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    v1.0.30
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyConnecticut DSS CHCPE Appeals Policy Update | Open…
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    ModifiedConnecticut Department of Social ServicesPolicy UP-09-05

    State-Funded Connecticut Home Care Program for Elders (CHCPE) Extended Period to Request an Administrative Hearing with Continuation of Benefits

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    This policy governs when state-funded Connecticut Home Care Program for Elders clients may request continuation of benefits while appealing an adverse action. It applies to CHCPE applicants and recipients, authorized representatives, access agencies, assisted living service agencies, and the Department of Social Services.

    Policy Summary
    PayerConnecticut Department of Social Services
    PolicyState-Funded CHCPE Extended Period to Request an Administrative Hearing with Continuation of Benefits
    Policy CodePolicy UP-09-05
    Change TypeRevised
    Effective DateJul 29, 2008
    Next Review DateN/A
    Key ActionWhen a state-funded CHCPE client requests a hearing before the proposed effective date of an adverse action, postpone the proposed adverse action until there is a hearing decision favorable to the Department, unless the client requests that the action proceed.
    SourceLink
    POLICY UPDATE CHANGES

    The continuation-of-benefits request period changed from within 10 days of an adverse action notice to any time before the proposed effective date of the adverse action.

    Before effective dateDeadline for requesting continuation of benefits
    60 daysAdministrative appeal request period

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    3 entities
    Appealable decision-making entities
    Any service decisionAppealable decision scope

    Continuation of Benefits and Appealable Decisions

    Continuation of Benefits During CHCPE Appeal

    A state-funded CHCPE client may continue receiving benefits during an appeal when the hearing is requested before the proposed effective date of the adverse action.

    ALL of the following

    • The individual or authorized representative requests a hearing before the proposed effective date of the adverse action.
    • The Department postpones the proposed adverse action pending the hearing decision; the adverse action will not be taken unless requested by the client or there is a hearing decision favorable to the Department.

    Appealable CHCPE Decisions

    An individual or authorized representative may appeal decisions made by the access agency, assisted living service agency, or Department of Social Services through the administrative appeal process.

    ALL of the following

    • The decision was made by one of the following

      • The access agency.
      • The assisted living service agency.
      • The Department of Social Services.

    • The decision may involve any of the following

      • The type or quantity of service.
      • The amount of the financial contribution.
      • Denial of an assessment.
      • Any other eligibility or service decision.

    Appeal process and deadline

    • For an access agency or assisted living service agency decision, the individual or authorized representative first requests, in writing, that the agency review its decision.
    • If dissatisfied with the agency's review, the individual may request, in writing, a Department of Social Services hearing.
    • The individual may challenge a decision of the Department, access agency, or assisted living service agency by writing to the Department of Social Services Administrative Appeals Unit within 60 days from the date the Department mails the notice of action.

    Appeal and Continuation Deadlines

    Administrative appeal request period
    Request periodWithin 60 days from the date the Department mails a notice of action
    Submission destinationWrite to the Department of Social Services Administrative Appeals Unit
    Decisions subject to challengeDecisions made by the Department of Social Services, access agency, or assisted living service agency
    Continuation-of-benefits request period
    Request periodAny time before the effective date of the adverse action
    Effect of timely requestThe Department will not take the adverse action while the hearing is pending

    Required Actions During the Appeal Process

    Denial Risk

    Continue benefits pending a timely hearing request

    When a state-funded CHCPE client requests a hearing before the proposed effective date of an adverse action, postpone the proposed adverse action until there is a hearing decision favorable to the Department. The action may proceed if the client requests that it proceed.

    • A continuation-of-benefits request may be made any time before the effective date of the adverse action.
    Documentation Required

    Complete written agency review before Department appeal

    Access agencies and assisted living service agencies must provide a written review of their decisions when requested by an individual or authorized representative. If the individual is not satisfied with the review, the decision may then be appealed in writing to the Department of Social Services.

    • Appealable decisions include those affecting the type or quantity of service, the amount of the financial contribution, or denial of an assessment.

    Key Appeal Terms

    Authorized representative
    DefinitionA person or entity authorized to act on behalf of the CHCPE individual
    Agency reviewMay request, in writing, that the access agency or assisted living service agency review its decision
    Department hearingMay request a Department of Social Services hearing on the CHCPE individual's behalf
    Adverse action
    DefinitionA decision affecting CHCPE services, financial contribution, assessment, eligibility, or another matter that may be challenged through the administrative appeal process
    Service-related decisionsIncludes decisions affecting the type or quantity of service
    Policy Summary
    PayerConnecticut Department of Social Services
    PolicyState-Funded CHCPE Extended Period to Request an Administrative Hearing with Continuation of Benefits
    Policy CodePolicy UP-09-05
    Change TypeRevised
    Effective DateJul 29, 2008
    Next Review DateN/A
    Key ActionWhen a state-funded CHCPE client requests a hearing before the proposed effective date of an adverse action, postpone the proposed adverse action until there is a hearing decision favorable to the Department, unless the client requests that the action proceed.
    SourceLink
    On This Page
    Continuation of Benefits and Appealable DecisionsAppeal and Continuation DeadlinesRequired Actions During the Appeal ProcessKey Appeal Terms
    Client-initiated exception
    The adverse action may proceed if requested by the client
    Other appealable decisions
    Includes decisions affecting the amount of the financial contribution or denial of an assessment