The ALJ will make their decision which is then affirmed, amended, reversed, or remanded by the Director of BHA. The Director may reverse a decision based on law or policy but may not reverse facts. However, the case may be remanded to the ALJ for further finding of facts. If the decision is reversed, the Director will provide the reasons in writing. The notice which is sent includes the ALJ's preliminary decision and the final decision by the Director of BHA.
55 Pa. Code § 275.4(h) 7 CFR 273.15(q)
BHA must reach a decision and send a notice of the decision within the following time limits:
60 days from the date of an appeal affecting SNAP benefits. Exception is 90 days if there is also a TANF or SSI MA issue.
90 days from the date of an appeal affecting cash assistance, medical assistance, or services.
55 Pa. Code § 275.4(b) 7 CFR 273.15(c)
The time limits for BHA 's decision are extended if the CAO or the individual requests a postponement or continuation of the hearing. For SNAP, the individual may request up to a 30-day postponement. If the individual delays the hearing process, the length of the delay is added to the 60 or 90 days. BHA will establish controls to ensure that decisions are made within the required time frames.
BHA sends a notice of its decision and applicable reconsideration forms to the individual, the individual's representative, and the Executive Director of the CAO. BHA may send the Department’s copy of the decision via email. The Area Manager is copied on all decisions wherein the appeal is sustained.
The notice gives the reasons for the decision, identifies supporting evidence, specifies the individual's eligibility, and, if appropriate, gives the amount of the cash assistance payment, SNAP, medical assistance, or services. It also explains the right to request reconsideration. BHA notifies the CAO, agency, or provider at the same time it notifies the individual.
55 Pa. Code § 275.4(h)(3) 7 CFR 273.15(q)
The CAO directly data enters the hearing decision into the system.
All hearing records and decisions are available for public inspection and copying. The names and addresses of the household members and other persons are kept confidential.
NOTE: Public inspection is subject to the provisions found in Chapter 930, Safeguarding Information.
If the decision is in favor of the CAO, it will take action effective the first payment day for which deadline can be met following the decision. If benefits have been continued unchanged during the appeal, complete an Overpayment Referral (OIG 189) for benefits received immediately following the expiration of the advance notice period. For SNAP, complete an OIG 189 for overissuances prior to and during the appeal.
Exception: The CAO will complete the overpayment referral, but OIG does not collect continued benefits received after 60 days for SNAP or after 90 days for all other benefits if the appeal decision is not made within the 60 days or 90 days and the delay was not the fault of the individual.
55 Pa. Code § 275.4(h)(3) 7 CFR 273.15(s)
If the decision is in favor of the individual, the CAO will immediately implement the decision. If there is an underpayment in cash benefits, the CAO will authorize a corrective payment retroactive to the date the incorrect action or inaction was taken or was not taken.
If a provider has a bill for an individual whose medical assistance eligibility was reinstated and the eligibility period is too old to be updated on CIS, the CAO will send a memo to the provider advising him of the eligibility information. The provider will attach the memo when they submit their bill. See the Medical Assistance Eligibility Handbook, Section 338.7, Medicaid Providers.
For SNAP, the CAO will restore any lost benefits within 10 days of receipt of the hearing decision, even if a supplemental payment must be issued. Issuance of benefits may be included in the regular cycle if it will occur within 60 days of the date of the appeal. See the SNAP Handbook, Chapter 581, Restoring Benefits.
If the CAO receives an order granting reconsideration, refer to Section 870.9, “Requests For Reconsideration,” for additional procedures.
55 Pa. Code § 275.4(h)(3) 7 CFR 273.15(s)
Updated September 19, 2024, replacing July 25, 2013