GENERAL PROVISIONS
§ 275.1. Policy.
(a) Right to appeal and have a fair hearing. The policy with regard to the right to appeal and have a fair hearing will be as follows:
(1) The freedom of the applicant or recipient to request a hearing is a fundamental right and is not to be limited or interfered with in any way.
(2) The regulations contained in this chapter, in accordance with the law, afford every person applying for or receiving a money payment, medical assistance, food stamps or services the right to appeal from a Departmental action or failure to act and to have a hearing if he is dissatisfied with a decision refusing or discontinuing assistance in whole or in part.
(3) As used in this chapter, the term departmental includes, in addition to County Assistance Offices, agencies which administer or provide social services under contractual arrangements with the Department.
(4) The term assistance as used in this chapter means a money payment, medical assistance, food stamps and services.
(i) Right of appeal. Therefore, the opportunity for a hearing will include the right of appeal from the following:
(A) A denial, suspension or discontinuance in whole or in part.
(B) A change in the amount of payment.
(C) A denial, discontinuance, reduction or exclusion from a Departmental service program including the failure to take into account the client’s choice of a service or a determination that he must participate in a service program.
(D) The manner or form of payments, including restricted or protective payments. Exception: When the Department denies or discontinues a protective or vendor payment the right of appeal in this clause will not apply.
(E) Undue delay in making a payment adjustment or acting upon a request or application.
(F) Overpayment and reimbursement claims, including the computation of the amount of the claim and collection procedures.
(G) An action taken under the Child Support Enforcement Program (IV-D), that is, assignment or reassignment of support orders, reimbursement of delayed support payments, arrearages and the like.
(H) A denial of a request for a correction or a deletion in the case file.
(ii) No right of appeal. An appeal will be dismissed by the Office of Hearings and Appeals under the following circumstances:
(A) A person will not have the right to appeal from the following:
(I) A decision by the Department to initiate prosecution proceedings under § 255.4 (relating to procedures).
(II) When the decision does not involve food stamps and the sole issue is one of State or Federal law requiring automatic grant adjustments for classes of recipients, unless there is an error in the mathematical computation of the grant. There is always a right to appeal a food stamp decision.
(III) Where a decision has been rendered after a WIN hearing before the manpower agency that a participant has, without good cause, refused to accept employment or participate in the WIN Program, or has failed to request such a hearing after notice of intended action for the refusal.
(IV) When a reimbursement claim has been collected by the Bureau of Claims Settlement, a client who desires to have money returned to him which has been reimbursed to the Department must petition the Department of Treasury, Board of Finance and Revenue.
(B) A client will be notified in writing of his right to request a hearing when a decision is made on eligibility and when a change in eligibility occurs. The written notices of this right appear on the Form PA 5-M, Form PA 162, Form PA 162-A, and Form PA 162-C.
(b) Objectives of appeals and fair hearings. The objectives of appeals and fair hearing will be as follows:
(1) To afford applicants and recipients an opportunity for an impartial, objective review of decisions, actions and delays, or in actions made by County Assistance Offices and the Department.
(2) To settle the issue or issues raised by the client in requesting a hearing and to produce a clear and definitive decision setting forth the findings of the Department.
(3) To contribute to uniformity in the application of Departmental regulations.
(4) To reveal aspects of Departmental regulations that are deficient, inequitable, or constitute a misconstruction of law.
Authority The provisions of this § 275.1 issued under sections 403(b) and 423 of the act of June 13, 1967 (P. L. 31, No. 21) (62 P. S. § § 403(b) and 423).
Source The provisions of this § 275.1 amended through June 19, 1981, effective August 19, 1981, 11 Pa.B. 2134. Immediately preceding text appears at serial page (60725).
Notes of Decisions A letter from the Department of Public Welfare denying attorney’s fees was not a final appealable adjudication for purposes of appellate jurisdiction under 42 Pa.C.S. § 763 (relating to direct appeals from government agencies). Simmons v. Cohen, 534 A.2d 140 (Pa. Cmwlth. 1987); affirmed 574 A.2d 600 (Pa. 1990).
The continuing right of appeal provided to recipients by 55 Pa. Code § 275.1 adequately satisfies due process. Philadelphia Welfare Rights Organization v. O’Bannon, 517 F. Supp. 501, 512 (E.D.Pa. 1981); affirmed 681 F.2d 808 (3rd. Cir. (Pa.) 1982).
A DPW adjudication in which a petitioner who represents himself requests a modification of a liability assessment on the grounds that the petitioner’s income has decreased is not in accord with law if the hearing examiner fails to ask the petitioner to state the issues at the commencement of the hearing and fails to settle the issue of whether petitioner had a loss of income and, if so, the effect of such loss on his liability. Brandt v. Department of Public Welfare, 427 A.2d 758 (Pa. Cmwlth. 1981).
AFDC recipients are not entitled to notice of their right to receive a hearing to contest the computation of the claim by the DPW for reimbursement of interim assistance, and GA recipients are not entitled to a hearing prior to collection of such reimbursement. Moore v. Colautti, 483 F. Supp. 357 (E.D. Pa. 1979); affirmed 633 F.2d 211 (3rd. Cir. (Pa.) 1980).
Cross References This section cited in 55 Pa. Code § 105.5 (relating to access by an individual to his case file); 55 Pa. Code § 165.51 (relating to compliance review); 55 Pa. Code § 275.4 (relating to procedures); and 55 Pa. Code § 291.23 (relating to requirements).
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