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 Bill No. 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, begin insert and to amend Sections 10950, 10951, and 10960 of the Welfare and Institutions Code, end insert 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 the Exchange board to establish an appeals process for prospective and current enrollees of the Exchange that complies with all requirements of the federal act concerning the role of a state Exchange in facilitating federal appeals of Exchange-related determinations.

This bill would require the Exchange board to contract with the State Department of Social Services to serve as the Exchange appeals entity designated to hear appeals of eligibility determination or redetermination for persons in the individual market. The bill would establish an appeals process for begin delete initial end delete eligibility or enrollment determinations and redeterminations for insurance affordability programs, as defined, begin insert or exemption determinations within the Exchanges jurisdiction, end insert including an informal resolution process, as specified, establishing procedures and timelines for hearings with the appeals entity, and notice provisions. The bill would also establish continuing eligibility for individuals during the appeals process. begin insert The bill would make other related end insert begin insert changes. end insert

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

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

SECTION 1.  

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

100501.1.  

For purposes of this title, the following definitions
shall apply:

(a) “Insurance affordability program” means a program that is
one of the following:

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

(2) The state’s children’s health insurance program (CHIP)
under Title XXI of the federal Social Security Act (42 U.S.C. Sec.
1397aa et seq.).

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

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

begin delete

(b) “MRMIB” means the Managed Risk Medical Insurance
Board, established by Sections 12710 and 12710.1 of the Insurance
Code, or its successor.

end delete begin insert

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

end insert

SEC. 2.  

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

100506.1.  

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

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

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

(c) A failure to provide timely begin insert or adequate end insert notice of an
eligibility determination or redetermination or an enrollment
begin insert related end insert determination.

SEC. 3.  

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

100506.2.  

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

(b) The entity making an eligibility or enrollment determination
described in Section 100506.1 shall also issue a combined
eligibility begin delete notice, as defined by Section 435.4 of Title 42 of the
Code of Federal Regulations. end delete begin insert notice. end insert The combined eligibility
notice shall contain all of the following:

(1) Information about begin delete each insurance affordability program for
which an end delete begin insert eligibility or ineligibility for Medi-Cal, premium tax
credits and cost-sharing reductions, and, if applicable, eligibility
for the Medi-Cal Access Program, for each end insert individual begin insert , end insert or multiple
family members of a household begin delete have been determined to be eligible
or ineligible and the effective date of eligibility and enrollment. end delete begin insert ,
that has applied, including all of the following: end insert

begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert begin insert

(E) The effective date of eligibility and enrollment.

end insert

(2) Information regarding begin delete all of end delete the bases of eligibility for
begin delete non-Modified Adjusted Gross Income end delete begin insert non-modified adjusted gross
income end insert (MAGI) Medi-Cal and the benefits and services afforded
to individuals eligible on those bases, sufficient to enable the
individual to make an informed choice as to whether to appeal the
eligibility determination or the date of begin delete enrollment. end delete begin insert enrollment,
which may be included with the notice in a separate document. end insert

(3) An explanation that the applicant or enrollee may appeal
any action or inaction related to an individual’s eligibility for or
enrollment in an insurance affordability program with which the
applicant or enrollee is dissatisfied by requesting a state fair hearing
consistent with begin delete Section 100506.4 end delete begin insert this title end insert and the provisions of
Chapter 7 (commencing with Section 10950) of Part 2 of Division
9 of the Welfare and Institutions Code.

(4) Information on the applicant or enrollee’s right to represent
himself or herself or to be represented by legal counsel or an
authorized representative as provided in subdivision (f) of Section
100506.4.

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

SEC. 4.  

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

100506.3.  

