Amended in Senate August 22, 2014

Amended in Senate August 19, 2014

Amended in Senate August 4, 2014

Amended in Senate August 13, 2013

Amended in Assembly April 15, 2013

Amended in Assembly March 19, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 617


Introduced by Assembly Member Nazarian

February 20, 2013


An act to add Sections 100501.1, 100506.1, 100506.2, 100506.3, 100506.4, and 100506.5 to the Government Code, and to amend Sections 10950, 10951, and 10960 of the Welfare and Institutions Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 617, as amended, Nazarian. California Health Benefit Exchange: appeals.

Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that take effect January 1, 2014. PPACA also requires each state to, by January 1, 2014, establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, as specified. Existing law establishes the California Health Benefit Exchange (Exchange) to implement the federal law. Existing law also requires thebegin delete Exchangeend delete boardbegin insert of the Exchangeend insert to establish an appeals process for prospective and current enrollees of the Exchange that complies with allbegin insert of theend insert requirements of the federal act concerning the role of a state Exchange in facilitating federal appeals of Exchange-related determinations.

This bill would require thebegin delete Exchangeend delete boardbegin insert of the Exchangeend insert to contract with the State Department of Social Services to serve as the Exchange appeals entity designated to hear appeals of eligibilitybegin insert or enrollmentend insert determination or redetermination for persons in the individual marketbegin insert or exemption determinations within the Exchange’s jurisdictionend insert. The bill would establish an appeals process for eligibility or enrollment determinations and redeterminations for insurance affordability programs, as defined, or exemption determinations within the Exchange’s jurisdiction, including an informal resolution process, as specified, establishing procedures and timelines for hearings with the appeals entity, and notice provisions. The bill would also establishbegin insert a process forend insert continuing eligibility for individuals during the appeals process. The bill would make other related changesbegin insert, and would specify that certain provisions only be implemented to the extent they do not conflict with federal lawend insert.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 100501.1 is added to the Government
2Code
, to read:

3

100501.1.  

For purposes of this title,begin delete “insuranceend deletebegin insert the following
4definitions shall apply:end insert

5begin insert(a)end insertbegin insertend insertbegin insert“Insuranceend insert affordability program” means a program that is
6one of the following:

begin delete

7(a)

end delete

8begin insert(1)end insert The state’s Medi-Cal program under Title XIX of the federal
9Social Security Act (42 U.S.C. Sec. 1396 et seq.).

begin delete

10(b)

end delete

11begin insert(2)end insert The state’s children’s health insurance program (CHIP)
12under Title XXI of the federal Social Security Act (42 U.S.C. Sec.
131397aa et seq.).

begin delete

14(c)

end delete

15begin insert(3)end insert A program that makes available to qualified individuals
16 coverage in a qualified health plan through the Exchange with
P3    1advance payment of the premium tax credit established under
2Section 36B of the Internal Revenue Code.

begin delete

3(d)

end delete

4begin insert(4)end insert A program that makes available coverage in a qualified
5health plan through the Exchange with cost-sharing reductions
6established under Section 1402 of the federal act.

begin insert

7(b) “Combined eligibility notice” means an eligibility notice
8that informs an individual, or multiple family members of a
9 household, of eligibility for each of the insurance affordability
10programs and for enrollment in a qualified health plan through
11the Exchange, for which a determination of eligibility was made.

end insert
12

SEC. 2.  

Section 100506.1 is added to the Government Code,
13to read:

14

100506.1.  

An applicant or enrollee has the right to appeal any
15of the following:

16(a) Any action or inaction related to the individual’s eligibility
17for or enrollment in an insurance affordability program, or for
18advance payment of premium tax credits and cost-sharing
19reductions, or the amount of the advance payment of the premium
20tax credit and level of cost sharing, or eligibility for affordable
21plan options.

22(b) An eligibility determination for an exemption from the
23individual responsibility penalty pursuant to Section 1311(d)(4)(H)
24of the federal act.

25(c) A failure to provide timely or adequate notice of an eligibility
26determination or redetermination or an enrollment-related
27determination.

28

SEC. 3.  

Section 100506.2 is added to the Government Code,
29to read:

30

100506.2.  

(a) The entity making an eligibility or enrollment
31determination described in Section 100506.1 shall provide notice
32of the appeals process at the time of application and at the time of
33eligibility or enrollment determination or redetermination.

