13202-Due Process Under the Lanterman Act-Appeals Process

SCOPE:

This procedure applies to all Services and Supports staff of Tri-Counties Regional Center.

There may be instances where a person served, their parent, guardian or conservator do not agree on the initiation, frequency or eligibility of a service. When this occurs, every effort should be made to resolve disagreements at the lowest possible administrative level. If local administrative efforts are unsuccessful, a formal due process fair hearing shall be made available to the applicant or recipient of services. The following appeals process is available for this purpose. These processes are defined in Division 4.5, Chapter 7, Article 1-4 of the California Welfare and Institutions Code, Section 4700-4730. (For appeals concerning persons served or applicants who are under the age of three, see Procedure #08203). This procedure describes the appeal process that will be used by Tri-Counties Regional Center to resolve disputes.

PROCEDURE:

The Lanterman Act sets forth the regional center’s responsibility to provide:

• Adequate notice of the Regional Centers decision that is in plain, clear and nontechnical language.
• Aid Paid Pending to continue benefits or services at their current level while a person appeals a proposed action, such as a reduction or denial of benefits. 
• A Good Faith Belief Letter indicating mutual consent when the Regional Center takes an action to: (1) not initiate a service and (2) when services are reduced, terminated or changed WITH AGREEMENT by the person served; and
• A Notice of Action to persons served when the regional center takes an action to: (1) determine a person is not eligible or no longer eligible for services, (2) not initiate a service or (3) when services are reduced, terminated or changed WITHOUT AGREEMENT by the person; and
• An appeal process for persons served who are not in agreement with the regional center’s decision or action and believe the person is entitled to the service under the law.

1. Adequate Notice:

1. The service coordinator notifies each person served or, where appropriate, their parent, guardian or conservator in writing when a determination is made that:
   1. The person served is not eligible or no longer eligible for services;
   2. An existing service is reduced or terminated and the person served does not agree;
   3. A request for service is not initiated and the person served does not agree.
2. The notice must be sent by standard mail, certified mail or email per their preference as indicated in their IPP. The notice must clearly state the rationale and basis for the action. The time requirements for such notice are:
   1. Within 5 business days of the determination that the person served is no longer eligible;
   2. At least 30 days prior to any action to reduce, terminate or change a service when the person served does not agree;
   3. Within 5 business days of a request for a new service that is not initiated when the person served does not agree.
3. Each notice must be accompanied by the following:
   1. A letter explaining the request and legal rationale for denial, reduction or termination of the service,
   2. DS1820 Notice of Action (Attachment A), and
   3. Lanterman Appeal Process Informal Packet (Attachment B).
4. A Good Faith Belief Letter will be provided within 5 business days indicating the reason for the regional center’s belief that an agreement exists, the specific action they plan to take, the reasons for that action, and information on how to file an appeal, along with the needed forms. This is only needed if there is a reduction, termination or denial of a service and the agreement has not been documented in a signed Individual Program Plan (IPP) or Amendment.

II. Aid Paid Pending:

1. If services in place are reduced, terminated or changed, the person/family must be notified of this decision at least 30 days prior to the action taking place.
2. The person/family may file for Aid Paid Pending no later than 30-days after receiving the NOA, and not later than the date services are scheduled to end or change.
3. If the person/family files an appeal, they will continue to have the services they are receiving based on the timelines below:

1. Aid Paid Pending will end 10 days after the date of the informal meeting decision unless the person/family continues to appeal.

            2. Aid Paid Pending will end 10 days after the date the person/family         receives the Mediation Agreement or 10 days after the Mediation date if        an agreement was not reached.

            3. Aid Paid Pending will end 10 days after the date of receiving the far       hearing decision. Aid Paid Pending will continue if the person/family makes a request for reconsideration.

