Representatives of the State Hearings Division (SHD) met with representatives of the DHS on January 7, 2002 in a Quality Circle. This was the first in a series of meetings scheduled to try and improve the hearing process in cases where the DHS is a party. The SHD and DHS discussed the Interagency Agreement and each side presented an introductory list of issues to be addressed.

Issues raised by the SHD among other issues include:

• DHS providing a representative for all hearings when DHS is the party.

• DHS providing a liaison responsible for a variety of functions including transmitting proposed decisions to the appropriate person for review by DHS and forwarding hearing requests to the appropriate entity within DHS so that the DHS is prepared to submit a position statement or resolve the issue in each case.

• The need for DHS and SHD to establish a regular meeting process for problem resolution.

The DHS list of issues includes the following:

• While DHS will attempt to improve in providing complete and timely position statements, DHS is not required to make a position statement available to the claimant two working days in advance of the hearing. Welfare and Institutions Code (W&IC) §10952.5 and MPP §§22-053.165 and 22-073.252 require the county to make a position statement available to the claimant at least two working days in advance of the hearing. W&IC §10952.5 and MPP §22-001c.(4) specifically exempt the DHS from this requirement.

• Many DHS issues are mandatory proposed decisions. These issues include managed care cases, orthodontic issues, EPSDT cases and others. Judges should check their delegation document and write a proposed decision when final decision authority has not been delegated.

• Senate Bill 87 mandated new requirements for counties regarding the Medi-Cal eligibility determination process that became effective July 1, 2001. There is an All County Welfare Director’s Letter (ACWDL) No. 01-36, June 19, 2001, that explains the county responsibility in evaluating Medi-Cal eligibility on another basis for a person who is being discontinued from CalWORKs or Medi-Cal. Decisions that follow this ACWDL may be written as final decisions. However, this ACWDL does not address SSI/SSP-linked Medi-Cal discontinuances. The DHS has not yet determined if SB 87 applies to persons discontinued from SSI/SSP-linked Medi-Cal. If a judge applies SB 87 to an SSI/SSP discontinuance case, he/she must write the case as a proposed decision.

• The DHS position is that there is no jurisdiction for an Administrative Law Judge to review an issue that involves a billing dispute. Administrative Law Judges should write these cases as dismissals. Any decision finding jurisdiction on a billing dispute is a mandatory proposed decision.

DHS has also requested that all decisions involving the drug serostim be sent to DHS as proposed decisions.