- (1) Pursuant to 42 CFR 431 Subpart E, DIH shall provide an appeals hearing procedure for home and community-based waiver hearings. The office shall conduct the informal hearing pursuant to this rule and the requirements of 42 CFR 431.200 through 431.250.
(2)(a) For home and community-based waivers in which the Division of Services for People with Disabilities (DSPD) is the designated operating agency and the grievance is based on whether the person meets the eligibility criteria for state matching funds through the department in accordance with Section 26B-1-430, the eligibility determination of the operating agency is final.
- (b) If DSPD determines that an individual does not meet the eligibility criteria for state matching funds through the department, DSPD shall inform the individual in writing and provide the individual an opportunity to appeal the decision through the administrative hearing process in accordance with Section R539-3-8.
- (c) The DSPD decision is dispositive for the purposes of this subsection. The office shall sustain the determination, and there is no right to further agency review.
KEY: Medicaid
Date of Last Change: September 19, 2025
Notice of Continuation: August 12, 2022
Authorizing, and Implemented or Interpreted Law: 26B-1-202(1); 26B-1-204; 63G-4-102