La. Admin. Code tit. 48 § I-1909

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-1909 - Individual Appeals Rights [Formerly LAC 67:VII.1911]

A. Administrative Review. The administrative review is the first level appeal process used by individuals for a timely resolution of disagreements pertaining to eligibility decisions or a denial of services.

1. All applicants/participants shall be provided written notification to inform them of their appeal rights regarding eligibility and/or the denial of services.

a. The written notification shall include:

i. the decision being reached;

ii. the basis for and effective date of the decision;

iii. the specific means for appealing the decision;

iv. the individual's right to submit additional evidence and information;

v. information about the individual's right to representation; and

vi. the name and address of the trust fund program.

2. The appeal must be requested by the individual (or their representative) and shall be:

a. made in writing; and

b. post-marked or received in the trust fund program office within 15 business days of the date on the written notification of denial.

c. Repealed.

d. Repealed.

e. Repealed.

3. The administrative review may be conducted face-to-face or via telephone with the program manager of the Traumatic Head and Spinal Cord Injury Trust Fund Program.

4. Services shall continue during the administrative review process unless the services being provided have been obtained through:

a. misrepresentation;

b. fraud; and/or

c. collusion or criminal conduct on the part of the individual.

5. The administrative review must take place, a decision reached, and written notification of the decision provided to the individual within 30 calendar days of the receipt of the individuals' appeal request.

6. The written notification of the administrative review decision shall include:

a. the decision being reached;

b. the basis for and effective date of the decision;

c. the specific means for appealing the administrative review decision;

7. If the individual fails to attend the administrative review either in person or via telephone, the appeal will be considered abandoned and the appeal process is exhausted.

B. Advisory Board Review. In the event that a disputed decision is not resolved through the administrative review process, the individual may request a second level appeal before the advisory board.

1. Requests for advisory board review shall be:

a. made in writing to the program manager of the trust fund program;

b. post-marked or received in the trust fund program office within 15 business days of the date on the administrative review decision notice.

c. Repealed.

d. Repealed.

e. Repealed.

2. The advisory board review shall take place at the time of the next regularly scheduled advisory board meeting following the receipt of the individual's written request, unless the program manager deems that it is necessary to address the situation sooner, in which case a special meeting of the advisory board could be called for the purpose of conducting the review.

3. The individual shall have the right to:

a. submit additional evidence, and

b. bring representation to the advisory board review.

4. The advisory board shall:

a. make an impartial decision;

b. provide a written notice of the decision within 10 business days of the advisory board review.

5. The decision of the advisory board is final and the appeal process is exhausted.

6. If the individual fails to attend the appeal hearing either in person or via telephone, the appeal will be considered abandoned and all appeal processes shall be exhausted.

La. Admin. Code tit. 48, § I-1909

Promulgated by the Department of Social Services, Office of Rehabilitation Services, LR 21:1254 (November 1995), amended by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 40:85 (January 2014), Amended by the Louisiana Department of Health, Office of Aging and Adult Services, LR 441905 (10/1/2018).

AUTHORITY NOTE; Promulgated in accordance with R.S. 46:2631-2635 and R.S. 36:259(T).

NOTE: Repealed.