D.C. Mun. Regs. tit. 29, r. 4202

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 4202 - APPEAL RIGHTS FOR APPLICANTS/BENEFICIARIES

4202.1

Applicants and beneficiaries shall receive advance notice and shall have the opportunity to request a Fair Hearing if:

(a) They are found ineligible for participation in the EPD Waiver based on the criteria set forth in Subsection 4201.2;

(b) They are not given the choice between HCB waiver services or institutional care;

(c) They are denied the choice of service(s) from a qualified and willing provider in accordance with 42 CFR § 431.51; or

(d) If DHCF or its designee takes action to deny, discontinue, suspend, reduce, or terminate services, or disenroll a beneficiary or applicant from the EPD Waiver Program.

4202.2

An EPD Waiver provider shall issue a written notice in cases of intended actions to discontinue, discharge, suspend, transfer, or terminate services to any applicant or beneficiary in accordance with the requirements sets forth in Section 4205. The notice shall be provided at least thirty (30) days prior to the effective date of the proposed action and shall provide the following information:

(a) The intended action;

(b) The reason(s) for the intended action;

(c) Citations to the law(s) and regulations supporting the intended action;

(d) A list of EPD waiver standards supporting the decision;

(e) An explanation of the applicant or beneficiary's right to request a hearing;

(f) The circumstances under which the applicant or beneficiary's current level of services will be continued if a hearing is requested; and

(g) A copy of the directory of other EPD waiver providers.

4202.3

DHCF or its designee shall issue a written notice in cases where it intends to take action to deny, discontinue, discharge, suspend, or reduce Waiver services, or dis-enroll applicants or beneficiaries from the EPD Waiver program. The notice shall be issued at least thirty (30) calendar days prior to the effective date of the proposed action and shall state the following information:

(a) The intended action;

(b) The reason(s) for the intended action;

(c) Citations to the law(s) and regulations supporting the intended action;

(d) An explanation of the individual's right to request a hearing; and

(e) The circumstances under which the individual's current level of services will be continued if a hearing is requested.

D.C. Mun. Regs. tit. 29, r. 4202

Final Rulemaking published at 64 DCR 6787 (7/21/2017)