34(b) The entity making an eligibility or enrollment determination
35described in Section 100506.1 shall also issuebegin delete an eligibility notice.
36Theend delete
begin insert a combined eligibility notice after the Director of Health Care
37Services determines in writing that the California Healthcare
38Eligibility, Enrollment, and Retention System (CalHEERS) has
39been programmed for the implementation of this section, but no
P4    1later than July 1, 2017. The combinedend insert
eligibility notice shall
2contain all of the following:

3(1) Information about eligibility or ineligibility for Medi-Cal,
4premium tax credits and cost-sharing reductions,begin delete or eligibility for
5the Medi-Cal Access Programend delete
begin insert and, if applicable, for the Medi-Cal
6Access Program, for each individual, or multiple family members
7of a household, that has appliedend insert
, including all of the following:

8(A) An explanation of the action reflected in the notice,
9including the effective date of the action.

10(B) Any factual bases upon which the decision is made.

11(C) Citations to, or identification of, the legal authority
12supporting the action.

13(D) Contact information for available customer service
14resources, including local legal aid and welfare rights offices.

15(E) The effective date of eligibility and enrollment.

16(2) Information regarding the bases of eligibility for
17non-modified adjusted gross income (MAGI) Medi-Cal and the
18benefits and services afforded to individuals eligible on those
19bases, sufficient to enable the individual to make an informed
20choice as to whether to appeal the eligibility determination or the
21date of enrollment, which may be included with the notice in a
22separate document.

23(3) An explanation that the applicant or enrollee may appeal
24any action or inaction related to an individual’s eligibility for or
25enrollment in an insurance affordability program with which the
26applicant or enrollee is dissatisfied by requesting a state fair hearing
27consistent with this title and the provisions of Chapter 7
28(commencing with Section 10950) of Part 2 of Division 9 of the
29Welfare and Institutions Code.

30(4) Information on the applicant or enrollee’s right to represent
31himself or herself or to be represented by legal counsel or an
32authorized representative as provided in subdivision (f) of Section
33100506.4.

34(5) An explanation of the circumstances under which the
35applicant’s or enrollee’s eligibility shall be maintained or reinstated
36pending an appeal decision, pursuant to Section 100506.5.

begin insert

37(c) This section shall be implemented only to the extent it does
38not conflict with federal law.

end insert
39

SEC. 4.  

Section 100506.3 is added to the Government Code,
40to read:

P5    1

100506.3.  

begin insert(a)end insertbegin insertend insert The board shall enter into a contract with the
2State Department of Social Services to serve as the Exchange
3appeals entity designated to hear appeals of eligibility or enrollment
4determination or redetermination for persons in the individual
5market, or exemption determinations within the Exchange’s
6jurisdiction.begin delete Except as otherwise provided in this title, this hearing
7process shall be governed by the Medi-Cal hearing process
8established in Chapter 7 (commencing with Section 10950) of Part
92 of Division 9 of the Welfare and Institutions Code, Section
10100506, Subpart F of Part 155 of Title 45 of the Code of Federal
11Regulations, and Article 7 of Chapter 12 of Title 10 of the
12California Code of Regulations to the extent applicable and
13consistent with the act that added this sectionend delete
begin insert To the extent
14applicable, the provisions of this title, Subpart F of Part 155 of
15Title 45 of the Code of Federal Regulations, and Article 7 of
16Chapter 12 of Title 10 of the California Code of Regulations shall
17govern the Exchange hearing process. If those provisions are not
18applicable, the Medi-Cal hearing process established in Chapter
197 (commencing with Section 10950) of Part 2 of Division 9 of the
20Welfare and Institutions Code shall govern the Exchange hearing
21processend insert
.

begin insert

22(b) This section shall be implemented only to the extent it does
23not conflict with federal law.

end insert
24

SEC. 5.  

Section 100506.4 is added to the Government Code,
25to read:

26

100506.4.  

(a) (1) Except as provided in paragraph (2), the
27State Department of Social Services, acting as the appeals entity,
28shall allow an applicant or enrollee to request an appeal within 90
29days of the date of the notice of an eligibility or enrollment
30determination, or exemption determination within the Exchange’s
31jurisdiction, unless there is good cause as provided in Section
3210951 of the Welfare and Institutions Code.