The board shall enter into a contract with the State
Department of Social Services to serve as the Exchange appeals
entity designated to hear appeals of eligibility or enrollment
determination or redetermination for persons in the individual
market, begin delete pursuant to Section 100506 and Subpart F of Part 155 of
Title 45 of the Code of Federal Regulations. end delete begin insert or exemption
determinations within the Exchange’s jurisdiction. end insert Except as
otherwise provided in this title, begin delete the end delete begin insert this end insert hearing process shall be
governed by the Medi-Cal hearing process established in Chapter
7 (commencing with Section 10950) of Part 2 of Division 9 of the
Welfare and Institutions begin delete Code. end delete begin insert Code, Section 100506, Subpart F
of Part 155 of Title 45 of the Code of Federal Regulations, and
Article 7 of Chapter 12 of Title 10 of the California Code of
Regulations to the extent applicable and consistent with the act
that added this section. end insert

SEC. 5.  

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

100506.4.  

(a) (1) Except as provided in paragraph (2), the
State Department of Social Services, acting as the appeals entity,
shall allow an applicant or enrollee to request an appeal within 90
days of the date of the notice of an eligibility or enrollment
determination, begin insert or exemption determination end insert begin insert within the Exchange’s
jurisdiction, end insert unless there is good cause as provided in Section
10951 of the Welfare and Institutions Code.

(2) The appeals entity shall establish and maintain a process for
an applicant or enrollee to request an expedited appeals process
where there is immediate need for health services because a
standard appeal could seriously jeopardize the appellant’s life,
health, or the ability to attain, maintain, or regain maximum
function. If an expedited appeal is granted, the decision shall be
issued begin delete within three working days or as soon as is required by the
appellant’s condition. end delete begin insert no later than five working days unless the
appellant agrees to a delay to submit additional documents for
the appeals record. end insert If an expedited appeal is denied, the appeals
entity shall notify the appellant within begin delete two end delete begin insert three end insert days by telephone
or begin insert through other end insert commonly available begin insert secure end insert electronic means, to
be followed begin delete in writing, end delete begin insert by a notice in writing, within five working
days. end insert of the denial of an expedited appeal. If an expedited appeal
is denied, the appeal shall be handled through the standard appeal
process.

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

(c) The staff of the Exchange, the county, or begin delete MRMIB end delete begin insert the State
Department of Health Care Services or its designee end insert shall assist
the applicant or enrollee in making the appeal request.

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

(2) Upon receipt of an appeal request, the appeals entity shall
send, via secure electronic begin delete interface, end delete begin insert means, end insert timely notice of the
appeal to the Exchange and the county begin delete and, if related to the Access
for Infants and Mothers or the Healthy Families Program, MRMIB. end delete begin insert ,
and the State Department of Health Care Services or its designee
if applicable. end insert

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

(e) A member of the board, employee of the Exchange, a county,
begin delete MRMIB, end delete begin insert the State Department of Health Care Services or its
designee, end insert or the appeals entity shall not limit or interfere with an
begin delete applicant end delete begin insert applicant’s end insert or enrollee’s right to make an appeal or
attempt to direct the individual’s decisions regarding the appeal.

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

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

(1) A representative of the begin delete Exchange, the county, or MRMIB end delete
begin insert entity that made the eligibility or enrollment determination end insert shall
contact the appellant begin insert or the appellant’s appropriately authorized
representative end insert and offer to discuss the determination with the
appellant if he or she agrees.

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

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

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

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

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

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

(B) Counties shall conduct informal resolution involving issues
related to non-MAGI begin delete Medi-Cal. end delete begin insert Medi-Cal eligibility or enrollment
decisions. end insert

begin delete

(C) MRMIB shall conduct informal resolution involving issues
related only to the Access for Infants and Mothers Program or the
Healthy Families Program.

end delete begin insert

(C) The State Department of Health Care Services or its
designee shall conduct informal resolution involving issues related
to the Medi-Cal Access Program.

end insert

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

(8) The informal resolution process set forth by the State
Department of Social begin delete Services’ Manual of Policies and Procedures
Section 22-073 end delete begin insert Services for Medi-Cal fair hearings end insert shall be used
for the informal resolutions pursuant to this begin delete subdivision. end delete
begin insert subdivision and shall require the Exchange, county representative,
or the State Department of Health Care Services or its designee end insert
begin insert to do the following: end insert

begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert

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

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

(3) The begin delete format of the hearing shall be in person, end delete begin insert hearing format
may be held via telephone or video conference, end insert unless the appellant
requests the hearing be held begin delete telephonically or via video conference end delete
begin insert in person end insert pursuant to paragraph (2).