            4. Aid Paid Pending will end 10 days after the reconsideration decision or the new hearing decision.

III. Good Faith Belief Letter:

A. When there is affirmative documentation of mutual consent, the regional center does not have to send a Notice of Action. The mutual consent requirement applies to all regional center decisions regarding reductions, terminations, or changes to services specified in an individual program plan or denial of the initiation of a service or support requested for inclusion in the individual program plan. Mutual consent is defined as an agreement that affirmatively is documentedin any of the following:

1. A signed IPP that reflects the regional center’s proposal or denial,
   1. A signed list of services reflecting the regional center’s proposal or denial,
   1. or Other written communication from the recipient regarding the regional center’s proposal or denial OR

B.   A good faith belief by the regional center that the recipient agrees with the proposal or denial, which is followed by regional center sending a confirming good faith belief letter to the recipient within five (5) business days.  The good faith belief letter must contain:

1. Factual basis for the good faith belief that an agreement exists.
2. The action that the regional center intends to take,
3. The reason(s) for that action,
4. The availability of an appeal process and a link to the Department’s website with information about the appeals process,
5. How to express disagreement,
6. How to get information about the appeal process, and
7. The appeal request form

C. Regional Centers must follow the template for the good faith belief letter.

IV. Notice of Action

• A person served, a parent or guardian of a minor or conservator may file an appeal through the DDS website if they do not agree with a decision the regional center has made.
• A person served, a parent or guardian of a minor or conservator may authorize representation by indicating this on the request for appeal form.
• A person served, a parent or guardian of a minor or conservator may request to have an informal meeting, formal mediation and/or fair hearing to review the appeal issue.
• The Assistant Director will assign a manager to review the appeal with the person served, parent/guardian, conservator or representative and represents TCRC through the appeal process.
• The Manager makes every effort to resolve the issue in dispute during the appeal process. The initiation of the appeal process by a person served or family does not prohibit on-going problem solving, planning meetings or other activity directed at resolving the issue.
• The Manager demonstrates a non-adversarial and collaborative demeanor. Every effort is made to facilitate an open dialogue, utilizing active listening techniques with the person served, parent and/or representative. The service coordinator and/or team manager’s presence at each meeting is determined by the nature of the issue.
• Information that clarifies and leads to an understanding of the regional center decision and its specific reference in law, regulation, service policy, etc. must be provided at each opportunity.
• All requests for appeal are coordinated through the Federal Programs Department/Appeals Coordinator.

1. All appeal requests are submitted to DDS through the online portal, email, mail or facsimile and received by TCRC directly from DDS.
2. Services currently authorized are extended as “aid paid pending” if the person served, parent, guardian/conservator and/or representative requests continuation of the service and the request for the fair hearing form is received by Tri-Counties Regional Center within thirty (30) days of the date the person served, their parent, guardian or conservator received the adequate notice letter (as documented by the date on the return receipt from the certified mail); the vendor agrees or a substitute vendor of comparable quality can be agreed upon.
3. Upon receipt of the request for appeal, a copy of the Notice of Action and/or Good Faith Belief Letter will be sent to DDS if not provided in the appeal request.
4. The Manager representing TCRC should not be the same manager who participated in the action subject to the appeal.