33(2) The appeals entity shall establish and maintain a process for
34an applicant or enrollee to request an expedited appeals process
35where there is immediate need for health services because a
36standard appeal could seriously jeopardize the appellant’s life,
37health, or the ability to attain, maintain, or regain maximum
38function. If an expedited appeal is granted, the decision shall be
39issuedbegin insert as expeditiously as possible, butend insert no later than five working
40daysbegin insert after the hearing,end insert unless the appellant agrees to a delay to
P6    1submit additional documents for the appeals record. If an expedited
2appeal is denied, the appeals entity shall notify the appellant within
3three days by telephone or through other commonly available
4secure electronic means, to be followed by a notice in writing,
5within five working days of the denial of an expedited appeal. If
6an expedited appeal is denied, the appeal shall be handled through
7the standard appeal process.

8(b) Appeal requests may be submitted to the appeals entity by
9telephone, by mail, in person, through the Internet, through other
10commonly available electronic means, or by facsimile.

11(c) The staff of the Exchange, the county, or the State
12Department of Health Care Services or its designee shall assist the
13applicant or enrollee in making the appeal request.

14(d) (1) Upon receipt of an appeal, the appeals entity shall send
15timely acknowledgment to the appellant that the appeal has been
16received. The acknowledgment shall include information relating
17to the appellant’s eligibility for benefits while the appeal is
18pending, an explanation that advance payments of the premium
19tax credit while the appeal is pending may be subject to
20reconciliation if the appeal is unsuccessful, an explanation that the
21appellant may participate in informal resolution pursuant to
22subdivision (g), information regarding how to initiate informal
23resolution, and an explanation that the appellant shall have the
24opportunity to review his or her entire eligibility file, including
25information on how an income determination was made and all
26papers, requests, documents, and relevant information in the
27possession of the entity that made the decision that is the subject
28of the appeal at any time from the date on which an appeal request
29is filed to the date on which the appeal decision is issued.

30(2) Upon receipt of an appeal request, the appeals entity shall
31send, via secure electronic means, timely notice of the appeal to
32the Exchange and the county, and the State Department of Health
33Care Services or its designee if applicable.

34(3) Upon receipt of the notice of appeal from the appeals entity,
35the entity that made the determination of eligibility or enrollment
36being appealed shall transmit, either as a hardcopy or electronically,
37the appellant’s eligibility and enrollment records for use in the
38adjudication of the appeal to the appeals entity.

39(e) A member of the board, employee of the Exchange, a county,
40the State Department of Health Care Services or its designee, or
P7    1the appeals entity shall not limit or interfere with an applicant’s
2or enrollee’s right to make an appeal or attempt to direct the
3individual’s decisions regarding the appeal.

4(f) An applicant or enrollee may be represented by counsel or
5designate an authorized representative to act on his or her behalf,
6including, but not limited to, when making an appeal request and
7participating in the informal resolution process provided in
8subdivision (g).

9(g) An applicant or enrollee who files an appeal shall have the
10opportunity for informal resolution, prior to a hearing, that
11conforms with all of the following:

12(1) A representative of the entity that made the eligibility or
13enrollment determination shall contact the appellant or the
14appellant’s appropriately authorized representative and offer to
15discuss the determination with the appellant if he or she agrees.

16(2) The appellant’s right to a hearing shall be preserved if the
17appellant is dissatisfied with the outcome of the informal resolution
18process. The appellant or the authorized representative may
19withdraw the hearing request voluntarily or may agree to a
20conditional withdrawal that shall list the agreed-upon conditions
21that the appellant and the Exchange, county, or the State
22Department of Health Care Services or its designee shall meet.

23(3) If the appeal advances to a hearing, the appellant shall not
24be required to provide duplicative information or documentation
25that he or she previously provided during the application,
26 redetermination, enrollment, or informal resolution processes.

27(4) The informal resolution process shall not delay the timeline
28for a provision of a hearing.

29(5) The informal resolution process is voluntary and neither an
30appellant’s participation nor nonparticipation in the informal
31resolution process shall affect the right to a hearing under this
32section.

33(6) For eligibility or enrollment determinations for insurance
34affordability programs based on modified adjusted gross income
35(MAGI), the appellant or the appellant’s appropriately authorized
36representative may initiate the informal resolution process with
37the entity that made the determination, except that all of the
38following shall apply:

39(A) The Exchange shall conduct informal resolution involving
40 issues related only to the Exchange, including, but not limited to,
P8    1exemption from the individual responsibility penalty pursuant to
2Section 1311(d)(4)(H) of the federal act, offers of affordable
3employer coverage, special enrollment periods, and eligibility for
4affordable plan options.

5(B) Counties shall conduct informal resolution involving issues
6related to non-MAGI Medi-Cal eligibility or enrollment decisions.

