Due Process Rights

Under the Developmental Services program, you have rights to appeal decisions under two authorities. The first is Chapter 120, Florida Statutes (FS), and the second is Chapter 42, 431.200 of the Code of Federal Regulations. Chapter 42, 431.200 of the Code of Federal Regulations provides for "fair hearings" which are used to challenge or appeal actions relating to Medicaid services. Chapter 120, FS, provides for "administrative" hearings. These are used to challenge actions related to services funded only by state general revenue money. Providers of Medicaid services may also request administrative hearings.

A fair hearing is only available when services are paid using federal Medicaid funding. You may request a fair hearing when a request for services is denied, when the Department fails to act on a request for services within ninety days of request, or when the services you are currently receiving are suspended, terminated or reduced. This process can be used when your services are provided under a Developmental Services Home and Community-Based Services waiver.

Rights to a Fair Hearing

What is a fair hearing? A fair hearing is an appeal by an individual when an agency, in this case Developmental Services, takes any action the individual thinks is not appropriate. This may include denial of assistance, delay in acting on a request for assistance, suspension, termination or reduction of services.

When may I request a fair hearing? You or your authorized representative may request a fair hearing when any state agency takes an action to suspend, terminate or reduce services. A fair hearing may also be requested when an agency denies or fails to act on your request for assistance.

You may also contact the local Developmental Services program office to see if your issue can be resolved through reconsideration. A request for reconsideration does not affect the time frame to request a fair hearing. You must request a fair hearing no later than ninety (90) days of the date of the notice of the Department's actions was mailed or you will waive your right to request a fair hearing.

How do I request a fair hearing? T request a fair hearing you must make a request, preferably in writing, to the Developmental Services Program Administrator in your district or the Office of Appeal Hearing in Tallahassee, no later than ninety (90) days of the notice of the Department's actions was mailed. No one may interfere with your freedom to request a fair hearing. Developmental Services can assist you in making your request.

Agency action on your request for a hearing. In most instances, if you request a hearing, your request will be granted. If your request for hearing is denied, you will be notified in writing of the denial. You may appeal to the appropriate District Court of Appeal any written denial of a request for a hearing.

What happens when I request a fair hearing? If you make a request for a fair hearing and the request is granted, then what occurs next depends on whether you have been receiving the services and supports which are at issue. If you have been notified that a request for services has been denied or if there has been a delay in acting on your request, then the services will not be initiated unless and until you win the fair hearing.

If you have been notified that your services are to be suspended, reduced or terminated, then if you timely request a fair hearing, generally, those services will continue until the hearing process is completed. If you make your request for hearing prior to the effective date of the suspension, reduction or termination of services, then the services should generally continue uninterrupted, although there may be exceptions to this rule. If you request the hearing after the effective date of the action, but no later than ninety (90) days from the date the notice of the Department's actions was mailed, then the services may need to be reinstated.

If you prevail on your hearing request, then services will continue. If you do not prevail on your fair hearing (challenging the proposed suspension, reduction or termination of services), then you may be required to reimburse the state for the cost of services.

What are the steps in the fair hearing process? The first step in the fair hearing process is a local review of the evidence. If the issue is resolved on the district level, you may then request that your fair hearing request be withdrawn.

The next step is a hearing that must be conducted at a reasonable time, date, and place; after written notice: by a hearing officer from the Office of Appeal Hearing.

What happens in a fair hearing? You have the right to bring witnesses, establish all pertinent facts, present your side of the story without undue interference, and question or refute any testimony or evidence presented. You may present your own case t the hearing officer or bring an attorney, relative, friend or other spokesperson to represent you.

What is a final order? Considering the evidence presented at the hearing, the hearing officer will prepare a written final order within ninety (90) days of the request. If the hearing officer finds that the action taken was correct, the officer will order that the necessary action be taken. If the hearing officer finds the action taken was wrong, he will authorize corrective action back to the date of the incorrect action.

Rights to an Administrative Hearing

An administrative hearing is an appeal of agency action involving services funded through state general revenue dollars. The hearing may be informal or formal in nature. An informal hearing is held when you admit the basic facts relating to your claim. A formal hearing is held when there is a dispute about the facts relating to your claim. A Hearing Officer employed by the Department of Administrative Appeal Hearings conducts a formal hearing. The Department conducts an informal hearing.

You may request an administrative hearing if you believe that your "substantial interests" have been affected. Generally, this would mean that your request for services has been denied, or that services provided to you have been suspended, terminated or reduced. You must request an administrative hearing within 21 days after receiving notice of the Department's action. If you do not request an administrative hearing within 21 days of receipt of the notice, you will waive your rights to request an administrative hearing.

At an informal hearing you can present evidence to "lessen" the action of the Department. You may also argue that the action is not legally correct. At a formal hearing, you may present evidence and witnesses and cross-
examine the Department's witnesses.

Generally, in the other respects, the administrative hearing process is similar to a fair hearing process. However, the final order is always issued by the agency. If a formal hearing is held, the officer issues a recommended order which is then considered by the agency in the final order process.

You have the right to appeal an unfavorable final order to the appropriate district court.

Additional information on your rights to a fair hearing may be found in Chapter 42, 431.200 Code of Federal Regulations and Section 65-2.042 through sections 65, Florida Administrative Code.

Go over the information with the individual on Intake, obtain signatures and submit to the Program Administrator. For Annual and Quarterly Reviews, use this information for reference only and have the client sign the Topics form as proof the client received this information. Provide a copy if the client wants one.
Individual	Signature	Date
Individual
Guardian/Representative
Staff