12-152 C.M.R. ch. 5, § 3 - BRAIN INJURY EXTENDED SUPPORT APPEALS PROCESS

An applicant for or recipient of Extended Support services who is dissatisfied with any determination made by the Bureau of Rehabilitation Services concerning the furnishing or denial of services may request a timely review of the determination. The Bureau shall make reasonable accessibility accommodations for the individual with disabilities during the appeals process. Whenever possible, the Bureau will attempt to resolve conflicts through Informal Review or through Mediation. An individual may request a Due Process Hearing immediately without having to go through other appeal steps.

1. Informal Review

Whenever possible, Maine DVR or DBVI will attempt to resolve conflicts informally, prior to Mediation or a Due Process Hearing. An individual may request a meeting with the counselor, the appropriate supervisor, and/or a Client Assistance Program representative, if desired, to explore options for resolving any conflicts. An individual may request Mediation or a Due Process Hearing immediately, without having to go through the informal process.

2. Continuation of Services Pending Completion of the Hearing

Pending a final determination of an appeal hearing, the DVR or DBVI may not suspend, reduce, or terminate services being provided under an Individualized Plan of Employment (IPE), unless the services were obtained through misrepresentation, fraud or collusion of the individual, or unless the individual, or individual's authorized representative, requests suspension, reduction, or termination of services.

3. Time Frames

The time frames listed under Section 4. Mediation and 5. Due Process Hearing may be waived if both parties agree to an extension of time in order to conduct the Mediation or Hearing, and render a decision.

4. Mediation
A. Mediation is a voluntary process conducted by a qualified and impartial mediator. At any point during the mediation process, either party, or the mediator, may elect to terminate the mediation.
B. An individual must request Mediation within thirty (30) calendar days of the agency notice regarding the provision or denial of services that is in question. The request shall be in writing, and the request shall describe the complaint. The request should be sent to the Director of DVR or DBVI who will immediately forward it to a qualified mediator.
C. The mediator will commence a mediation meeting within fifteen (15) calendar days of receipt of the request, and shall be held in a location that is convenient to the parties in the dispute.
D. Mediation will be conducted in accordance with the Court Alternative Dispute Resolution Service's (CADRES) standards on ethics and neutrality.
E. An agreement reached in the mediation process shall be set forth in a written mediation agreement, and shall be signed by both parties.
F. Discussions that occur during the mediation process shall be confidential and may not be used as evidence in any subsequent due process hearing or civil proceeding in accordance with CADRES confidentiality standards.
G. The individual may be represented at the mediation, including but not limited to, representation by the Client Assistance Program.
H. The Mediation process may not be used to deny or delay the individual's right to pursue resolution of the dispute through a due process hearing within the specified time period.
5. Due Process Hearing
A. Due Process Hearing is a procedure whereby an individual who is dissatisfied with any determinations concerning the provision or denial of DVR or DBVI services may seek a re-determination of agency action before an impartial hearing officer.
B. The individual must request a Due Process Hearing within thirty (30) calendar days of the agency notice regarding the provision or denial of service, if Mediation was not requested.
C. If no request for Due Process Hearing is made within thirty (30) calendar days, the agency decision is considered final.
D. The request for Due Process Hearing shall be in writing, and shall describe the complaint. Maine DVR or DBVI will accommodate an individual's disability and offer assistance, if appropriate, in this process. The request should be sent to the Director of DVR or DBVI who will immediately forward the request to a qualified hearing officer.
E. A pre-hearing conference may be held to clarify issues and explore options for resolving grievances.
F. The Due Process Hearing shall be conducted within sixty (60) calendar days of receipt of the request for Due Process Hearing.
G. A Due Process Hearing shall be conducted by an impartial hearing officer assigned on a random basis, from the pool of qualified persons identified jointly by the Director of Maine DVR or DBVI and the State Rehabilitation Council.
H. Maine DVR or DBVI may not deny or dismiss a request for Due Process Hearing unless the individual or his/her representative:
(1) withdraws the request in writing; or
(2) is adjudged by the Due Process Hearing Officer to be in default for failure to appear at the hearing without good cause.
I. The Due Process Hearing shall be conducted and will include an opportunity for the individual or the individual's representative to present witnesses and relevant evidence. A decision shall be issued in accordance with Maine's Administrative Procedure Act, 5 M.R.S.A. Chapter 375, subchapter IV.
J. The Due Process Hearing Officer will issue a full written report of the findings and grounds for the decision within thirty (30) days of the completion of the hearing.
K. The Hearing Officer's decision is final unless either party brings a civil action.
6. Civil Action

Any party who disagrees with the final decision of the Due Process Hearing has the right to file a petition in Superior Court under Rule 80C of the Maine Rules of Civil Procedure.

Notes

12-152 C.M.R. ch. 5, § 3

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