7(C) The State Department of Health Care Services or its designee
8shall conduct informal resolution involving issues related tobegin delete the
9Medi-Cal Access Programend delete
begin insert eligibility or enrollment determinations
10for programs when the State Department of Health Care Services
11is the entity making the determinationend insert
.

12(7) The staff involved in the informal resolution process shall
13try to resolve the issue through a review of case documents, in
14person or through electronic means as desired by the appellant,
15and shall give the appellant the opportunity to review case
16 documents, verify the accuracy of submitted documents, and submit
17updated information or provide further explanation of previously
18submitted documents.

19(8) The informal resolution process set forth by the State
20Department of Social Services for Medi-Cal fair hearings shall be
21used for the informal resolutions pursuant to this subdivision and
22shall require the Exchange, county representative, or the State
23Department of Health Care Services or its designee to do the
24following:

25(A) Review the file to determine the appropriateness of the
26action and whether a hearing is needed.

27(B) Attempt to resolve the matter if the action was incorrect.

28(C) Determine whether a dual agency appeal is required to
29resolve the matter at hearing and notice the other agency if not
30already included.

31(D) Determine whether interpretation services are necessary
32and arrange for those services accordingly.

33(E) Inform appellants of other agencies that may also be
34available to resolve the controversy.

35(h) (1) A position statement, as required by Section 10952.5
36of the Welfare and Institutions Code, shall be made available at
37least two working days before the hearing on the appeal. The
38position statement shall be made available electronically by the
39entity that determined eligibility if the entity has the capacity to
40send information electronically in a secure manner.

P9    1(2) The appeals entity shall send written notice, electronically
2or in hard copy, to the appellant of the date, time, and location of
3the hearing no later than 15 days prior to the date of the hearing.
4If the date, time, and location of the hearing are prohibitive of
5participation by the appellant, the appeals entity shall make
6reasonable efforts to set a reasonable, mutually convenient date,
7time, and location. The notice shall explain what format the hearing
8shall be held in, via telephone or video conference or in person,
9and include the right of the appellant to request that the hearing
10be held via telephone or video conference or in person. The notice
11shall include instructions for submitting the request on the notice,
12by telephone or through other commonly available electronic
13means.

14(3) The hearing format may be held via telephone or video
15conference, unless the appellant requests the hearing be held in
16person pursuant to paragraph (2).

17(4) The hearing shall be an evidentiary hearing where the
18appellant may present evidence, bring witnesses, establish all
19relevant facts and circumstances, and question or refute any
20testimony or evidence, including, but not limited to, the opportunity
21to confront and cross-examine adverse witnesses, if any.

22(5) The hearing shall be conducted by one or more impartial
23officials who have not been directly involved in the eligibility or
24enrollment determination or any prior appeal decision in the same
25matter.

26(6) The appellant shall have the opportunity to review his or
27her appeal record, case file, and all documents to be used by the
28appeals entity at the hearing, at a reasonable time before the date
29of the hearing as well as during the hearing.

30(7) Cases and evidence shall be reviewed de novo by the appeals
31entity.

32(i) Decisions shall be made within 90 days from the date the
33appeal is filed and shall be based exclusively on the application
34of the applicable laws and eligibility and enrollment rules to the
35information used to make the eligibility or enrollment decision,
36as well as any other information provided by the appellant during
37the course of the appeal. The content of the decision of appeal
38shall include a decision with a plain language description of the
39effect of the decision on the appellant’s eligibility or enrollment,
40a summary of the facts relevant to the appeal, an identification of
P10   1the legal basis for the decision, and the effective date of the
2decision, which may be retroactive at the election of the appellant
3if the appellant is otherwise eligible.

4(j) Upon adjudication of the appeal, the appeals entity shall
5transmit the decision of appeal to the entity that made the eligibility
6or enrollment determination via a secure electronic means.

7(k) If an appellant disagrees with the decision of the appeals
8entity, he or she may make an appeal request regarding coverage
9in a qualified health plan through the Exchange to the federal
10Department of Health and Human Services within 30 days of the
11notice of decision through any of the methods in subdivision (b).

12(l) An appellant may also seek judicial review to the extent
13provided by law. Appeal to the federal Department of Health and
14Human Services is not a prerequisite for seeking judicial review,
15nor shall seeking an appeal to the federal Department of Health
16and Human Services preclude a judicial review.

17(m) Nothing in this section, or in Sections 100506.1 and
18100506.2, shall limit or reduce an appellant’s rights to notice,
19hearing, and appeal under Medi-Cal, county indigent programs,
20or any other public programs.

begin insert

21(n) This section shall be implemented only to the extent it does
22not conflict with federal law.

end insert
23

SEC. 6.  

