Sec.17a-230-14. Hearings and reviews

(a) Case Review, as defined in these regulations:

(1) Shall be offered to persons: (A) who have been denied initial eligibility for authorization under Section 7, (B) who dispute the level of care that was initially assigned to them by the regional eligibility team, or (C) who have been denied admission by a private residential facility.

(2) The request for a case review shall be made in writing by the individual, or his legal representative, to the superintendent of the region or to the private residential facility or to both according to subsections (4) and (5) below. The superintendent or the private residential facility shall transmit such request to the regional eligibility team within five days. The request shall be made within fifteen days after the receipt of notice of denial or eligibility, dispute of level of care or denial of admission to a private residential facility.

(3) At the time of request for a case review, any additional information may be submitted by the client or his legal representative.

(4) If a client has been denied eligibility or disputes his level of care, the regional eligibility team shall, within thirty days after receipt of request for case review, review its previous decision and any new information submitted and either confirm or change its original decision.

The chairperson of the regional eligibility team shall notify the individual of the team's decision in writing.

(5) If a client has been denied admission to a private residential facility, the private residential facility's selection body shall review its decision and if the initial decision prevails, a notice shall be sent to the client stating the reasons for denial of admission. A copy of the decision shall be sent to the regional eligibility team.

(b) A supplemental case review, as defined in these regulations, shall apply as follows:

(1) A client or his representative, who is not satisfied with the decision in subsection (a) (4) and (5) may request a supplemental case review.

(2) Request for a supplemental case review shall be made in writing to the superintendent of the region in which the decision was made. Requests shall be made within fifteen days of receipt of notice of the case review decision.

(3) The superintendent of the region, upon receipt of such request, shall appoint an impartial individual to review the decision of the regional eligibility team of the private residential facility.

(4) The impartial individual shall solicit any information from the client or his legal representative and the regional eligibility team or the private residential facilities and may require attendance at a meeting by such parties in order to make a binding determination of the dispute.

(5) If the impartial individual schedules a meeting of the parties, he shall do so within five days of the receipt of the request for supplemental case review and such meeting shall be held within fifteen days of receipt of the request.

(6) The decision of the impartial individual shall be sent in writing to all parties involved within ten days of any meeting or if no meeting is held, within ten days of receipt of the request and will be binding.

(c) Fair hearings, as defined in these regulations, shall apply:

(1) Whenever a regional eligibility team declines to reauthorize a person for continued funding or there is a change in the level of care of a previously authorized individual, the regional eligibility team shall give thirty days notice in writing to the individual and such individual's parent, conservator, guardian, or other legal representative and the private residential facility in which the person lives. Such notice shall also inform such individual the reason for determination and of his right to contest the determination by submitting in writing a request for fair hearing under the provisions of this subsection.

(2) Request for a hearing shall be made to the commissioner in writing within fifteen days of receiving the notice required by this subsection.

(3) The hearing, if requested, shall be held within thirty days of the request with proper notification to all parties.

(4) The hearing shall be conducted in accordance with the provisions of Section 4-177 to 4-184 inclusive of the General Statutes.

(Effective June 28, 1994)