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What Happens to My Services?

What Happens to my Services While I am Appealing the Action?

Services may continue during your appeal or State Fair Hearing if all of these things are true:

  1. Sunflower has reduced, suspended, or ended previously authorized services.
  2. You fIle your appeal or State Fair Hearing request within 10 days of the notice or 10 days from when the service change started, and you ask to keep your benefIts during this time.
  3. The services were ordered by an approved provider. AND
  4. The time period covered by the approval has not ended.

If you are receiving non-HCBS services and the appeal decision or State Fair Hearing upholds Sunflower’s decision to reduce, pause or end your services, those services will end 10 calendar days after the notice containing the appeal decision.

If you request a State Fair Hearing and ask to keep your benefits within 10 calendar days from the date on the notice of the appeal decision, your services and benefits will continue until the State Fair Hearing decision is made.

HCBS Services will continue during appeal or State Fair Hearing if all of these things are true:

  1. Sunflower has reduced, suspended or ended your previously approved HCBS services or benefits.
  2. You file your appeal within 60 calendar days from the date of the notice about the service change. Three extra calendar days will be allowed for mailing time. Or if you request a State Fair Hearing, you do it within 120 calendar days from the date of the appeal decision notice. Three extra calendar days will be allowed for mailing time.
  3. The services were ordered by an approved provider. AND
  4. The time period covered by the approval has not ended.

If you asked for new HCBS services to replace your old services, and Sunflower approved them, your old services will end so your new services can start. If your new HCBS services will start within 63 days of the date of the notice ending your old services, your old services will continue only until your new services begin. HCBS services will continue during the appeal or State Fair Hearing process until:

  • 123 calendar days after you get the notice about the appeal decision if you don’t ask for a State Fair Hearing.
  • If you request a State Fair Hearing within 123 calendar days from the date on the appeal decision notice, your services will continue until the State Fair Hearing decision is made.

  1. You withdraw your appeal.
  2. You do not request an appeal within 60 calendar days from the date on the notice or do not request State Fair Hearing within 120 calendar days from date on the appeal decision notice. Three additional calendar days will be allowed for mailing time.
  3. The State Fair Hearing ofcer makes a decision that is not in your favor.
  4. The time period or service limits of your approved services have been met.
  5. You or your guardian ask for the HCBS services to end and be replaced with other services.

Requests for new services do not count for continuing services.

If you are not sure if you are receiving HCBS services, please call Customer Service toll free 1-877-644-4623.

If you receive Non-HCBS Services and the decision is not in your favor, you may need to pay for the services you got while waiting for the appeal or State Fair Hearing decision.

If you receive HCBS Services and the decision is not in your favor, you will not have to pay for those services, unless there was fraud.

Not sure if your services are HCBS? Call Customer Service toll free 1-877-644-4623.