Section 100506.5 is added to the Government Code,
24to read:

25

100506.5.  

For appeals of redetermination of Exchange advance
26premium tax credits or cost-sharing reductions, upon receipt of
27notice from the appeals entity that it has received an appeal, the
28entity that made the redetermination shall continue to consider the
29applicant or enrollee eligible for the same level of advance
30premium tax credits or cost-sharing reductions while the appeal
31is pending in accordance with the level of eligibility immediately
32before the redetermination being appealed.

33

SEC. 7.  

Section 10950 of the Welfare and Institutions Code is
34amended to read:

35

10950.  

(a) If any applicant for or recipient of public social
36services is dissatisfied with any action of the county department
37relating to his or her application for or receipt of public social
38services, if his or her application is not acted upon with reasonable
39promptness, or if any person who desires to apply for public social
40services is refused the opportunity to submit a signed application
P11   1therefor, and is dissatisfied with that refusal, he or she shall, in
2person or through an authorized representative, without the
3necessity of filing a claim with the board of supervisors, upon
4filing a request with the State Department of Social Services or
5the State Department of Health Care Services, whichever
6department administers the public social service, be accorded an
7opportunity for a state hearing.

8(b) (1) The requirements of Sections 100506.2begin delete, 100506.3,end delete and
9100506.4 of the Government Code apply to state hearings regarding
10eligibility for or enrollment in an insurance affordability program
11administered by the State Department of Health Care Services to
12the extent that those sections conflict with the state hearing
13requirements under this chapter.

14(2) Notwithstanding Chapter 3.5 (commencing with Section
1511340) of Part 1 of Division 3 of Title 2 of the Government Code,
16the department, without taking any further regulatory action, shall
17implement, interpret, or make specific this subdivision by means
18of all-county letters, plan letters, plan or provider bulletins, or
19similar instructions until the time regulations are adopted. The
20department shall adopt regulations by July 1, 2017, in accordance
21with the requirements of Chapter 3.5 (commencing with Section
2211340) of Part 1 of Division 3 of Title 2 of the Government Code.
23Notwithstanding Section 10231.5 of the Government Code,
24beginning July 1, 2015, the department shall provide a semiannual
25status report to the Legislature, in compliance with Section 9795
26of the Government Code, until regulations have been adopted.

begin insert

27(3) This subdivision shall be implemented only to the extent it
28does not conflict with federal law.

end insert

29(c) Priority in setting and deciding cases shall be given in those
30cases in which aid is not being provided pending the outcome of
31the hearing. This priority shall not be construed to permit or excuse
32the failure to render decisions within the time allowed under federal
33and state law.

34(d) Notwithstanding any other provision of this code, there is
35no right to a state hearing when either (1) state or federal law
36requires automatic grant adjustments for classes of recipients unless
37the reason for an individual request is incorrect grant computation,
38or (2) the sole issue is a federal or state law requiring an automatic
39change in services or medical assistance which adversely affects
40some or all recipients.

P12   1(e) For the purposes of administering health care services and
2medical assistance, the Director of Health Care Services shall have
3those powers and duties conferred on the Director of Social
4Services by this chapter to conduct state hearings in order to secure
5approval of a state plan under applicable federal law.

6(f) The Director of Health Care Services may contract with the
7State Department of Social Services for the provisions of state
8hearings in accordance with this chapter.

9(g) As used in this chapter, “recipient” means an applicant for
10or recipient of public social services except aid exclusively financed
11by county funds or aid under Article 1 (commencing with Section
1212000) to Article 6 (commencing with Section 12250), inclusive,
13of Chapter 3 of Part 3, and under Article 8 (commencing with
14Section 12350) of Chapter 3 of Part 3, or those activities conducted
15under Chapter 6 (commencing with Section 18350) of Part 6, and
16shall include any individual who is an approved adoptive parent,
17as described in subdivision (C) of Section 8708 of the Family
18Code, and who alleges that he or she has been denied or has
19experienced delay in the placement of a child for adoption solely
20because he or she lives outside the jurisdiction of the department.

21

SEC. 8.  

Section 10951 of the Welfare and Institutions Code is
22amended to read:

23

10951.  

(a) A person is not entitled to a hearing pursuant to
24this chapter unless he or she files his or her request for the same
25within 90 days after the order or action complained of.

