651 CMR, § 1.08 - Provision of Services Pending Reviews and Appeals

(1) Denials. When an Applicant files a request for Review during the 14 calendar day Appeal period from a ASAP decision to Deny Home Care Program Services such Services shall not be provided to the Applicant until a Review or Appeals decision is rendered which is favorable to the Applicant. If the Applicant is determined to be eligible as the result of such Review or Appeals decision, the ASAP shall initiate provision of the appropriate services as soon as possible following notification to all parties of such final adjudicatory decision.

(2) Terminations.

(a) A Client who files a timely request for Review of an ASAP decision to Terminate Home Care Program Services shall continue to receive such Services at the level in effect prior to the ASAP's decision until the occurrence of any of the following events:

1. The Client does not file a timely request for Appeal of a Review decision of the Internal Case Review Committee which Terminates Home Care Program Services; or

2. The Hearings Officer on Appeal upholds the decision of the Internal Case Review Committee to terminate Home Care Program Services; or

3. The Appeal is dismissed pursuant to 651 CMR 1.09.

(b) If the decision of the Internal Case Review Committee or Hearings Officer is favorable to the Client, Services shall be continued in accordance with the decision. If the decision of the Internal Case Review Committee is unfavorable to the Client, and is not timely Appealed, Services shall be Terminated following the expiration of the Client's 14 calendar day Appeal period to Elder Affarrs, or as soon as possible thereafter. If the decision of the Hearings Officer is unfavorable to the Client, Services shall be terminated effective on the date of receipt by the Client and ASAP of such decision, or as soon as possible thereafter, regardless of the further Appeal of such decision by the Client pursuant to 651 CMR 1.11.

(3) Terminations: Exceptions. Notwithstanding the provisions of 651 CMR 1.08(2), a Client who files a timely request for Review of an ASAP decision to Terminate Home Care Program Services shall continue to receive such Services at the level in effect prior to the ASAP's decision only during the 14 calendar day request for Review period, at the end of which Services shall be Terminated, in the following circumstances:

(a) Termination of Home Care Program Services due to the unavailability of funds as defined in 651 CMR 3.05J T);ot

(b) Termination of Home Care Program Services based the determiation of an ASAP that the Services authorized and/or arranged are deemed inappropriate to safely maintain a Client in his/her home.

(4) Reductions. A Client who files a timely request for Review of an ASAP decision to Reduce Home Care Program Services, including but not limited to an ASAP decision to reduce Services due to unavailability of funding as described in 651 CMR 3.05(1), shall continue to receive such Services at the level in effect prior to the ASAP's decision only during the 14 calendar day request for Review period. Such Services shall be reduced to the level set forth in the ASAP notice of action to the Client following such 14 calendar day request for Review period. If the decision of the Internal Case Review Committee or Hearing Officer is favorable to the Client, Services shall be resumed at the previous level in accordance with such decision. If the decision is unfavorable to the Client, Services shall continue at the reduced level pending the Client's next Reassessment.

Notes

651 CMR, § 1.08