Effective - 28 Aug 2014
208.080. Appeal to director of the respective division, when — procedure. — 1. Any applicant for or recipient of benefits or services provided by law by the family support division, children's division, or MO HealthNet division may appeal to the director of the respective division from a decision in any of the following cases:
(1) If his or her right to make application for any such benefits or services is denied; or
(2) If his or her application is disallowed in whole or in part, or is not acted upon within a reasonable time after it is filed; or
(3) If it is proposed to cancel or modify benefits or services; or
(4) If he or she is adversely affected by any determination of the family support division, children's division, or MO HealthNet division in the administration of the programs administered by such divisions; or
(5) If a determination is made pursuant to subsection 2 of section 208.180 that payment of benefits on behalf of a dependent child shall not be made to the relative with whom he or she lives.
2. If a division proposes to terminate or modify the payment of benefits or the providing of services to the recipient or a division has terminated or modified the payment of benefits or providing of services to the recipient and the recipient appeals, the decision of the director as to the eligibility of the recipient at the time such action was proposed or taken shall be based on the facts shown by the evidence presented at the hearing of the appeal to have existed at the time such action to terminate or modify was proposed or was taken.
3. In the case of a proposed action by the family support division, children's division, or MO HealthNet division to reduce, modify, or discontinue benefits or services to a recipient, the recipient of such benefits or services shall have ten days from the date of the mailing of notice of the proposed action to reduce, modify, or discontinue benefits or services within which to request an appeal to the director of the division. In the notice to the recipient of such proposed action, the appropriate division shall notify the recipient of all his or her rights of appeal under this section. Proper blank forms for appeal to the director of the division shall be furnished by the* appropriate division to any aggrieved recipient. Every such appeal to the director of the division shall be transmitted by the appropriate division immediately upon the same being filed with the appropriate division. If an appeal is requested, benefits or services shall continue undiminished or unchanged until such appeal is heard and a decision has been rendered thereon, except that in an aid to families with dependent children case the recipient may request that benefits or services not be continued undiminished or unchanged during the appeal.
4. When a case has been closed or modified and no appeal was requested prior to closing or modification, the recipient shall have ninety days from the date of closing or modification to request an appeal to the director of the division. Each recipient who has not requested an appeal prior to the closing or modification of his or her case shall be notified at the time of such closing or modification of his or her right to request an appeal during this ninety-day period. Proper blank forms for requesting an appeal to the director of the division shall be furnished by the appropriate division to any aggrieved applicant. Every such request made in any manner for an appeal to the director of the division shall be transmitted by the appropriate division to the director of the division immediately upon the same being filed with the appropriate division. If an appeal is requested in the ninety-day period subsequent to the closing or modification, benefits or services shall not be continued at their prior level during the pendency of the appeal.
5. In the case of a rejection of an application for benefits or services, the aggrieved applicant shall have ninety days from the date of the notice of the action in which to request an appeal to the director of the division. In the rejection notice the applicant for benefits or services shall be notified of all of his or her rights of appeal under this section. Proper blank forms for requesting an appeal to the director of the division shall be furnished by the appropriate division to any aggrieved applicant. Any such request made in any manner for an appeal shall be transmitted by the appropriate division to the director of the division, immediately upon the same being filed with the appropriate division.
6. If the division has rejected an application for benefits or services and the applicant appeals, the decision of the director as to the eligibility of the applicant at the time such rejection was made shall be based upon the facts shown by the evidence presented at the hearing of the appeal to have existed at the time the rejection was made.
7. The director of the division shall give the applicant for benefits or services or the recipient of benefits or services reasonable notice of, and an opportunity for, a fair hearing in the county of his or her residence at the time the adverse action was taken. The hearing shall be conducted by the director of the division or such director's designee. Every applicant or recipient, on appeal to the director of the division, shall be entitled to be present at the hearing, in person and by attorney or representative, and shall be entitled to introduce into the record of such hearing any and all evidence, by witnesses or otherwise, pertinent to such applicant's or recipient's eligibility between the time he or she applied for benefits or services and the time the application was denied or the benefits or services were terminated or modified, and all such evidence shall be taken down, preserved, and shall become a part of the applicant's or recipient's appeal record. Upon the record so made, the director of the division shall determine all questions presented by the appeal, and shall make such decision as to the granting of benefits or services as in his or her opinion is justified and is in conformity with the provisions of the law. The director shall clearly state the reasons for his or her decision and shall include a statement of findings of fact and conclusions of law pertinent to the questions in issue.
