10108.1 If DHCF or its designee denies any PDCS services or individual-directed good or service requested in a participant’s PDS budget, the participant may request reconsideration of the denial in accordance with § 10108.2.

10108.2 If the participant wishes to request reconsideration of the denial, the following steps shall occur:

(a) The participant shall submit a written request for reconsideration to DHCF within twenty-one (21) days of the postmark date on the notice of denial, containing the following elements:

(1) The reason the participant believes the denial decision should not be upheld; and

(2) Any additional information and/or documentation the participant believes is relevant to the reconsideration decision;

(b) The Director of DHCF or a designee shall issue a reconsideration decision within forty-five (45) days of the date the reconsideration request was received, containing the following elements:

(1) A clear statement that the PDS budget denial explained in the initial notice has been upheld or overturned on reconsideration;

(2) An explanation of the reason(s) the PDS budget denial was upheld or overturned;

(3) Citation to regulations supporting the decision;

(4) Information regarding the participant’s right to appeal the reconsideration decision by filing a notice of appeal with the Office of Administrative Hearings; and

(5) An explanation of the circumstances under which the participant’s current level of PDCS and individual-directed goods and services will be continued if the participant files a timely notice of appeal with the Office of Administrative Hearings.

10108.3 A Services My Way participant shall not be required to request reconsideration of the denial and may appeal the PDS budget denial decision directly by filing a notice of appeal with the Office of Administrative Hearings.

SOURCE: Final Rulemaking published at 64 DCR 9567 (September 29, 2017); as amended by Final Rulemaking published at 69 DCR 012090 (October 7, 2022).