAFF 340:2-5-103

1.When the Appeals Committee relies upon sources of law other than Department of Human Services (DHS) regulations, the written decision indicates the source of the law upon which the Appeals Committee relied and the reasons for that reliance.

2.A hearing decision normally contains:

(1) the date and place of the hearing;

(2) the hearing participants;

(3) a clear and precise statement of the:

(A) issues; and

(B) specific points which must be resolved to decide the case;

(4) a listing of all the material placed into evidence at the hearing, upon which the hearing decision is based;

(5) a summary of the pertinent evidence;

(6) the findings of fact, which are sufficient to apprise the parties of the basis for the decision;

(7) a clear and precise statement of the decision;

(8) a clear explanation of the reasoning underlying the decision, including specific references to applicable regulations, statutes, cases, or other authority;

(9) when applicable:

(A) the amount of benefit, or that the local office will make a determination of the amount of benefit; and

(B) that the sustained decision implies nothing as to current or continuing eligibility and that further determination of eligibility is required to establish current eligibility when testimony reveals changes have occurred subsequent to the protested action, which might affect a decision regarding the client's current eligibility; and

(10) in cases where the parties have mutually agreed to the outcome of a hearing, the content of the decision need not include all of the information listed in (1) - (9) of this Instruction.Any such decision, however, states with clarity:

(A) the identity of the parties involved;

(B) the subject matter of the decision;

(C) the results of the agreed decision; and

(D) a determination that the result is in accordance with applicable law.