Assistive Care Services and Assisted Living for the Elderly Waiver

Assistive Care Services and Assisted Living for the Elderly Wavier Services
Coverage and Limitations Handbook
Termination of Services, continued
Reasons For
Termination
A recipient who is terminated from ALE services for any one of the following
reasons must be given a fair hearing notice:
• Loss of Medicaid eligibility;
• The recipient’s physical condition no longer meets functional criteria;
• The recipient moved to a non-waiver setting;
• The recipient was placed in a nursing facility;
• The recipient elected to stop ALE services;
• The recipient refused to comply with the plan of care; and,
• The recipient would not accept treatment from any of the available
enrolled providers.
DOEA Grievance
Procedure
ALE waiver consumers can file a grievance with DOEA concerning any
action taken by DOEA or the DOEA service provider network. Consumers
should contact their case managers for assistance with their grievance. Case
managers must assist the consumer or the designated representative with
preparation and presentation of the grievance. Participation in the DOEA
grievance process does not affect a consumer’s right to a fair hearing.
Right To A Fair
Hearing
An ALE consumer has the right to appeal any action taken by the ALF,
AHCA, DOEA or DCF that adversely affects the recipient’s receipt of
services.
Note: See Part II, Appendix G for details on how to access the fair hearing
process.
July 2001 5-19