26(b) (1) Notwithstanding subdivision (a), a person shall be
27entitled to a hearing pursuant to this chapter if he or she files the
28request more than 90 days after the order or action complained of
29and there is good cause for filing the request beyond the 90-day
30period. The director may determine whether good cause exists.

31(2) For purposes of this subdivision “good cause” means a
32substantial and compelling reason beyond the party’s control,
33considering the length of the delay, the diligence of the party
34making the request, and the potential prejudice to the other party.
35The inability of a person to understand an adequate and
36language-compliant notice, in and of itself, shall not constitute
37good cause. The department shall not grant a request for a hearing
38for good cause if the request is filed more than 180 days after the
39order or action complained of.

P13   1(3) This section shall not preclude the application of the
2principles of equity jurisdiction as otherwise provided by law.

3(c) Notwithstanding the Administrative Procedure Act (Chapter
43.5 (commencing with Section 11340) of Part 1 of Division 3 of
5Title 2 of the Government Code), the department shall implement
6this section through an all-county information notice no later than
7January 1, 2008. The department may also provide further
8instructions through training notes.

9

SEC. 9.  

Section 10960 of the Welfare and Institutions Code is
10amended to read:

11

10960.  

(a) Within 30 days after receiving the decision of the
12director, which is the proposed decision of an administrative law
13judge adopted by the director as final, a final decision rendered by
14an administrative law judge, or a decision issued by the director
15himself or herself, the affected county or applicant or recipient
16may file a request with the director for a rehearing. The director
17shall immediately serve a copy of the request on the other party
18to the hearing and that other party may within five days of the
19service file with the director a written statement supporting or
20objecting to the request. The director shall grant or deny the request
21no later than the 35th working day after the request is made to
22ensure the prompt and efficient administration of the hearing
23process. If the director grants the request, the rehearing shall be
24conducted in the same manner and subject to the same time limits
25as the original hearing.

26(b) The grounds for requesting a rehearing are as follows:

27(1) The adopted decision is inconsistent with the law.

28(2) The adopted decision is not supported by the evidence in
29the record.

30(3) The adopted decision is not supported by the findings.

31(4) The adopted decision does not address all of the claims or
32issues raised by the parties.

33(5) The adopted decision does not address all of the claims or
34issues supported by the record or evidence.

35(6) The adopted decision does not set forth sufficient information
36to determine the basis for its legal conclusion.

37(7) Newly discovered evidence, that was not in custody or
38available to the party requesting rehearing at the time of the
39hearing, is now available and the new evidence, had it been
40introduced, could have changed the hearing decision.

P14   1(8) For any other reason necessary to prevent the abuse of
2discretion or an error of law, or for any other reason consistent
3with Section 1094.5 of the Code of Civil Procedure.

4(c) The notice granting or denying the rehearing request shall
5explain the reasons and legal basis for granting or denying the
6request for rehearing.

7(d) The decision of the director, which is the proposed decision
8of an administrative law judge adopted by the director as final, a
9final decision rendered by an administrative law judge, or a
10decision issued by the director himself or herself, remains final
11pending a request for a rehearing. Only after a rehearing is granted
12is the decision no longer the final decision in the case.

13(e) Notwithstanding any other provision of law, a rehearing
14request or decision shall not be a prerequisite to filing an action
15under Section 10962.

16(f) (1) Notwithstanding subdivision (a), an applicant or recipient
17otherwise may be entitled to a rehearing pursuant to this chapter
18if he or she files a request more than 30 days after the decision of
19the director is issued, or if he or she did not receive a copy of the
20decision of the director, or if there is good cause for filing beyond
21the 30-day period. The director may determine whether good cause
22exists.

23(2) For purposes of this subdivision, “good cause” means a
24substantial and compelling reason beyond the party’s control,
25considering the length of the delay, the diligence of the party
26making the request, and the potential prejudice to the other party.
27The inability of a person to understand an adequate and
28language-compliant notice, in and of itself, shall not constitute
29good cause. The department shall not grant a request for a rehearing
30for good cause if the request is filed more than 180 days after the
31order or action complained of.

32(3) This section shall not preclude the application of the
33principles of equity jurisdiction as otherwise provided by law.

34(g) Notwithstanding the Administrative Procedure Act (Chapter
353.5 (commencing with Section 11340) of Part 1 of Division 3 of
36Title 2 of the Government Code), the department shall implement
37this section through an all-county information notice no later than
P15   1January 1, 2008. The department may also provide further
2instructions through training notes.



O

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