I. PURPOSE
The purpose of this Directive is to advise Local Departments of Social
Services (LDSS) and Long Term Home Health Care Programs (LTHHCP) of new fair hearing procedures. These procedures relate to LTHHCP
participants’ existing as well as new fair hearing rights. With
respect to LTHHCP participants’ existing fair hearing rights, this
Directive includes fair hearing notices that districts must send under
the following circumstances described in 83 ADM-74: when the Medicaid
recipient’s application for participation in the LTHHCP is denied; when
the recipient’s participation in the LTHHCP is discontinued; and, when
there is a change in the recipient’s level of care budget cap from
Skilled Nursing Facility (SNF) to Health Related Facility (HRF). With
respect to LTHHCP participants’ new fair hearing rights, this Directive
describes the additional fair hearing rights now required when a LDSS
or a LTHHCP proposes to deny, discontinue or reduce one or more
services in the recipient’s plan of care, contrary to treating
physician’s orders, but does not propose to terminate the recipient’s
participation in the LTHHCP.
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