Appeal ProcedureFair Hearing Procedure
Section § 4710
This law requires regional centers or state-operated facilities to give a minimum of 30 days' notice before reducing, ending, or changing services in a recipient's individual program plan, unless both parties agree otherwise. This notice must be sent by their preferred method (mail or email) and must also be in their preferred language.
Notice must be given within five business days if a requested service is denied. If services are affected due to budget issues, the regional center must notify the department and provide details, including projected costs, to request funds. If a person is deemed ineligible for services, prompt notice is required. Exceptions to the advance notice apply if actions are needed for health and safety, but a notice must still be provided within 10 days.
Section § 4710.5
If you're unhappy with a decision made by a regional center or state-run facility about receiving services, you can ask for an informal meeting, mediation, or a fair hearing within 60 days of being notified about the decision. You'll need to fill out a specific appeal request form to do this.
An employee must help you with the form if you need it, and if they don't, they might face criminal charges. Once your request is submitted, an electronic copy is sent to the appropriate offices within a day. These rules have been in effect since March 1, 2023.
Section § 4710.6
If someone wants an informal meeting after appealing a decision related to a regional center or state facility in California, both parties must agree on a date, time, and place within 10 days of the appeal request being received, unless more time is requested by the claimant. This meeting can be in person or via phone or video call if both agree. The chosen date, time, and place must be communicated in writing to the claimant in their preferred language. Additionally, the claimant will receive written information about their rights unless they've already been given this information before. This rule takes effect on March 1, 2023.
Section § 4710.7
This law describes the process and purpose of having an informal meeting before moving to mediation or a fair hearing regarding an appeal. The meeting is intended to resolve issues beforehand and is conducted by a director or their designee at a regional center or state-operated facility. After the meeting, the decision maker must provide a written decision within five days, identifying and ruling on each issue with supporting facts and the applicable laws or policies. The decision must be in the preferred language of the applicant or recipient. This section became effective on March 1, 2023.
Section § 4710.8
This section explains that during an informal meeting, claimants will have specific rights as outlined in another section (Section 4701). These meetings will follow guidelines set by Section 4710.6 and must be conducted in English. However, if the claimant or their representative does not speak English, an interpreter must be provided at no cost to the claimant, with the expense covered by the regional center or state-operated facility. This rule becomes effective on March 1, 2023.
Section § 4710.9
After an informal meeting about a decision from a regional center or state-operated facility, if a person is happy with the outcome, they should withdraw their appeal, and the decision will take effect in 10 days. If they're not happy, they'll continue with the appeal process. The claimant has up to three days to decide whether to go to mediation or a fair hearing but can decide later, although this could waive their right to a decision within 90 days. Services during the appeal will end according to specific rules. If no action is taken within 60 days, the appeal is considered withdrawn. There is also a possibility to suggest combining cases for hearings under specific conditions.
Section § 4711
If someone requests a mediation or a fair hearing, the hearing office must quickly inform both the person appealing and their representative, as well as the director of the relevant facility, about the process in their preferred language. They need to provide details like when and where the mediation or hearing will happen, which can be virtual if agreed upon. The notice also explains the parties' rights during the proceedings, the availability of advocacy help, contact details for those involved in the process, and the parties' rights and responsibilities under related sections. This law became effective on March 1, 2023.
Section § 4711.5
This section covers the mediation process for appeals connected to certain state services. When a mediation is requested, the hearing office informs all parties about mediation details in their preferred language. The mediation happens within 30 days unless an extension is requested. If a claimant asks for more time, they agree to wait longer for a decision. Mediation is informal and non-threatening, respecting the claimant's rights. Mediators must be knowledgeable and neutral, avoiding conflicts with parties involved. They can privately discuss matters with parties to help reach an agreeable solution. If a mediator can't be impartial, they or any party can request a substitution. After the first session, any party can leave mediation and seek a fair hearing. This law is effective from March 1, 2023.
