Assistive Care Services and Assisted Living for the Elderly Waiver

Assistive Care Services and Assisted Living for the Elderly Waiver Services
Coverage and Limitations Handbook
PART I
APPENDIX B
APPEAL RIGHTS AND FAIR HEARING PROCESS
Fair Hearing Process
Right to a Fair
Hearing
An ACS recipient or applicant has the right to appeal any action taken by the
Agency for Health Care Administration (AHCA), Department of Children and
Families (DCF) or service providers that adversely affects the recipient’s receipt
of services.
ACS recipients must be given at least 10 calendar days advance written notice
of any suspension, reduction, or termination of services or program participation.
The advance notice must inform the ACS recipient of the right to a fair hearing.
Where to Apply for
a Hearing
Hearing requests must be sent to the DCF, Office of Hearing Appeals (OSIH),
1317 Winewood Boulevard, Building 5, Room 203, Tallahassee, Florida
32399-0700. The telephone number is (850) 488-1429.
How to Request a
Hearing
The ACS applicant, recipient, or authorized representative must request a
hearing within 90 days of the receipt of the written notification of the adverse
decision. ACS providers must offer assistance to recipients or applicants with
the fair hearing process.
Continuation of
Benefits
If the ACS applicant, recipient, or authorized representative requests a fair
hearing within 10 calendar days of the receipt of the notice of case action or
denial of service, ACS services must be reinstated at the level prior to the
adverse action.
If an ACS applicant or recipient requests a fair hearing and services are
reinstated to the prior level, the recipient might be requested to repay that
portion of the benefits that the hearing decision determines to be invalid. The
recipient must be given written notice of this responsibility.
July 2001 B-1