Section He-M 503.16 - Challenges and Appeals(a) Any determination, action, or inaction by the bureau, a service coordination agency, provider agency, or area agency may be appealed by an individual, guardian, or representative.(b) An individual, guardian, or representative may choose to pursue formal or informal resolution to resolve any disagreement with the bureau, a service coordination agency, provider agency, or an area agency. If informal resolution is sought, at any time during the process or within 30 business days of the bureau, service coordination agency, provider agency, or area agency decision, the individual may choose to file a formal appeal pursuant to (e)-(g) below. All formal appeals shall be filed within 30 days of the bureau, area agency, provider agency, or service coordination agency determination, action, or inaction.(c) The following actions shall be subject to the notification requirements of (d) below: (1) Adverse eligibility actions under He-M 503.05(i) and (q) and He-M 503.06(e) and (f);(2) Proposed service agreements or service agreement amendments if the individual, guardian, or representative disapproves pursuant to He-M 503.10(h); and(3) A determination to terminate services under He-M 503.14(f).(d) The bureau, area agency, provider agency, or service coordination agency, as applicable, shall provide written notice to the applicant, individual, and guardian or representative of the actions specified in (c) above, including: (1) The specific rules that support, or the federal or state law that requires, the action;(2) Notice of the individual's right to appeal in accordance with He-C 200 within 30 business days and the process for filing an appeal, including the contact information to initiate the appeal with the bureau's administrator;(3) Notice of the individual's continued right to services pending appeal, when applicable, pursuant to (g) below;(4) Notice of the right to have representation with an appeal by:(5) Notice that neither the area agency, provider agency, service coordination agency, nor the bureau is responsible for the cost of representation; and(6) Notice of organizations with their addresses and phone numbers that might be available to provide pro bono or reduced fee legal assistance and advocacy, including the Disability Rights Center-NH.(e) Appeals shall be forwarded, in writing, to the bureau administrator in care of the department's office of client and legal services. An exception shall be that appeals may be filed verbally if the individual is unable to convey the appeal in writing.(f) The bureau administrator shall immediately forward the appeal to the department's administrative appeals unit which shall assign a presiding officer to conduct a hearing, as provided in He-C 200. The burden shall be as provided by He-C 204.12.(g) If a hearing is requested, the following actions shall occur:(1) For current recipients, services and payments shall be continued as a consequence of an appeal for a hearing until a decision has been made; and(2) If the bureau, service coordination agency, provider agency, or area agency decision is upheld: a. Benefits shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later; orb. In the instance of termination of services, services shall cease one year after the initial decision to terminate services or 30 days from the hearing decision, whichever is later.N.H. Admin. Code § He-M 503.16
#1969, eff 2-25-82; ss by #2615, eff 2-6-84; ss by #2962, eff 1-22-85; ss by #5211, eff 8-28-91; EXPIRED: 8-28-97
New. #6581, INTERIM, eff 9-19-97, EXPIRED: 1-17-98
New. #6932, eff 1-27-99; ss by #8805, eff 1-27-07 (from He-M 503.13 )
Amended byVolume XXXV Number 06, Filed February 12, 2015, Proposed by #10774, Effective 1/27/2015, Expires7/27/2015.Amended by Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10900, Effective 7/25/2015, Expires7/25/2025.Amended by Number 2, Filed January 11, 2024, Proposed by #13841, Effective 12/29/2023, Expires 12/29/2033 (formerly He-M 503.17).