Revision 23-1; Effective July 31, 2023
The hearings officer issues a decision for every appeal requested. There are several types of fair hearing decisions:
Decision Type | Definition |
---|---|
Dismissed – Abandonment | This decision type should be used when the appellant disconnects from the hearing and does not call back in. |
Dismissed - Failure to Appear | This decision type should be used when the appellant or appellant’s authorized representative fails to appear for a scheduled hearing or pre-hearing conference. |
Dismissed – Generic | This decision type should be used when:
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Dismissed – 90-Day No Jurisdiction (Untimely Request) | This decision type should be used when:
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Dismissed – Want of Jurisdiction | This decision should be used when the Fair Hearings department does not have jurisdiction and the appeal is not in the 90-Day No Jurisdiction category (untimely request over 90 days for non-managed or 120 days for managed care). |
Reversed – Benefits Due | This decision type should be used when the hearings officer determines the agency’s action was not appropriate according to policy and law, and the agency is ordered to approve or issue benefits or services. |
Reversed – Information Needed | This decision type should be used when the hearings officer determines the agency’s action was not appropriate according to policy and law, but it is not clear whether benefits are due. |
Reversed – No Benefits Due | This decision type should be used when the hearings officer determines the agency’s action was not appropriate according to policy and law but did not result in a loss of benefits or services. |
Sustained | This decision type should be used when the hearings officer determines the agency’s action was appropriate according to policy and law. |
Sustained with Instructions | This decision type should be used when the hearings officer determines the agency’s action was appropriate according to policy and law at the time of the initial determination; however, new information obtained during the hearing requires additional action by the agency. |
Withdrawn – Favorable Action | This decision type should be used when the appellant or appellant’s representative withdraws the appeal after the agency corrects or overturns its original decision in the appellant’s favor. |
Withdrawn – Sustained | This decision type should be used when the appellant or appellant’s representative withdraws the appeal, and the agency’s action was correct, or the hearings officer is unable to determine whether the agency’s action was correct. |