Ala. Admin. Code r. 560-X-44-.07

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-44-.07 - Fair Hearings

(1) An individual whose application to the waiver program is denied or waiver participants whose services are terminated, suspended, or reduced based on Rule No. 560-X-44-.02, may request an appeal in accordance with 42 CFR Section 431, Subpart E and Chapter 3 of the Alabama Medicaid Administrative Code, as modified by the below provisions.

(2) ACT waiver participants will be given at least a ten-day notice before termination, suspension or reduction of services.

(3) If an individual/guardian chooses to appeal the decision, a written request for an informal conference must be received by the Operating Agency within 30 days from the effective date of the notice. Services may continue for waiver participants until the final outcome of the administrative appeal process, if the written request is received within 10 days after the effective date of the action.

(4) If the individual/guardian is dissatisfied with the Informal Conference decision, a Fair Hearing may be requested. A written request for a Fair Hearing must be received no later than 30 days from the date of the Informal Conference decision notice.

(5) If the individual/guardian is dissatisfied with the Fair Hearing decision, he/she may appeal pursuant to the provisions of the Alabama Administrative Procedure Act.

(6) The Operating Agency will take the lead role for the Informal Conferences, Fair Hearings and subsequent judicial appeals. Medicaid legal counsel and program staff will function as support staff.

Ala. Admin. Code r. 560-X-44-.07

Rule effective October 12, 1988. Repealed: Filed January 9, 2004; effective February 13, 2004. New Rule: Filed February 10, 2012; effective March 16, 2012. Amended: Filed June 12, 2012; effective July 17, 2012.

Author: Mattie M. Jackson, Program Manager, LTC Program Management Unit.

Statutory Authority: Social Security Act §1915(c); 42 CFR Section 431, Subpart E.