Section 17b-262-847 - Review process(a) a client or client representative may request a review with the hospice whenever a requested good or service is denied.(b)Review Process:(1) The hospice shall have a timely and organized review process. The review process shall be available whenever: (A) the hospice denies a requested good or service; or(B) the hospice fails to respond to a client's request for goods and services within five working days of such request.(2) The results of the review shall be in writing and shall include a brief statement of the reasons for the decision and shall state that the client may request review by the department and how to obtain such review.(3) The hospice's review process shall allow for an expedited review within one business day when the standard time frames for determining a review could jeopardize the comfort of the client.(c)Department review:(1) A client who is denied a good or service by the hospice provider may request a review by the department in accordance with the following procedures: (A) The client shall file a written or verbal request for a review within fifteen days from the date of the hospice denial of the good or service.(B) The request shall state the reasons the client believes he or she should receive the goods or services and include any additional documentation in support of his or her case.(C) Within five days of the request, the department shall make a finding based on an evaluation of the evidence submitted and shall notify the client in writing.(2) If the standard timeframe for the department's review could jeopardize the comfort of the client, an expedited review shall be completed by the department within one business day of the request.Conn. Agencies Regs. § 17b-262-847
Adopted effective July 7, 2009