Appeals

Scope and Purpose. 115 CMR 14.11 contains the standards and procedures for an individual or participant to file an appeal related to their SDS. (2) Initiation of an Appeal. (a) An appeal may be initiated by the participant within 30 days of the receipt of the individual budget determination or notice of termination from SDS pursuant to 115 CMR 14.10(2). (b) Appeals of ISPs, Plans of Care, and individual budgets shall be consolidated for efficiency and to ensure the timely adjudication of appeals. (3) Grounds for Appeal. An individual may appeal based on the following grounds: (a) the individual budget amount was not based upon the participant's assessed needs as determined by the Department; (b) the value of the individual budget is not the equivalent of what the Department would have spent providing services, supports, or goods to the participant if the participant had chosen to receive traditional services; (c) denial of an individual's request for enrollment in SDS; and (d) termination from SDS pursuant to 115 CMR 14.10(2). The Appeal Process: Informal conferences and fair hearings shall be conducted in accordance with applicable provisions at 115 CMR 6.33: The Appeal Process. (a) General provisions at 115 CMR 6.34 (1) through (3) and (5) shall apply to appeals under 115 CMR 14.11. (b) For appeals based on 115 CMR 14.11(3)(a) or (b), the individual budget set by the Department will remain in effect during the pendency of the appeal.