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

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

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

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

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

(j) Upon adjudication of the appeal, the appeals entity shall
transmit the decision of appeal to the entity that made the eligibility
or enrollment determination via a secure electronic begin delete interface. end delete
begin insert means. end insert

(k) If an appellant disagrees with the decision of the appeals
entity, he or she may make an appeal request regarding begin delete issues
relating to end delete begin insert coverage in a qualified health plan through end insert the
Exchange to the federal begin insert Department end insert Health and Human Services
begin delete Agency end delete within 30 days of the notice of decision through any of
the methods in subdivision (b).

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

(m) Nothing in this section, or in Sections 100506.1 and
100506.2, shall limit or reduce an appellant’s rights to notice,
hearing, and appeal under Medi-Cal, county indigent programs,
or any other public programs.

SEC. 6.  

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

100506.5.  

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

begin insert

begin insert SEC. 7. end insert   

end insert

begin insert Section 10950 of the end insert begin insert Welfare and Institutions Code end insert begin insert is
amended to read: end insert

10950.  

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

begin insert

(b) (1) The requirements of Sections 100506.2, 100506.3,
100506.4 of the Government Code apply to state hearings
regarding eligibility for or enrollment in an insurance affordability
program administered by the State Department of Health Care
Services to the extent that those sections conflict with the state
hearing requirements under this chapter.

end insert begin insert

(2) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department, without taking any further regulatory action, shall
implement, interpret, or make specific this subdivision by means
of all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time regulations are adopted. The
department shall adopt regulations by July 1, 2017, in accordance
with the requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
Notwithstanding Section 10231.5 of the Government Code,
beginning July 1, 2015, the department shall provide a semiannual
status report to the Legislature, in compliance with Section 9795
of the Government Code, until regulations have been adopted.

end insert begin delete

Priority

end delete

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

begin delete

Notwithstanding

end delete

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

begin delete

For

end delete

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

begin delete

The State

end delete

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

begin delete

As

end delete

begin insert (g) end insert begin insert   end insert begin insert As end insert used in this chapter, “recipient” means an applicant for
or recipient of public social services except aid exclusively financed
by county funds or aid under Article 1 (commencing with Section
12000) to Article 6 (commencing with Section 12250), inclusive,
of Chapter 3 of Part 3, and under Article 8 (commencing with
Section 12350) of Chapter 3 of Part 3, or those activities conducted
under Chapter 6 (commencing with Section 18350) of Part 6, and
shall include any individual who is an approved adoptive parent,
as described in subdivision (C) of Section 8708 of the Family
Code, and who alleges that he or she has been denied or has
experienced delay in the placement of a child for adoption solely
because he or she lives outside the jurisdiction of the department.

begin insert

begin insert SEC. 8. end insert   

end insert

begin insert Section 10951 of the end insert begin insert Welfare and Institutions Code end insert begin insert is
amended to read: end insert

10951.  

(a)  begin delete No end delete begin insert A end insert person begin delete shall be end delete begin insert is not end insert entitled to a hearing
pursuant to this chapter unless he or she files his or her request for
the same within 90 days after the order or action complained of.

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

(2) For purposes of this subdivision “good cause” means a
substantial and compelling reason beyond the party’s control,
considering the length of the delay, the diligence of the party
making the request, and the potential prejudice to the other party.
The inability of a person to understand an adequate and language
compliant notice, in and of itself, shall not constitute good cause.
begin delete In no event shall the end delete begin insert The end insert department begin insert shall not end insert grant a request for
a hearing begin delete where end delete begin insert for good cause if end insert the request is filed more than
180 days after the order or action complained of.

(3)  begin delete Nothing in this end delete begin insert This end insert section shall begin insert not end insert preclude the application
of the principles of equity jurisdiction as otherwise provided by
law.

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

begin insert

begin insert SEC. 9. end insert   

end insert

begin insert Section 10960 of the end insert begin insert Welfare and Institutions Code end insert begin insert is
amended to read: end insert

10960.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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