Due Process Protection

Due Process Protection A. The Division of Medicaid is responsible for operating the dispute mechanism for waiver beneficiaries separate from a fair hearing process. The Division of Medicaid has the final authority over any dispute. 1. The types of disputes addressed by an informal dispute resolution process include issues concerning service providers, waiver services, and other issues that directly affect waiver services. 2. At the initial assessment, the case manager must inform the beneficiary/representative of the specific criteria for the dispute, complaint/grievance, and hearing processes. B. The Division of Medicaid provides an opportunity to request a Fair Hearing to beneficiaries: 1. Who are not given the choice of home and community-based services as an alternative to the institutional care, 2. Who are denied the service(s) of their choice or the provider(s) of their choice, or 3. Whose services are denied, suspended, reduced, or terminated. C. Notice of Action (NOA) must include: 1. A description of the action the provider has taken or intends to take, 2. An explanation for the action, 3. Notification that the beneficiary/representative has the right to file an appeal, 4. Procedures for filing an appeal, 5. Notification of beneficiary/representative’s right to request a Fair Hearing, 6. Notice the beneficiary/representative has the right to have benefits continued pending the resolution of the appeal, and 7. The specific regulations or the change in Federal or State law that support or require the action.