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 II
APPENDIX G
APPEAL RIGHTS AND FAIR HEARING PROCESS
Fair Hearing Process
Right to a Fair
Hearing
A recipient or applicant has the right to appeal any action taken by the Agency
for Health Care Administration (AHCA), Department of Elder Affairs (DOEA),
Department of Children and Families (DCF) or service providers that adversely
affects the recipient’s receipt of services.
ALE 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 ALE 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 ALE waiver applicant, recipient, or authorized representative must request a
hearing within 90 days of the receipt of the written notification of the adverse
decision. ALE case managers must offer assistance to recipients or applicants
with the fair hearing process.
Continuation of
Benefits
If the ALE 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, waiver services must be reinstated at the level prior to the
adverse action.
If an ALE 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 G-1