12 Colo. Code Regs. § 2512-2-12.552
Current through Register Vol. 47, No. 22, November 25, 2024
Section 12 CCR 2512-2-12.552 - Appeal ProcessAn "appeal" is a request to review a decision of a Contractor to deny or revoke Program eligibility or to deny, reduce, suspend, or terminate the delivery of Program services.
A. The Contractors performing eligibility determinations and providing Program services shall provide written notice to applicants and Program participants of decisions adversely impacting the individual's eligibility and Program services. The notice shall include the decision the Contractor has made, the reasons for the decision, the individual's right to appeal the Contractor's decision, and the appeal procedures.B. Applicants and Program participants shall have ninety (90) calendar days to file an appeal from the date of the Contractor's notice.C. The Contractor shall accept oral and written appeals, and shall document oral appeals in writing.D. The Contractor shall give applicants and Program participants reasonable assistance in filing an appeal and completing procedural steps in the appeal process, upon request.E. The Contractor shall ensure that the individuals who make decisions on appeals are individuals who were not involved in any previous level of review or decision-making regarding the decision under appeal.F. The Contractor shall provide a reasonable opportunity for the individual making the appeal to present information, in person as well as in writing.G. The Contractor shall resolve each appeal and provide written notice within thirty (30) calendar days from the date the Contractor receives the appeal. The notice shall include the Contractor's decision regarding the appeal, the individual's right to a second level appeal to the Colorado Department of Human Services, Executive Director or his or her designee, and information on how to contact the Executive Director or his or her designee.H. Applicants and Program participants shall have ninety (90) calendar days from the date of the Contractor's notice to file a second-level appeal with the Department of Human Services, Executive Director or his or her designee. I. The Executive Director or his or her designee shall have the right to additional information and may request oral argument or a hearing if it deems necessary.J. The applicant, Program participant may represent himself/herself or use legal counsel or other spokesperson at a hearing.K. The decision of the Executive Director or his or her designee shall constitute final agency action.L. The Contractor whose decision is under appeal shall participate in the appeals process, provide any documentation required, and implement any decision made by the Executive Director or his or her designee.M. The appeal process shall be conducted pursuant to Sections 24-4-105 and 106, C.R.S.38 CR 23, December 10, 2015, effective 1/1/201640 CR 11, June 10, 2017, effective 7/1/201741 CR 17, September 10, 2018, effective 10/1/201842 CR 01, January 10, 2019, effective 2/1/201944 CR 13, July 10, 2021, effective 8/1/2021