Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 1 - General
Chapter 19 - Traumatic Head and Spinal Cord Injury
Section I-1909 - Individual Appeals Rights [Formerly LAC 67:VII.1911]
Universal Citation: LA Admin Code I-1909
Current through Register Vol. 50, No. 9, September 20, 2024
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c. Repealed.
d. Repealed.
e. Repealed.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.
AUTHORITY NOTE; Promulgated in accordance with R.S. 46:2631-2635 and R.S. 36:259(T).
NOTE: Repealed.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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