8. All appeal requests may initially be made orally or in any written form, but all such requests shall be transcribed on forms furnished by the division and signed by the aggrieved applicant or recipient or his or her representative prior to the commencement of the hearing.
--------
(RSMo 1939 § 9411, A. 1949 S.B. 1063, A.L. 1951 p. 772, A.L. 1969 H.B. 804, A.L. 1981 S.B. 73, A.L. 1987 H.B. 518, A.L. 2014 H.B. 1299 Revision)
*Words "the the" appear in original rolls.
CROSS REFERENCE:
Administrative hearings procedure, 536.060 to 536.090.
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 208 - Old Age Assistance, Aid to Dependent Children and General Relief
Section 208.001 - Citation of law — MO HealthNet created — division created — rulemaking authority.
Section 208.022 - TANF electronic benefit cards to include photograph of recipient.
Section 208.044 - Child day care services to be provided certain persons — eligible providers.
Section 208.048 - Aid to families with dependent child — school attendance required — rules.
Section 208.050 - Aid to dependent children denied, when.
Section 208.060 - Applications for benefits, how and where filed.
Section 208.065 - Verification of eligibility for public assistance, contract for.
Section 208.067 - TANF set-aside minimums for certain programs.
Section 208.071 - Individualized assessment of applicant — rulemaking authority.
Section 208.080 - Appeal to director of the respective division, when — procedure.
Section 208.090 - Reinstatement and payment of benefits to applicant.
Section 208.100 - Appeal to circuit court — procedure.
Section 208.110 - Appeals from circuit court.
Section 208.120 - Records, when evidence, restrictions on disclosure — penalty.
Section 208.125 - Records may be destroyed, when.
Section 208.130 - Benefits granted may be reconsidered.
Section 208.140 - Grants subject to any change of law.
Section 208.145 - Medical assistance benefits, eligibility based on receipt of AFDC benefits, when.
Section 208.146 - Ticket-to-work health assurance program — eligibility — expiration date.
Section 208.150 - Monthly benefits, how determined.
Section 208.154 - Insufficient funds, benefits to be paid pro rata.
Section 208.155 - Records concerning applicants and recipients of medical assistance confidential.
Section 208.158 - Payments to be made only when federal grants-in-aid are provided.
Section 208.159 - Payments for nursing home services, how administered — rules.
Section 208.160 - Payment rolls, how prepared — checks and warrants, how issued.
Section 208.163 - Direct payment on request by authorized providers of services.
Section 208.170 - Duties of state treasurer — special funds created.
Section 208.171 - Effective date of certain sections.
Section 208.172 - Reduction or denial of benefits, basis for, restrictions on.
Section 208.173 - Committee established.
Section 208.175 - Drug utilization review board established, members, terms, compensation, duties.
Section 208.176 - Division to provide for prospective review of drug therapy.
Section 208.180 - Payment of benefits, to whom — disposition of benefit check of deceased person.
Section 208.181 - Expedited eligibility process, pregnant women.
Section 208.190 - Division to comply with acts of congress relating to Social Security benefits.
Section 208.198 - Same or similar services, equal reimbursement rate required.
Section 208.210 - Undeclared income or property — benefits may be recovered by division, when.
Section 208.212 - Annuities, affect on Medicaid eligibility — rulemaking authority.
Section 208.213 - Personal care contracts, effect on eligibility.
Section 208.221 - Jurisdiction, administrative hearing commission, procedure.
Section 208.223 - Reimbursement for ambulance service to be based on mileage.
Section 208.225 - Medicaid per diem rate recalculation for nursing homes, amount.
Section 208.229 - Rebates on outpatient drugs — definitions.
Section 208.230 - Public assistance beneficiary employer disclosure act — report, content.
Section 208.238 - Eligibility, automated process to check applicants and recipients.
Section 208.240 - Statewide dental delivery system authorized.
Section 208.247 - Food stamp eligibility, felony conviction not to make ineligible, when.
Section 208.250 - Definitions.
Section 208.265 - Rules and procedures, developed by whom, published, where.
Section 208.341 - School programs — postponing sexual involvement — QUEST — rites of passage.
Section 208.342 - Earned income tax credit program, AFDC recipients.
Section 208.345 - Protocols for referral of public assistance recipients to federal programs.
Section 208.400 - Definitions.