Section § 4711.7
This law explains the process for resolving disputes through mediation in cases involving fair hearings under California's welfare and institutions code. If mediation results in a resolution or partial resolution agreed upon by both parties, the mediator documents this, and the claimant needs to withdraw any related hearing requests in writing. This resolution becomes effective ten days after the claimant agrees to it.
If mediation doesn't resolve certain issues, the claimant can request a fair hearing to address those. The mediator must inform all parties, including the hearing office and regional center, about the mediation outcome and whether the claimant wants a fair hearing. If the claimant doesn't request a hearing, the matter is paused, and their right to a timely decision is waived. The appeal is considered withdrawn if the claimant doesn't signal intent to proceed within 60 days of the mediator's notice.
Services during the appeal follow the recipient's individual program plan as outlined in another section. These rules have been operative since March 1, 2023.
Section § 4712
This section outlines the procedures for fair hearings related to services for individuals with developmental disabilities. Hearings must occur within 50 days of a request unless more time is requested and justified. Both parties can request continuances if there's good cause, such as illness or emergencies. Hearing officers must be impartial and trained in relevant law and procedures, helping claimants understand the process, especially those unfamiliar with legal settings.
Before the hearing, both parties must share their case details, including witness lists and evidence. Hearings should be convenient for the claimant and can be conducted electronically if needed. Hearings aim to be fair and informative, encouraging the free exchange of information, but without strict adherence to formal evidence rules. Proceedings are recorded and can be conducted in the claimant's preferred language with an interpreter. Evaluations of hearing officers occur every two years to ensure fairness and competence. Fair hearings become operative from March 1, 2023.
Section § 4712.2
This law allows multiple people or organizations with a shared legal concern to combine their appeals into one hearing, as long as it doesn't unfairly affect anyone involved or delay the process. Each individual still maintains their rights and will receive their own written decision. Requests to combine these appeals must be sent within five days of receiving notice. The process ensures each party's rights are protected and confidentiality is maintained unless they agree otherwise.
Section § 4712.5
This law outlines the process and rules for administrative hearings related to appeals under specific programs. After a fair hearing, a hearing officer has specific timeframes to issue a final or proposed decision. If there's a continuance, it may affect the timeframe for decision-making. Decisions must be written clearly, include facts and related laws, and be provided in the claimant's preferred language. The Director of Health Care Services and the Director of Developmental Services have roles in adopting or modifying decisions. Hearing officer decisions, especially those involving Medicaid programs, may be proposed before finalized by the Director. Redacted versions of these decisions must be publicly available online, ensuring transparency and accountability. This section became effective on March 1, 2023.
Section § 4713
If a decision isn't in the claimant's favor and they are currently receiving services, the decision won't take effect for 15 days, allowing time to request a reconsideration. During this period, services continue as usual. Parties have 15 days post-decision to request a correction for any factual, legal, or clerical mistakes.
If such a request is made, it goes to a different hearing officer within the office. The office or director can deny, modify, or schedule further proceedings, notifying involved parties the next day. Corrected decisions get served to all parties and the State Department of Developmental Services within five business days. This process started on March 1, 2023.
Section § 4713.5
If a regional center has received a final decision from a hearing, they must put that decision into action within 30 days. If the decision has been reconsidered, they have 30 days after the correction to implement it. However, if there are unusual circumstances that prevent this timeline, the regional center must notify the claimant in writing, explaining the delay and providing a new implementation date.
If the claimant is unhappy with how the regional center or a state facility is following through with the decision, they can reach out to the department for help in making sure the decision is being implemented.
Section § 4714
This section explains the process for collecting information related to appeals from regional centers or state-operated facilities. When someone submits an appeal, the department gathers details about how each case is handled, like if it was resolved before or during a meeting, the outcome, and why a request might be withdrawn. They also collect demographic data about the claimants.
The department keeps track of resolution methods, such as mediation or hearings, and records the time it takes to resolve requests. Collected data is compiled and shared in summary form on the department's website annually, ensuring privacy by not including any personal details. The rules for this data collection started on March 1, 2023.