New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-M - Former Division of Mental Health and Developmental Services
Chapter He-M 500 - DEVELOPMENTAL SERVICES
Part He-M 525 - PARTICIPANT DIRECTED AND MANAGED SERVICES
Section He-M 525.11 - Appeals

Universal Citation: NH Admin Rules He-M 525.11

Current through Register No. 40, October 3, 2024

(a) An individual or guardian may choose to pursue informal resolution to resolve any disagreement with an area agency, or, within 30 business days of the area agency decision, she or he may choose to file a formal appeal pursuant to (e) below. Any determination, action, or inaction by an area agency may be appealed by an individual or guardian.

(b) An applicant for certification, provider, subcontract agency, or area agency may request a hearing regarding a proposed revocation or denial of certification, except as provided in He-M 525.10 above.

(c) The following actions shall be subject to the notification requirements of (d) below:

(1) Adverse eligibility actions under He-M 525.03;

(2) Area agency determinations regarding an individual's or guardian's selection of a provider under He-M 525.05(h) or removal of a provider under He-M 525.05(k) ;

(3) Area agency determinations regarding provider certification under He-M 525.09;

(4) Area agency determinations regarding the removal of a service coordinator selected by an individual or guardian under He-M 503.08(f) (2) and (3) ; and

(5) A determination to terminate services under He-M 503.15(f) .

(d) An area agency shall provide written and verbal notice to the applicant and guardian 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 administrator;

(3) Notice of the individual's continued right to services pending appeal, when applicable, pursuant to (f) below;

(4) Notice of the right to have representation with an appeal by:
a. Legal counsel;

b. A relative;

c. A friend; or

d. Another spokesperson;

(5) Notice that neither the area agency nor the bureau is responsible for the cost of representation;

(6) Notice of organizations with their addresses and phone numbers that might be available to provide legal assistance and advocacy, including the Disabilities Rights Center and pro bono or reduced fee assistance; and

(7) Notice of individual's right to request a second formal risk assessment from a qualified evaluator.

(e) Appeals shall be submitted, in writing, to the bureau administrator in care of the department's office of client and legal services within 30 business days following the date of the notification of an area agency's decision or the bureau's denial or revocation of certification. 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 or independent review, as provided in He-C 200. The burden shall be as provided by He-C 203.14.

(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's decision is upheld, benefits shall cease 60 days from the date of the denial letter or 30 days from the hearing decision, whichever is later.

#9391, eff 2-21-09; ss by #9890-A, eff 3-22-11

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