Section 208.405 - JOBS program established, duties of department.
Section 208.420 - Department to apply for and accept federal funds.
Section 208.425 - Welfare reform coordinating committee established.
Section 208.431 - Medicaid managed care organization reimbursement allowance, amount.
Section 208.432 - Record keeping required, submission to department.
Section 208.434 - Amount final, when — protest, procedure.
Section 208.435 - Rulemaking authority.
Section 208.436 - Remittance to the department — deposit in dedicated fund.
Section 208.455 - Formula for federal reimbursement allowance established by rule — procedure.
Section 208.463 - Documents content and form prescribed by rule.
Section 208.469 - Tax exempt or nonprofit status granted by state not to be affected.
Section 208.471 - Medicaid reimbursement payments to hospitals, amount, how calculated.
Section 208.475 - Effective date of allowance.
Section 208.477 - Medicaid eligibility, criteria used, effect when more restrictive than FY2003.
Section 208.480 - Federal reimbursement allowance expiration date.
Section 208.530 - Definitions.
Section 208.533 - Commission established — members, qualifications — terms — expenses.
Section 208.535 - Commission, duties.
Section 208.600 - Citation of law, definitions.
Section 208.603 - Department of health and senior services to administer federal program.
Section 208.618 - Program to address mental health needs.
Section 208.621 - Program, at-risk elderly.
Section 208.624 - Invest in caring, model program — intergenerational care and training program.
Section 208.627 - Report, delivery of case management services, contents — delivery of report.
Section 208.631 - Program established, terminates, when — definitions.
Section 208.633 - Eligible children, income limits of parents or guardians.
Section 208.636 - Requirements of parents or guardians.
Section 208.640 - Co-payments required, when, amount, limitations.
Section 208.643 - Rules, compliance with federal law.
Section 208.646 - Waiting period required, when.
Section 208.647 - Special health care needs, waiver of waiting period for coverage.
Section 208.650 - Studies and reports required by department of social services.
Section 208.655 - Abortion counseling prohibited, exceptions.
Section 208.657 - Rules, effective when, invalid when.
Section 208.659 - Revision of eligibility requirements for uninsured women's health program.
Section 208.670 - Practice of telehealth, definitions — reimbursement of providers.
Section 208.677 - School children, parental authorization required for telehealth.
Section 208.690 - Citation of law — definitions.
Section 208.692 - Program established, purpose — asset disregard — departments duties — rules.
Section 208.694 - Eligibility — discontinuance of program, effect of — reciprocal agreements.
Section 208.696 - Director's duties — rules.
Section 208.698 - Reports required.
Section 208.750 - Title — definitions.
Section 208.760 - Eligibility — withdrawal of moneys, when.
Section 208.765 - Forfeiture of account moneys, when — death of account holder, effect of.
Section 208.770 - Tax exemption, credit, when.
Section 208.775 - Independent evaluation — report.
Section 208.780 - Definitions.
Section 208.782 - Missouri Rx plan established, purpose — rulemaking authority.
Section 208.786 - Authority of department in providing benefits — start of program benefits, when.
Section 208.788 - Program not an entitlement — payer of last resort requirements.
Section 208.794 - Fund created.
Section 208.798 - Termination date.
Section 208.853 - Findings and purpose.
Section 208.856 - Council created, expenses, members, terms, removal.
Section 208.859 - Powers and duties of the council.
Section 208.862 - Consumer rights and employment relations.
Section 208.865 - Definitions.
Section 208.868 - Federal approval and funding.
Section 208.871 - Severability clause.
Section 208.900 - Definitions.
Section 208.903 - Financial assistance for personal care, eligibility requirements.
Section 208.909 - Responsibilities of recipients and vendors.
Section 208.918 - Vendor requirements, philosophy and services.
Section 208.921 - Denial of eligibility, applicant entitled to hearing.
Section 208.924 - Discontinuation of services, when.
Section 208.927 - Rulemaking authority.
Section 208.935 - Assessment tool, home and community-based services.
Section 208.951 - Request for proposals.
Section 208.952 - Committee established, members, duties.
Section 208.955 - Committee established, members, duties — issuance of findings.
Section 208.990 - MO HealthNet eligibility requirements.
Section 208.991 - Definitions — persons eligible for MO HealthNet — rulemaking authority.
Section 208.1050 - Fund created, use of moneys.
Section 208.1060 - Food banks, state plan to be submitted for federal project.