(1/1/09 ML #3172)
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An individual dissatisfied with a decision made regarding personal care services may appeal that decision to the Department of Human Services under the fair hearing rules set forth in N.D.A.C. 75-01-03-03. An individual must be informed of the right to appeal any actions by the case manager or the department that result in denial, suspension, reduction, discontinuance, or termination of personal care services. Refer to Service Chapter 449-08 for more information with regard to Hearings and Appeals.
Denial/Termination/Reduction
The applicant/client must be informed in writing of the reason(s) for the denial/termination/reduction. The Case Manager is responsible to send a completed SFN 1647 with all applicable information to the client or applicant.
The Notice of Denial/Termination/Reduction form is dated the date of the mailing. Contact the HCBS Program Administrator to obtain the legal reference required at “as set forth . . . ." The legal reference must be based on federal law, state law and/or administrative code; reliance on a policy and procedures manual reference is not sufficient.
The client must be notified in writing at least 10 days (it may be more) prior to the date of terminating services UNLESS it is for one of the reasons stated in this section. The date entered on the line, the effective date field, is 10 calendar days from the date of mailing the Notice (SFN 1647) or the next working day if it is a Saturday, Sunday, or legal holiday.
Any of the reasons below do not require a 10-day notice:
The client enters a nursing home.
The county or Human Service Center has received in writing the client’s decision to terminate services.
The client agrees with the plan of care.
Client’s whereabouts are unknown.
State or federal government initiates a mass change which uniformly and similarly affects all similarly situated applicants, recipients, and households.
Case Management has factual information confirming the death of the client.