La. Admin. Code tit. 48 § V-5103

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

Section V-5103 - Appeal Process for Denied Applications

A. The Eligibility Determination Value shall be calculated at the time of initial application to the Program and annually thereafter, or, when a major expenditure is anticipated, or, whenever staff becomes aware of major changes in any portion of the formula. These changes may include salary raises, unemployment, additions or deletions of family members from the home, or any changes in the medical category. If such a redetermination of eligibility occurs prior to a major expenditure (i.e. hospitalization, purchase of an appliance or home IV therapy lasting longer than 10 days, etc.) and the family is determined to be no longer eligible for services, the expenditure may be covered prior to discharge from the Program.

B. The CSHS Regional Staff shall document extenuating circumstances that may arise and refer them to the CSHS Program Manager for special consideration. The CSHS Program Manager may convene the Administrative Unit made up of CSHS Program Specialist, medical, nursing, social service, nutrition and parent consultants for a team decision which then becomes the Program Manager's final decision.

C. When an application is denied, for whatever reason, the denial must be written, dated and hand delivered or sent by certified mail to the applicant's parents or legal representative. The letter of denial shall include information on the family's right to have the denial referred for an Administrative Review. The family must request an Administrative Review in writing within 15 days of the date of certified mailing or hand-delivery of the notice of denial. The written request will be forwarded by CSHS Regional Staff to the CSHS Program Manager for reconsideration.

D. After the Administrative Review, the CSHS Program Manager's decision shall be forwarded to the applicant's parents/or legal representative through the CSHS Regional Office. If the applicant's parent/legal representative disagrees with the decision, a fair hearing may be requested within 30 days from the date of mailing or hand-delivery of the Administrative Review denial.

La. Admin. Code tit. 48, § V-5103

Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services, LR 13: 246 (April 1987), amended by the Department of Health and Hospitals, Office of Public Health, LR 15: (October 1989), amended by the Department of Health and Hospitals, Office of Public Health, LR 22:362 (May 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:31.2, R.S. 40:1299. 111-120, and Title XIX, Public Health Service Act, §1905