Appendix VI, Decision Types

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 TypeDefinition
Dismissed – AbandonmentThis decision type should be used when the appellant disconnects from the hearing and does not call back in.
Dismissed - Failure to AppearThis 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:    

  • the appeal was added in error;
  • a decision was already issued; or
  • in CHIP denials.
Dismissed – 90-Day No Jurisdiction (Untimely Request)

This decision type should be used when: 

  • Non-managed care cases: appellant takes more than 90 days (without good cause) from the date of the action on appeal or the effective date, whichever is longer, to request a fair hearing. 
  • Managed care cases: appellant takes more than 120 days (without good cause) from the date the internal appeal was completed or exhausted to request a fair hearing.
Dismissed – Want of JurisdictionThis 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 DueThis 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 NeededThis 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 DueThis 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.
SustainedThis decision type should be used when the hearings officer determines the agency’s action was appropriate according to policy and law.
Sustained with InstructionsThis 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 ActionThis 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 – SustainedThis 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.