V. Types of dispute resolution:

1. Informal meeting:
   1. The lowest level of the appeal process is an informal meeting.
   2. The Manager contacts the person served and/or their parent, guardian, conservator and/or representative by telephone as soon as possible upon receipt of the appeal to hold an informal meeting. The informal meeting must occur within ten (10) days of receipt of the appeal unless otherwise requested by the person served and/or parent/guardian/conservator/representative, The date, time and location of the meeting must be convenient for the person served and/or parent/guardian/conservator/representative to participate.
      1. The Manager will send a letter to the person served and/or their parent, guardian, conservator and/or representative introducing themselves and indicating the mutually agreed-upon date, time and place for the informal meeting in their preferred language.
      2. Timelines may be waived/extended only with person served/parental consent.
      3. Any resolution achieved during the informal meeting must be documented in the DS1822 Notice of Resolution.
   3. Informal meetings are to be conducted in a comfortable atmosphere, allowing the individual/family ample time and opportunity to present their issue or request(s) and rationale.
   4. The Manager must follow up with a letter outlining the decision within five (5) calendar days of the informal meeting. Informal meeting decision letters must be sent by certified mail and include:
      1. Restatement of the issue;
      2. A decision on the appeal issue to resolve or what services or assistance can be offered;
      3. A description of the process and considerations utilized to arrive at the decision;
      4. The basis for the decision: i.e., law, regulation, contract, service policy, etc.;
      5. The right to continue the formal mediation and/or fair hearing if they do not agree with the decision.
2. Formal Mediation
   1. Upon receipt of a Request for Appeal, if Formal Mediation and/or Fair Hearing are requested, the appeal documentation and Request to Set are sent to the Office of Administrative Hearings by the Federal Programs Department/Appeals Coordinator, within five (5) business days.
   2. The Office of Administrative Hearings (OAH) is responsible for scheduling, conducting and issuing decisions on fair hearings. The OAH will schedule the Formal Mediation no later than within 30 days and the Fair Hearing no later than 50 days from the date of receiving the Request.
   3. OAH issues an order to all parties indicating the date, time, and requested location of the mediation and/or fair hearing. All OAH hearings are conducted at the Tri-Counties Regional Center office location from which the person served receives services. Tri-Counties Regional Center is represented by the Director’s designee. Mediation must be held within thirty (30) calendar days and Fair Hearing within fifty (50) calendar days of receipt of the request by OAH. Continuance may be granted without cause by the person served and for just cause by the regional center. All further requests for Continuance must have just cause.
3. Fair Hearing
   1. The Manager seeks consultation as needed to develop the presentation, including witnesses, subpoenas, direct questions, exhibits, cross examination, closing argument, written statements and rebuttal. Direct and/or cross examination of persons served/parents/guardian/conservator/representative is conducted in a non-adversarial manner, with focus on the issue and presentation on information to establish and support Tri-Counties Regional Center’s decision/action.
   2. OAH will issue a final decision within ten (10) business days of the last fair hearing date, and no more than eighty (80) days after the date the appeal was received by DDS.
   3. All appeals related to the Self Determination Program, Coordinated Family Supports and funding of out of state services are reviewed with a final decision issued by DDS no more than ninety (90) days after the date the appeal request was received by DDS. These timelines may be extended if a Continuance and/or Waiver of Time were requested.
   4. Final administrative decisions received from OAH are distributed to:
      1. Manager, service coordinator, and person served case record;
      2. Assistant Director of Supports and Services for the region;
      3. Director of Supports and Services.
      4. Upon receipt, the decision is immediately reviewed by all parties. The regional center must implement the final hearing decision as soon as possible and not more than thirty (30) days after the date of the final decision. The team responsible for case management will implement the OAH Order. If the regional center cannot meet that deadline, a Hearing Decision Implementation Delay Letter must be sent to the person served, their parent/guardian/conservator and/or representative explaining the exceptional circumstances and when the decision will be implemented.
   5. If the appeal has services paid under “Aid Paid Pending”, current services will end 15 days after receiving the final hearing decision unless the person served and/or their representative or the regional center request a reconsideration.

VI. Reconsideration Requests

1. After the hearing, the person served and/or their representative or the regional center may request reconsideration within fifteen (15) days of receiving the hearing decision. Reconsideration is a way to correct a clerical error or correct a mistake of fact or law in a hearing decision, or if there was a denied a request to disqualify a Hearing Officer.
2. If the reconsideration has services under “Aid Paid Pending”, services will end fifteen (15) days after receiving the reconsideration decision.
3. The Reconsideration Request will either be denied, granted and the decision modified, or granted and a new hearing will be set within fifteen (15) days.
4. If the Reconsideration Request is granted and a new hearing is set, the new hearing will be held within fifty (50) days from the date the request was granted.
5. A new Decision will be issued within ten (10) business days and communicated to all parties.

Revision Date 12/2025